Print and complete this application.

Name_______________________________ Social Security____________________
Mailing Address____________________________________ How Long__________
City________________________________State_____________Zip______________
Telephone _______________________________ Date of Birth__________________
Date you will be available for orientation____________________________________
Driver’s License __________________________State _________Exp. Date________
CDL Y/N____________ Number of tickets in the last 3 years_________
How many years total OTR experience____________________________________
Number of accidents in the last 3 years___ 
Have you ever been arrested for driving while intoxicated? If yes, when____________
Have you ever had your license suspended or revoked? If yes, when_______________
Please list ten years employment history. Please include additional information on separate paper.

Dates of Employment: From _________to_________
Employer Name_______________________________________________________
Address_______________________________City________________State________
Phone Number ___________________Trailer type ____________
Reason for leaving______________________________________________________

Dates of Employment: From ________To_________
Employer Name_______________________________________________________
Address_______________________________City________________State________
Phone Number ______________________Trailer type __________
Reason for leaving______________________________________________________

Dates of Employment: From _________To_________
Employer Name_______________________________________________________
Address_______________________________City________________State________
Phone Number ______________________Trailer type __________
Reason for leaving______________________________________________________


I certify that I personally completed this application and that all of the information contained here is true and correct. I authorize Ag Express to do a complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by Ag Express and hold them harmless of all liability from the release of said information. I authorize release of any information, including all information related to my alcohol and controlled substance testing and training records, by any former employers and hold them harmless of any liability from release of information.

Signature_________________________ Date___
Please return by fax to 406-655-0121 or mail to P.O. Box 80166, Billings, MT 59108