Becker Transportation

Apply

Becker Transportation, Inc. is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, national origin, sex, age, veteran status, or disability in accordance with applicable laws.

Please complete this pre-qualification application in its entirety and we will contact you for complete information should your initial qualifications align with our current openings.

Your submission of the following information allows Becker Transportation to obtain driving records, employment records, and information regarding prior drug and alcohol screens for purposes of investigation as required by the Federal Motor Carrier Safety Regulations.

Thank you for your interest in Becker Transportation.

Becker Transportation Prequalification Application

Select the postion you are applying for: Postion
Name First Middle Last
Phone Number - (###) - ### ####
Secondary Phone Number - (###) - ### ####
Date of Birth Month Day Year

Social Security Number - ### - ## ####
Email
Driver's License Address 1 Address 2 City State Zip Code License # Type Endorsements
Expriration Date
Current/Most Recent Employer
- Address 1 Address 2 City State Zip Code
- Are you presently employed? Yes No
- May we call your current employer? Yes No
- How many states have you driven in?

Second Most Recent Employer
- Address 1 Address 2 City State Zip Code
- How many states did you drive in?

Third Most Recent Employer
- Address 1 Address 2 City State Zip Code
- How many states did you drive in?

Fourth Most Recent Employer
- Address 1 Address 2 City State Zip Code
- How many states did you drive in?

Additional Questions
1. How many years of Tractor/Trailer experience do you have?
2. Can you prove your previous work experience? Yes No
3. Has your drivers license EVER been suspended, revoked, or restricted? Yes No
  If YES, explain:
4. Have you received any tickets in the last 3 years? Yes No
  If YES, explain:
5. Have you been in any accidents in the last 3 years? Yes No
  If YES, explain:
6. Can you read and write English? Yes No
7. Have you ever tested positive or refused to test on any pre-employment drug or alcohol test? Yes No
Becker Transportation Disclosure and Release

I certify that I personally completed this application for the purpose of employment or contract, and that all information herein is true and correct. I authorize Becker Transportation to do a complete background investigation in accordance with federal and state laws. I authorize release of any information including all information released to my alcohol and controlled substances testing and training records, by any present or former employers and hold them harmless of any liability from release of said information. I also consent to the procurement and use of any MVR, consumer report, including reports from DAC Services, INC. deemed necessary by Becker Transportation in consideration of any employment or contract.

By electronic submission of this authorization, I agree that my identity may be verified by a telephone call from Becker Transportation in lieu of a signature.

I agree to the Background/MRV/DAC checks:
Please enter the anti-spam code: