asterisk (*) indicates required fields.

Pre-Application Form

*Desired Position:
*First Name:
 Middle Initial:
*Last Name:
*Home Phone:
*Mobile/Cell:
 Email Address:
*Current Address:
*City:
*State:
*Zip Code:
*Years At Current Address:
Check if you have lived at current address less than 3 years.
*Birthdate:
*Social Security Number:
*Driver's License Number:
*DL State:
*DL Expiration Date:
Check if you have any prior out-of-state driver's licenses
If you have CDL endorsement, please check any that apply:
DBLS    TRPS    TANK    HAZMAT   
Referred By:
*How many years of driving experience do you have:

Employment History (Please list the last 3 years):

Current Employer

Start Date:
End Date:
Employer Name:
Address:
City:
State:
Zip Code:
Phone Number:
Position Held:
Type of Equipment Used (If Driving Position):
Please explain any gaps in employment history:

Please Answer A Few Questions:

(Check box if the answer is yes)
Ever Applied/Work Here Before?
Have You Ever Tested Positive for Drugs/Alcohol?
Any Prior DUI's or Reckless Driving?
Any prior felonies or misdemeanors on file?
Do You Have a Class "A" License?
Are You Under 25 Years Old?
Do You Have a Current DMV Print Out?
Have You Ever Had Your License Suspended?
Do You Have Any Points Against Your License?
Have You Ever Received a Two-Point Violation?
Do You Have Any Moving Violations?
Have You Had Any Accidents?

I certify that this application was completed by me, and all information is complete, accurate, and true to the best of my knowledge. Falsification or omission of any required information on this application or in any other documents required in the driver qualification process will result in the disqualification to drive/or termination.


I authorize Cimarron Express, Inc. to investigate my background, work record and drug and alchohol testing results, and I release employers and persons named herein from liability for any damages on account of furnishing such information.

Please use your mouse to sign your name in the box below.
I have read and agree to the above release and I give permission to obtain consumer reports about me from DAC.