Thank you for your interest in Roadway Ninjas. To qualify for Company Driver or Owner Operator opportunities, please complete the application below Full Application * = Required Information Company Driver Owner Operator Driving Position Over the RoadLocalRegionalAny Personal Information First Name* Last Name* Date of Birth* Email Address* Street Address* City* State* - Please select state -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Telephone Number* Application Date Experience Recent Experience: (Check all that apply) Van Flatbed Reefer Tractor Trailer Straight Truck Endorsements: (Check all that apply) HAZ-MAT Flatbed Doubles/Triples Tankers CDL CDL Number* State* - Please select state -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Expiration Date* OTR Driving Experience* Less than 1 yr 1-3 yrs 3-5 yrs 5+ yrs Number of accidents* Accidents012345678910 Number of moving violations* moving violations012345678910 Has your license ever been suspended or revoked?* Yes No Have you ever been cited for a DUI or DWI?* Yes No Most Recent Employers Company* Employed From* - Choose Month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Employed To* - Choose Month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Present Supervisor* Telephone Number* Street Address* City* State* - Please select state -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code* Reason for leaving* Company Employed From - Choose Month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Employed To - Choose Month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Supervisor Telephone Number Street Address City State - Please select state -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Reason for leaving Company Employed From - Choose Month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Employed To - Choose month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Supervisor Telephone Number Street Address City State - Please select state -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Reason for leaving Company Employed From - Choose month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Employed To - Choose month -JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember - Choose year -19801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017 Supervisor Telephone Number Street Address City State - Please select state -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Reason for leaving Additional Information Any additional comments you'd like to make? Can you begin working immediately? Yes No If not, then when? Referred By Request for Previous Employer Information I hereby authorize you to release the following information to Roadway Ninjas Inc.Jersey City,NJ 07306 Ph 201-763-6236, Fax 201-763-6289, for the purpose of investigation as required under 49 CFR 40.331, 382.413, 391.23 and other applicable requirements. You are released from any and all liability which may result from furnishing such information. I acknowledge that I have the right to due process as identified in 49 CFR 391.23 to correct information submitted under this authorization. Date: Applicant’s Signature*: Please Read Carefully I declare the information provided by me in this application is true, correct and complete to the best of my knowledge. I understand that if employed, any falsification, misstatement, or omission of fact in connection with my application, whether on this document or not, may result in immediate termination of employment. By typing in my name and submitting this application, I hereby authorize my prior employers to release the following information to Roadway Ninjas (or its agents), and release those prior employers from any and all liability which may result from furnishing such information: All records, including dates of any and all drug or alcohol tests, those confirmed results, and/or my refusal to submit to any alcohol or drug test. Any and all information needed for a purpose of investigation as required by Section 391.23 of the Federal Motor Carrier safety Regulations. Reports which may include, but are not limited to MVR, employment history and criminal records. Signature* Security Code* Attach a copy of your Class A CDL(image file only)
