Oddson Underground Application

Step 1 of 14

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• Personal Details

• Name*
  
  First
  
  Last
• Email*
  
• Address*
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
  
• How long?*

• Date of Birth*
  
  Date Format: MM slash DD slash YYYY
  
• Social Security Number
• Phone Number*
• Cell Phone Number

• Name of First Emergency Contact
  
  First
  
  Last
• First Emergency Contact Phone Number
• Name of Second Emergency Contact
  
  First
  
  Last
• Second Emergency Contact Phone Number

• Three Previous Years of Residency

• Residency #1
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
  
• Number of Years
• Residency #2
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
  
• Number of Years
• Residency #3
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
  
• Number of Years

• License Information

• Type of ID*Drivers LicenseIdentification Card
• License or ID Number*
• State Issued to*
• Expiration Date*
  
  Date Format: MM slash DD slash YYYY
  

• Driving Experience- Straight Truck (If Applicable)
• Class of Equipment
• Type of Equipment (Van, Tank, Flat, etc.)
• Date From
  
  Date Format: MM slash DD slash YYYY
  
• Date To
  
  Date Format: MM slash DD slash YYYY
  
• Approximate Number of Total Miles

• Driving Experience- Tractor and Semi (If Applicable)
• Class of Equipment
• Type of Equipment (Van, Tank, Flat, etc.)
• Approximate Number of Total Miles
• Date From
  
  Date Format: MM slash DD slash YYYY
  
• Date To
  
  Date Format: MM slash DD slash YYYY
  

• Accident Record For Past Three Years (Upload a file if more space is needed)

• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Nature of Accident (Head- on, Rear- end, Upset, etc.)
• Number Fatalities
• Number of Injuries
• Upload File Here If Needed

• Traffic Convictions & Forfeitures For The Past Three Years (Other Than Parking Violations)

• Any?
  • Yes
  • No
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Violation
• State of Violation Location
• Penalty (Forfeited Bond, Collateral and/or Points)
• Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
  • Yes
  • No
• Has any license, permit, or privilege ever been suspended or revoked?
  • Yes
  • No
• If Yes, Explain

• **Please note that we will be running your drivers license prior to hiring to verify you have a valid drivers license and a clean driving record.**

• Education

• Name of High School
• Date Graduated
  
  Date Format: MM slash DD slash YYYY
  
• Name of College (If Any)
• Date Graduated
  
  Date Format: MM slash DD slash YYYY
  

• Employment Record

• Last Employers Name*
  
  First
  
  Last
• Address*
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
  
• Phone Number*
• Position Held
• Date From
  
  Date Format: MM slash DD slash YYYY
  
• Date To
  
  Date Format: MM slash DD slash YYYY
  
• Salary
• Reasons For Leaving
• Any gaps in between employment and/or unemployment must be explained
  • Yes
  • No
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Reasons
• Were you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer?*
  • Yes
  • No

• Second To Last Employers Name*
  
  First
  
  Last
• Address*
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
  
• Phone Number*
• Position Held
• Date From
  
  Date Format: MM slash DD slash YYYY
  
• Date To
  
  Date Format: MM slash DD slash YYYY
  
• Salary
• Reasons For Leaving
• Any gaps in between employment and/or unemployment must be explained
  • Yes
  • No
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Reasons
• Were you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer?
  • Yes
  • No

• Third To Last Employers Name*
  
  First
  
  Last
• Address*
  
  Street Address
  
  Address Line 2
  
  City
  
  State / Province / Region
  
  ZIP / Postal Code
  
• Phone Number*
• Position Held
• Date From
  
  Date Format: MM slash DD slash YYYY
  
• Date To
  
  Date Format: MM slash DD slash YYYY
  
• Salary
• Reasons For Leaving
• Any gaps in between employment and/or unemployment must be explained
  • Yes
  • No
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Date
  
  Date Format: MM slash DD slash YYYY
  
• Reasons
• Were you subject to the Federal Motor Carrier Safety Regulations (RMCSRs) while employed by the previous employer?
  • Yes
  • No

• Please note that Oddson Underground, Inc, reserves the right to contact previous employers to verify past employment

• Are you an American Citizen?*
  • Yes
  • No
• Have you ever been convicted of, of pleaded no contest, to a felony within the last five years?*
  • Yes
  • No
• Have you ever been in the Armed Forces?
  • Yes
  • No
• If Yes, Explain
• Are you currently a member of the Armed Forces?
  • Yes
  • No
• If Yes, please list your specialty
• Date Entered
  
  Date Format: MM slash DD slash YYYY
  

• By submitting this I certify that all of the information is true and complete to the best of my knowledge.

• Consent I agree to the privacy policy.