Name:

Address:

City: State: AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:

Phone: Cell:

Email: Social Security:

Birthdate: Age:

Date Available:

License Type: Endorsements:

License Number: State: AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Please select the number of traffic convictions in the last three years: 0 1 2 3 4 5 6+

Please select the number of accidents in the last three years: 0 1 2 3 4 5 6+

Please EXPLAIN the number of accidents in the last three years:

Have you ever been convicted of a FELONY? Yes No

Explain:

Do you have a valid US Passport or Passport Card? (Required for entry into Canada): Please Make a Selection YES NO

Previous Work Experience:

Employer:

Address:

City: State: AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:

Phone: Fax:

Date of Employment: to

Type of Work: Type of Equipment:

Reason for Leaving:

Starting Pay Rate: Exiting Pay Rate:

Supervisor: Phone: Ext:

Employer:

Address:

City: State: AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:

Phone: Fax:

Date of Employment: to

Type of Work: Type of Equipment:

Reason for Leaving:

Starting Pay Rate: Exiting Pay Rate:

Supervisor: Phone: Ext:

Employer:

Address:

City: State: AL AK AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:

Phone: Fax:

Date of Employment: to

Type of Work: Type of Equipment:

Reason for Leaving:

Starting Pay Rate: Exiting Pay Rate:

Supervisor: Phone: Ext:

How did you hear about Shomotion? Select One Website Driver Recomendation Recruitment Poster Recruitment Trailer Friend Recomendation Truck Stop Magazine Ad Classified Ad Forum Post

Please Elaborate on the previous (Name, Source, Location, etc)

Do you have computer use experience? Yes No

Do you have a laptop that travels with you? Yes No

Are you willing to stay out for 3+ months? Yes No

Do you have a rider that travels with you? Yes No

Is this rider CDL? Yes No

If yes do you normally operate as a team drive? Yes No

Rider's Name:

Do you have any previous Concert Touring or Mobile Marketing Experience? Yes No

Explain:

Please Provide an Emergency Contact:

Name: Phone:

Additional References:

Additional Information:

Please check your answers carefully and then click Submit below if you are satisfied.