Apply to Drive with Hauser Please enable JavaScript in your browser to complete this form.Date *today's dateName *FirstMiddleLastAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *PhoneDate of BirthEMERGENCY CONTACT Emergency Contact Name *FirstLastRelationship to CandidateEmergency Contact PhoneEmergency Contact AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSecond Emergency Contact Name *FirstLastRelationship to Candidate (2nd Contact)Second Emergency Contact PhoneSecond Emergency Contact AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDRIVER INFORMATION Are you eligible to lawfully work in the United States? *YesNoAre you at least 18 years of age? *YesNoAre you presently employed or under contract? *YesNoDo you have a former name? *YesNoIf Yes, please list former name:FirstMiddleLastHave you ever been discharged from a place of employment or contract? *YesNoIf yes, please explain:May we contact your current employers? *YesNoNOTE: Federal Motor Carrier Safety Regulations require Fedex Ground / Fedex Home Delivery to make inquires to each of your past employers.Do you have a current Department of Transportation (DOT) physical?YesNoLast DOT Physical InformationIssued Date:Expires Date:Did you qualify?YesNoPhysician NameMedical Facility AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDRIVER LICENSE INFORMATION Driver License #Date IssuedStateChoice 54AL : AlabamaAK : AlaskaAZ : ArizonaAR : ArkansasCA : CaliforniaCO : ColoradoCT : ConnecticutDE : DelawareFL : FloridaGA : GeorgiaHI : HawaiiID : IdahoIL : IllinoisIN : IndianaIA : IowaKS : KansasKY : KentuckyLA : LouisianaME : MaineMD : MarylandMA : MassachusettsMI : MichiganMN : MinnesotaMS : MississippiMO : MissouriMT : MontanaNE : NebraskaNV : NevadaNH : New HampshireNJ : New JerseyNM : New MexicoNY : New YorkNC : North CarolinaND : North DakotaOH : OhioOK : OklahomaOR : OregonPA : PennsylvaniaRI : Rhode IslandSC : South CarolinaSD : South DakotaTN : TennesseeTX : TexasUT : UtahVT : VermontVA : VirginiaWA : WashingtonWV : West VirginiaWI : WisconsinWY : WyomingDate ExpiresEndorsementsClass AClass BClass CHazmatTankerDoubles/Triples TrailerRestrictionsRESIDENTIAL ADDRESS HISTORY Please enter all addresses where you have lived in the last three (3) years, including your present address. Residential Address (1)From Date:AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTo Date: Additional Entry ↓ Residential Address (2)From Date:Address Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTo Date: Additional Entry ↓ Residential Address (3)From Date: Address Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeTo Date:DRIVING WORK HISTORY / EXPERIENCE If you do not have driving work history or experience please answer "NO" on this page and enter your work history on "Non-Driving Employment History". Do you have driving work history and experience in a Cargo Van, Commercial Truck, other Commercial Vehicle, or CDL Tractor Trailer? YesNoIf Yes please enter the information below. Driving Work History/Experience - Part 1Vehicle TypeChoice 1Trailer TypeChoice 120 ft flat bed20 ft van20 ft reefer20 ft van doubles28 ft van doubles40 ft flatbed40 ft van53 ft flatbed53 ft van53 ft reeferfuel tankermilk tankerwater tankerother tankerNoneOtherEmployment Start DateFuel TypeChoice 1GasDieselPropaneOtherTrailer Type if OtherEmployment End DateAre you an independent Contractor/Driver:YesNoEmployer (List employer name from payroll statements):Is this your current Employer:YesNoIs the motor carrier name same as employer?YesNoIf "NO" please Enter Motor Carrier Name!NOTE: If you were employed by an Agency (ie KellyServices) and drove for a Motor Carrier (ie FedexGround) then list the temporary Agency as the employer and enter the name of the motor carrier in the space provided. Motor Carrier Employment InformationAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountryPhoneCurrent StatusEnding Job TitleEnding Pay RateFrequencyBusiness TypeSupervisor Name# of People SupervisedExplain: Additional Entry ↓ Driving Work History/Experience - Part 2Vehicle TypeChoice 1Trailer Type Choice 120 ft flat bed20 ft van20 ft reefer20 ft van doubles28 ft van doubles40 ft flatbed40 ft van53 ft flatbed53 ft van53 ft reeferfuel tankermilk tankerwater tankerother tankerNoneOtherEmployment Start DateFuel