Lawrence Transportation Systems

Employment Application

Please complete all applicable fields, and click the 'Continue' button.

Basic Information

What type of driving position are you applying for?
What division are you applying with?
Please select your preferred home terminal.
Please select your preferred coverage area.
How many years experience do you have operating a tractor-trailer?	(YY)
How did you hear about us?

Personal Information

Last Name		First Name
		Middle Name
Address
City		State	(XX)
SSN	(888-88-8888)	DOB	(MM/dd/YYYY)
Phone	(888-888-8888)
Email
Have you lived at any address other than the above for the last 3 years?

How many years at address 2?		(YY)
Address
City		State	(XX)

How many years at address 3?		(YY)
Address
City		State	(XX)

Driving Record Information

Do you have a current CDL?
CDL Type		State	(XX)
DL Number		Expiration	(MM/dd/YYYY)
Please list any additional endorsements you carry.

Has your license been suspended at any time in the last 10 years?
Have you been convicted of a DUI or DWI in the last 10 years?
Has your license ever been revoked or suspended?
Please list any accidents which you were involved in during the past 3 years.
Date	(MM/dd/YYYY)	Location
Nature of Accident
Number of Injuries	(XX)	Number of Fatalities	(XX)

Date	(MM/dd/YYYY)	Location
Nature of Accident
Number of Injuries	(XX)	Number of Fatalities	(XX)

Date	(MM/dd/YYYY)	Location
Nature of Accident
Number of Injuries	(XX)	Number of Fatalities	(XX)

Please list any motor vehicle violations (other than parking) of which you were convicted during the past 3 years.
Violation Type
Date	(MM/dd/YYYY)	Location

Violation Type
Date	(MM/dd/YYYY)	Location

Violation Type
Date	(MM/dd/YYYY)	Location

In the past 3 years have you tested positive or refused to test on any pre-employment or random drug or alchohol test?

Education

Last School Attended
Year Graduated	(YYYY)
Have you attended a professional truck driving school?

Employment History

Please complete the information below for each employer/contractee for whom you have worked for in the last 10 years.
Period of Unemployment
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)

Most Recent/Current Employer
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)
Supervisor		Phone Number	(888-888-8888)
Address

Position Held		Salary
Nature of Work

Reason for Leaving


Period of Unemployment
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)

Most Recent/Current Employer
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)
Supervisor		Phone Number	(888-888-8888)
Address

Position Held		Salary
Nature of Work

Reason for Leaving


Period of Unemployment
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)

Most Recent/Current Employer
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)
Supervisor		Phone Number	(888-888-8888)
Address

Position Held		Salary
Nature of Work

Reason for Leaving


Period of Unemployment
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)

Most Recent/Current Employer
From Date	(MM/dd/YYYY)	To Date	(MM/dd/YYYY)
Supervisor		Phone Number	(888-888-8888)
Address

Position Held		Salary
Nature of Work

Reason for Leaving

Electronic Signature

By clicking the Submit Application button, I certify that I completed the information in this electronic form and that all entries and information in it are true and complete to the best of my knowledge. I authorize Lawrence Transportation Systems to make such investigations and inquiries of my personal, employment, state motor vehicle record, financial history, medical history and other related matters as may be necessary in arriving at a leasing/employment decision. (Generally, inquiries into medical and financial history will be made only if and after a conditional offer of lease or employment has been extended.) I hereby, with my electronic signature, release employers, schools, health care providers adn other persons from all liability in responding to inquiries and realeasing information in connection with my answers. In the event of leasing or employment, I understant that false or misleading information given in my answeres or interviews may result in discharge. I also understand that if hired or contracted, I am reqired to abide by all rules and regulations of the company.

Lawrence Transportation Systems strives to satisfy our customers through quality service.

872 Lee Highway Roanoke, VA 24019 | Phone: 800.336.9626 | Fax 540.966.4555