Western Express Driver Application

Applicant First Name *

Applicant Last Name *

Applicant Email *

Applicant Phone Number *

City*

State *

—Please choose an option—ALAZAKARCACOCTDEDCFLGAHIIDILINIAKSKYLAMDMAMEMIMNMSMOMTNENDNVNHNJNMNYNCOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip *

Years of Driving Experience *

—Please choose an option—0-3 mths3-6 mths6-12 mths1 yr1-2 yrs2-5 yrs5+ yrs

License Type *

Class A

Driver Type *

Company DriverLease PurchaseRecent Grad

Distance *

DedicatedRegionalOTR (Over-the-Road)

Preferred Haul Type (Dry Van, Flatbed)

Number of moving violations in the past 3 years *

—Please choose an option—0123+

Number of preventable accidents in the past 3 years *

—Please choose an option—0123+

DUI in the past 5 years? *

—Please choose an option—YesNo