JET EXPRESS, INC.

INTERNET DRIVER INFORMATION SHEET

Personal Information

First Name: * Last Name: *

Company Owner Operator Fleet Owner

Truck Year: Make: Model:

How many years driving an 18-wheeler? *

How many tickets have you received in the last 3 years? *

How many accidents in the last 3 years? *

Date of Birth: * SS#: *

Street Address: *

City: * State: * Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahmoa Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: *

Driver's License #: * State Issued: * Alabama Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahmoa Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Phone #: * Cell Phone #:

Have you worked at Jet Express, Inc. before? YES NO

* - required fields

Current Employer

Current/Most Recent Employer:

Are you presently employed? Yes No

May we call your current employer? Yes No

Phone Number:

Address:

Position Held? From: To:

Why do you want to change employers?

Previous Employer

Second Last Employer:

Are you presently employed? Yes No

May we call your current employer? Yes No

Phone Number:

Address:

Position Held? From: To:

Reason for Termination?

Previous Employer

Third Last Employer:

Are you presently employed? Yes No

May we call your current employer? Yes No

Phone Number:

Address:

Position Held? From: To:

Reason for Termination?

I hereby certify that all information on this form is correct and complete to the best of my knowledge. I hereby authorize Jet Express, Inc. to do a complete background investigation in accordance with state and federal laws. I authorize release of any information, including all information related to my alcohol and controlled substances testing and training records required by Federal Highway Administration (FHWA) 49 CFR PARTS 391 OR 382, By any past or current employers. I hereby release all such persons from any liability or damages. I consent to the procurement and use of any consumer reports, including reports from DAC Services, Inc., deemed necessary by Jet or its subsidiaries in their consideration of my employment.

  

If you receive an error when submitting this application, please print it and fax to: Marjean Akers, Fax Number: 937-276-8614, or mail to: Marjean Akers, Jet Express, Inc., 4518 Webster Street, Dayton, OH 45414. Thank you!

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