Type Choice 1GasDieselPropaneOtherTrailer Type if Other Employment End Date Are you an independent Contractor/Driver:YesNoEmployer (List employer name from payroll statements):Is this your current Employer: YesNoIs the motor carrier name same as employer? YesNoIf "NO" please Enter Motor Carrier Name!NOTE: If you were employed by an Agency (ie KellyServices) and drove for a Motor Carrier (ie FedexGround) then list the temporary Agency as the employer and enter the name of the motor carrier in the space provided. Motor Carrier Employment InformationAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountryPhone Current StatusEnding Job TitleEnding Pay RateFrequencyBusiness Type Supervisor Name # of People Supervised Explain: Additional Entry ↓ Driving Work History/Experience - Part 3Vehicle TypeChoice 1Trailer TypeChoice 120 ft flat bed20 ft van20 ft reefer20 ft van doubles28 ft van doubles40 ft flatbed40 ft van53 ft flatbed53 ft van53 ft reeferfuel tankermilk tankerwater tankerother tankerNoneOtherEmployment Start DateFuel TypeChoice 1GasDieselPropaneOtherTrailer Type if OtherEmployment End Date Are you an independent Contractor/Driver:YesNoEmployer (List employer name from payroll statements): Is this your current Employer: YesNoIs the motor carrier name same as employer? YesNoIf "NO" please Enter Motor Carrier Name! NOTE: If you were employed by an Agency (ie KellyServices) and drove for a Motor Carrier (ie FedexGround) then list the temporary Agency as the employer and enter the name of the motor carrier in the space provided. Motor Carrier Employment Information Address Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountryPhone Current StatusEnding Job TitleEnding Pay RateFrequencyBusiness Type Supervisor Name # of People Supervised Explain: Additional Entry ↓ Driving Work History/Experience - Part 4Vehicle Type Choice 1Trailer TypeChoice 120 ft flat bed20 ft van20 ft reefer20 ft van doubles28 ft van doubles40 ft flatbed40 ft van53 ft flatbed53 ft van53 ft reeferfuel tankermilk tankerwater tankerother tankerNoneOtherEmployment Start DateFuel TypeChoice 1GasDieselPropaneOtherTrailer Type if OtherEmployment End DateAre you an independent Contractor/Driver:YesNoEmployer (List employer name from payroll statements): Is this your current Employer: YesNoIs the motor carrier name same as employer? YesNoIf "NO" please Enter Motor Carrier Name! NOTE: If you were employed by an Agency (ie KellyServices) and drove for a Motor Carrier (ie FedexGround) then list the temporary Agency as the employer and enter the name of the motor carrier in the space provided. Motor Carrier Employment Information Address Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountryPhone Current StatusEnding Job TitleEnding Pay RateFrequencyBusiness TypeSupervisor Name# of People Supervised Explain:NON-DRIVING EMPLOYMENT HISTORY AND UNEMPLOYMENT HISTORY Please list the period of unemployment in this section. Enter Driving history and Experience in previous section. If Unemployed please fill out two sections of this page. Do you have Non-Driving employment history?YesNoIf Yes please enter this information below and entering necessary details. List Present and ALL previous Non-Driving employment in the past 10 years with NO gaps and enter any necessary details. Start with present and work back. To indicate period of unemployment please enter dates of unemployment and in section of Current Status select unemployed and explain details in the area after that. Non-Driving Employment History and Unemployment History - Part 1Employment Start:Employment End:Employer: (List employer name from payroll statements)Employer InformationAddress Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountryPhoneCurrent StatusEnding Job TitleEnding Pay RateFrequency Business TypeSupervisor Name # of People SupervisedExplain: Additional Entry ↓ Non-Driving Employment History and Unemployment History - Part 2Employment Start: Employment End:Employer: (List employer name from payroll statements)Employer InformationAddress Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountry Phone Current StatusEnding Job Title Ending Pay RateFrequency Business Type Supervisor Name# of People Supervised Explain: Additional Entry ↓ Non-Driving Employment History and Unemployment History - Part 