LCT Job Application
Personal Information
First Name:  
Last Name:  
Address (line 1):  
Address (line 2):  
City:  
State:  
Zip Code:  
Date of Birth:  
Social Security Number:  
Telephone Number:  
Cell Phone Number:  
Email Address:  

Drivers License
License Number:  
State Issued:  
Expiration Date:  

Are you currently working with an LCT Recruiter?
If so please enter the recruiter's name  

Driving Record
Do you have a class A CDL?   Yes No
Total Years of OTR Driving:  
Number of tickets in the last 3 years:  
Number of accidents in the last 3 years:  
Have any licenses, permits, or privileges ever been suspended or revoked?
 		   Yes No
  If yes, please explain:
Have you ever been convicted of or are any charges pending for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof?
 		   Yes No
  If yes, please explain:
Have you ever been convicted of or are any felony charges pending against you?   Yes No
  If yes, please explain:

Last Employer Information
Name  
Phone Number  
Address  
City  
State  
Zip Code  
Position Held  
Date Hired  
Date Left  
Salary  
Reason for Leaving  
If you were a driver, complete the following:
Equipment:     Division:  

2nd to Last Employer Information
Name  
Phone Number  
Address  
City  
State  
Zip Code  
Position Held  
Date Hired  
Date Left  
Salary  
Reason for Leaving  
If you were a driver, complete the following:
Equipment:     Division:  

3rd to Last Employer Information
Name  
Phone Number  
Address  
City  
State  
Zip Code  
Position Held  
Date Hired  
Date Left  
Salary  
Reason for Leaving  
If you were a driver, complete the following:
Equipment:     Division:  

4th to Last Employer Information
Name  
Phone Number  
Address  
City  
State  
Zip Code  
Position Held  
Date Hired  
Date Left  
Salary  
Reason for Leaving  
If you were a driver, complete the following:
Equipment:     Division:  

5th to Last Employer Information
Name  
Phone Number  
Address  
City  
State  
Zip Code  
Position Held  
Date Hired  
Date Left  
Salary  
Reason for Leaving  
If you were a driver, complete the following:
Equipment:     Division:  

6th to Last Employer Information
Name  
Phone Number  
Address  
City  
State  
Zip Code  
Position Held  
Date Hired  
Date Left  
Salary  
Reason for Leaving  
If you were a driver, complete the following:
Equipment:     Division:  
Disclaimer
                 I have read and accept the information above: