Drive for Us – MMAK Express

Are you interested in driving with us? Please complete and submit the following form to get your career with MMAK Express started!

Personal Information

Name(Required)

First Last

Social Security Number(Required)

Date of Birth (mm/dd/yyyy)(Required)

Email(Required)

Home Phone(Required)

Cell Phone(Required)

Present Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How long have you lived at this address?(Required)

Do you have a Transportation Worker Identification Card (TWIC)?(Required)

Yes

Do you have a Free & Secure Trade (FAST) Card for border crossing?(Required)

Yes

Emergency Contact Information

Emergency Contact Name(Required)

First Last

Emergency Home Phone(Required)

Emergency Cell Phone(Required)

Emergency Contact Email(Required)

Drug and Alchohol Testing Information

Did a DOT alcohol test, conducted within the past two years, confirm a BAC (brath alcohol concentration) of 0.04 or greater?(Required)

Yes

Did the applicant refuse to be tested as required by the DOT regulations?(Required)

Yes

Date of positive test or refusal?

Type of test

Alcohol

Controlled Substance

Both

Did you return to duty with your organization following evaluation by a Substance Abuse Professional (SAP)?

Yes

SAP's name and phone number?

Was follow up testing required and performed?

Yes

License Information

Have any of your licenses been revoked, suspended, restricted or denied?(Required)

If yes, explain:

Have you ever been convicted of reckless/unsafe driving or DUI/DWI?(Required)

If yes, explain:

List any license you have held in the last ten years (State, expiration date, class, endorsements):(Required)

Have any of these licenses been revoked, suspended, restricted or denied?(Required)

Yes

If yes, please explain:

Have you ever been convicted of reckless/unsafe driving or DUI/DWI?(Required)

Yes

Driver Information

Driving Experience(Required)

License Type (check all that apply)(Required)

Class A

Class B

Class C

Have you had any moving violations in the last 3 years?(Required)

Yes

If yes, how many?

Class of Equipment

Straight Truck

Tractor & Semi-Trailer

Tractor - Two Trailers

Other

Preferred transmission:

Preferred work type:

List any motor vehicle accidents you have had within the preceding 5 years regardless of whether you were issued a ticket, for both commercial and personal vehicles.(Required)

Include date, city, state, number of fatalities, number of injuries, were you driving a truck?, did your company hold you responsible? Description of accident.

List any violations of motor vehicle laws or ordinances of which you were convicted or forfeited bond or collateral within the preceding 5 years, for both commercial and personal vehicles.(Required)

Include date, city, state, moving violation description, points, penalty.

Please list any driving experience you've had in the last 10 years:(Required)

Give a complete and consecutive history of your employment for the last 7 years, starting with the present or most recent employers.(Required)

Include Company, dates employed, supervisor name and contact, location, postion, reason for leaving, type of equipment, OTR or local, were you subject ot FMCSRs while employed? Please account for any periods between jobs.

Certification(Required)

I verify that all questions asked in this application have been answered truthfully, accurately and completely to the best of my knowledge. Furthermore, I understand that any incorrect or false statement or misinformation furnished by myself intended or otherwise, will subject me to cancellation at any time. In addition, I certify that this application was completed by me.

Waiver(Required)

I understand that by signing this application I am consenting to and have authorized the Company and/or its authorized agents to collect, use and disclose personal information to conduct background/reference checks in connection with my application for employment. I hereby authorize all schools, companies, present/former employers, armed forces, person and agencies pertinent to my education, background and driving record, including information required under 49 CFR Parts 40, 382 and 391.23 to release and/or verify any information relevant to the background/reference check. The aforementioned are hereby released from any and all liability which may result from said lawful information. I agree that any action or suit against the Company - including all of its current, future and former parents, subsidiaries, companies, divisions, affiliates, owners, shareholders, members, directors, officers, employees, attorneys, insurers, benefit plans, agents and independent contractors, and the predecessors, successors, and assignes of each of them, in their individual, corporate or official capacities - arising out of my employment or termination of employment, including but not limited to claim arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claims or be forever barred. Any illegality or unenforceability of any part of this Waiver shall have no effect upon and shall not impair the enforceability of, any part of this Waiver. This Waiver shall be governed by and construed in accordance with the laws of the state of Michigan without regard to its conflict of laws rules.

The Undersigned acknowledges and agrees that faxed, photocopied and electronically scanned copies of their signature on Company documents shall be considered to be the same as the original document for all legal purposes.