3Employment Start:Employment End:Employer: (List employer name from payroll statements)Employer InformationAddress Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountry Phone Current StatusEnding Job TitleEnding Pay Rate Frequency Business TypeSupervisor Name# of People Supervised Explain: Additional Entry ↓ Non-Driving Employment History and Unemployment History - Part 4Employment Start:Employment End: Employer: (List employer name from payroll statements)Employer InformationAddress Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCountry Phone Current Status Ending Job Title Ending Pay Rate Frequency Business Type Supervisor Name# of People Supervised Explain:SCHOOLING AND TRUCK DRIVER TRAINING DETAILS Schooling and Truck Driver Training (1)School TypeDate Started: CountryDate Finished: Number of Years AttendedGraduated:YesNo Schooling and Truck Driver Training (1)SchoolZip CodeContact NameCityDegreeContact PhoneStateAL : AlabamaAL : AlabamaAK : AlaskaAZ : ArizonaAR : ArkansasCA : CaliforniaCO : ColoradoCT : ConnecticutDE : DelawareFL : FloridaGA : GeorgiaHI : HawaiiID : IdahoIL : IllinoisIN : IndianaIA : IowaKS : KansasKY : KentuckyLA : LouisianaME : MaineMD : MarylandMA : MassachusettsMI : MichiganMN : MinnesotaMS : MississippiMO : MissouriMT : MontanaNE : NebraskaNV : NevadaNH : New HampshireNJ : New JerseyNM : New MexicoNY : New YorkNC : North CarolinaND : North DakotaOH : OhioOK : OklahomaOR : OregonPA : PennsylvaniaRI : Rhode IslandSC : South CarolinaSD : South DakotaTN : TennesseeTX : TexasUT : UtahVT : VermontVA : VirginiaWA : WashingtonWV : West VirginiaWI : WisconsinWY : WyomingMajorContact Email Address Additional Entry ↓ Schooling and Truck Driver Training (2)School Type Date Started: CountryDate Finished: Number of Years AttendedGraduated: YesNo Schooling and Truck Driver Training (2)School Zip CodeContact NameCityDegreeContact PhoneStateAL : AlabamaAL : AlabamaAK : AlaskaAZ : ArizonaAR : ArkansasCA : CaliforniaCO : ColoradoCT : ConnecticutDE : DelawareFL : FloridaGA : GeorgiaHI : HawaiiID : IdahoIL : IllinoisIN : IndianaIA : IowaKS : KansasKY : KentuckyLA : LouisianaME : MaineMD : MarylandMA : MassachusettsMI : MichiganMN : MinnesotaMS : MississippiMO : MissouriMT : MontanaNE : NebraskaNV : NevadaNH : New HampshireNJ : New JerseyNM : New MexicoNY : New YorkNC : North CarolinaND : North DakotaOH : OhioOK : OklahomaOR : OregonPA : PennsylvaniaRI : Rhode IslandSC : South CarolinaSD : South DakotaTN : TennesseeTX : TexasUT : UtahVT : VermontVA : VirginiaWA : WashingtonWV : West VirginiaWI : WisconsinWY : WyomingMajorContact Email AddressLEGAL HISTORY Have you ever been convicted or pled guilty to a felony under your present or any other name?YesNoHave you ever been convicted or pled guilty to a misdemeanor under your present or any other name?YesNoDo you have any criminal matters pending under your present or any other name?YesNoCommentsDRIVING VIOLATIONS/CITATIONS Date of ViolationNature of Violation (If speeding, indicate rate of speed and speed limit):Driving Violation (1)Vehicle TypeCountryStateAL : AlabamaAL : AlabamaAK : AlaskaAZ : ArizonaAR : ArkansasCA : CaliforniaCO : ColoradoCT : ConnecticutDE : DelawareFL : FloridaGA : GeorgiaHI : HawaiiID : IdahoIL : IllinoisIN : IndianaIA : IowaKS : KansasKY : KentuckyLA : LouisianaME : MaineMD : MarylandMA : MassachusettsMI : MichiganMN : MinnesotaMS : MississippiMO : MissouriMT : MontanaNE : NebraskaNV : NevadaNH : New HampshireNJ : New JerseyNM : New MexicoNY : New YorkNC : North CarolinaND : North DakotaOH : OhioOK : OklahomaOR : OregonPA : PennsylvaniaRI : Rhode IslandSC : South CarolinaSD : South DakotaTN : TennesseeTX : TexasUT : UtahVT : VermontVA : VirginiaWA : WashingtonWV : West VirginiaWI : WisconsinWY : WyomingPenalty (Indicate fine and length of suspension):Points: Additional Entry ↓ Date of ViolationNature of Violation (If speeding, indicate rate of speed and speed limit): Driving Violation (2)Vehicle TypeCountry State AL : AlabamaAL : AlabamaAK : AlaskaAZ : ArizonaAR : ArkansasCA : CaliforniaCO : ColoradoCT : ConnecticutDE : DelawareFL : FloridaGA : GeorgiaHI : HawaiiID : IdahoIL : IllinoisIN : IndianaIA : IowaKS : KansasKY : KentuckyLA : LouisianaME : MaineMD : MarylandMA : MassachusettsMI : MichiganMN : MinnesotaMS : MississippiMO : MissouriMT : MontanaNE : NebraskaNV : NevadaNH : New HampshireNJ : New JerseyNM : New MexicoNY : New YorkNC : North CarolinaND : North DakotaOH : OhioOK : OklahomaOR : OregonPA : PennsylvaniaRI : Rhode IslandSC : South CarolinaSD : South DakotaTN : TennesseeTX : TexasUT : UtahVT : VermontVA : VirginiaWA : WashingtonWV : West VirginiaWI : WisconsinWY : WyomingPenalty (Indicate fine and length of suspension):Points: Additional Entry ↓ Date of Violation Nature of Violation (If speeding, indicate rate of speed and speed limit): Driving Violation (3)Vehicle TypeCountryState AL : AlabamaAL : AlabamaAK : AlaskaAZ : ArizonaAR : ArkansasCA : CaliforniaCO : ColoradoCT : ConnecticutDE : DelawareFL : FloridaGA : GeorgiaHI : HawaiiID : IdahoIL : IllinoisIN : IndianaIA : IowaKS : KansasKY : KentuckyLA : LouisianaME : MaineMD : MarylandMA : MassachusettsMI : MichiganMN : MinnesotaMS : MississippiMO : MissouriMT : MontanaNE : NebraskaNV : NevadaNH : New HampshireNJ : New JerseyNM : New MexicoNY : New YorkNC : North CarolinaND : North DakotaOH : OhioOK : OklahomaOR : OregonPA : PennsylvaniaRI : Rhode IslandSC : South CarolinaSD : South DakotaTN : TennesseeTX : TexasUT : UtahVT : VermontVA : VirginiaWA : WashingtonWV : West VirginiaWI : WisconsinWY : WyomingPenalty (Indicate fine and length of suspension): Points: Additional Entry ↓ Date of ViolationNature of Violation (If speeding, indicate rate of speed and speed limit):Driving Violation (4)Vehicle TypeCountryStateAL : AlabamaAL : AlabamaAK : AlaskaAZ : ArizonaAR : ArkansasCA : CaliforniaCO : ColoradoCT : ConnecticutDE : DelawareFL : FloridaGA : GeorgiaHI : HawaiiID : IdahoIL : IllinoisIN : IndianaIA : IowaKS : KansasKY : KentuckyLA : LouisianaME : MaineMD : MarylandMA : MassachusettsMI : MichiganMN : MinnesotaMS : MississippiMO : MissouriMT : MontanaNE : NebraskaNV : NevadaNH : New HampshireNJ : New JerseyNM : New MexicoNY : New YorkNC : North CarolinaND : North DakotaOH : OhioOK : OklahomaOR : OregonPA : PennsylvaniaRI : Rhode IslandSC : South CarolinaSD : South DakotaTN : TennesseeTX : TexasUT : UtahVT : VermontVA : VirginiaWA : WashingtonWV : West VirginiaWI : WisconsinWY : WyomingPenalty (Indicate fine and length of suspension): Points:ACCIDENT HISTORY Have you been involved in Any motor vehicle accident in the past 3 years?YesNoIf Yes list All accidents you have had while operating ANY TYPE of motor vehicle during the past (3) years below and enter all necessary details. Date of AccidentNature of AccidentDescribe Extent of damage / injuries including monetary value if applicable:Accident History (1)Number of DeathsNumber of InjuriesVehicle TypeAt Fault?YesNo Additional Entry ↓ Date of AccidentNature of Accident Describe Extent of damage / injuries including monetary value if applicable: Accident History (2)Number of DeathsNumber of Injuries Vehicle TypeAt Fault?YesNo Additional Entry ↓ Date of AccidentNature of Accident Describe Extent of damage / injuries including monetary value if applicable:Accident History (3)Number of DeathsNumber of InjuriesVehicle TypeAt Fault?YesNoFedEx Contacts and Relatives Do you know anyone employed or contracted by FedEx Ground or an affiliate company?YesNoIf Yes, please enter the person's information and any details below. FedEx Relative/Contact #1NameFirstLastPositionSuffixLocation/CompanyRelation Additional Entry ↓ FedEx Relative/Contact #2NameFirstLastPosition SuffixLocation/CompanyRelation Additional Entry ↓ FedEx Relative/Contact #3NameFirstLastPositionSuffixLocation/CompanyRelation Additional Entry ↓ FedEx Relative/Contact #4NameFirstLastPositionSuffixLocation/CompanyRelationMILITARY SERVICE Do you have any Military Service?YesNoMilitary Service Start DateMilitary Service End DateMilitary BranchRank at DischargeOtherMilitary Separation StatusPrimary SpecialtyHow did you find out about us? Select the Referral Source that best describes how you found out about the company. - If the Referral Source is other, provide the details in Other Referral Source. - If the Referral Source is Current Contractor, provide the details in Referring Fedex Contractor information selection. Referral SourceAdditional Referral SourceReferral NameAdd Text and Images to Your Form With Ease To get started, replace this text with your own. Submit ApplicationSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link