work with us / career

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1Start Here

2Application Agreement

3Personal Information

4Education

5Work Experience

6Drug and Alcohol Testing

7Accidents

8Traffic Convictions

9Asset Information

10Background

Name *

First

Middle

Last

Applying For *

Are you over 18 ? *

To be approved, you must be older than 18 years.

Agreement Authorization

To be read and signed before completing the application.

This company is an equal opportunity employer and seeks to employ and promote the most qualified personnel and to do this in such a manner that will not discriminate against any individual because of: race, color, gender, religion, age, veteran status, disability, or any other category protected by federal, state, and local laws. This commitment applies to all aspects of the employment relationship including hiring, promotion, training, compensation, discipline, discharge and any term or condition of employment, Those applicants requiring accomodation for the application and/or interview process should notify a representative of this company for assistance. This application is valid for consideration of employment for six months only.

Please complete this application and all fields completely with the understanding that any incorrect or false statement or misinformation furnished, intended or otherwise, will subject the applicant to discharge at any time.

By clicking here, the undersigned hereby accepts and acknowledges this signature as his/her valid signature for purposes of all executions requested and necessary herein. The undersigned agrees that this electronic signature is acceptable in process and accurately represents the undersigned's legal intent. Further, the undersigned, by clicking here, further agrees that this electronic signature is his/her signature in fact and is effective and binding upon the undersigned as though signed in person. The undersigned further releases and hold harmless Universal Logistics Holdings, Inc. and all related Universal entities from any and all liability for any claims of fraud, misappropriation, forgery, breach of duty and contract or any other reason or cause related to the alleged misuse of this electronic signature.

You must fill out the following fields exactly as they appear below.

Name *

Date *

Agreement Signature

Authorization *

I authorize use of my electronic signature

Name *

First

Last

Personal Info

Social Security Number (SSN) *

Date of Birth *

To be approved, you must be older than 18 years.

Phone *

Email *

Have you ever been employed by this company ? *

Employment Period *

Truck Number *

Have you ever been known by any other name ? *

Other Name *

Address

Please list the addresses where you have lived over the past 5 years, starting with the most recent.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Total Years of Residence *

Address 2

Please list the addresses where you have lived over the past 5 years, starting with the most recent.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Total Years of Residence *

Still Want to Add More *

Address 3

Please list the addresses where you have lived over the past 5 years, starting with the most recent.

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Total Years of Residence *

Emergency Contact

Please enter at least one emergency contact number.

Emergency Contact 1

Name *

Last Name *

Phone *

Relationship *

Want to Add More ? *

Emergency Contact 2

Name *

Last Name *

Phone *

Relationship *

Add Education ? *

Education 1

Institute Name *

Degree Type *

Institute Address *

Year Attended *

Did you graduate ? *

Year of Graduation *

Want to Add More Education History ? *

Education 2

Institute Name *

Degree Type *

Institute Address *

Year Attended *

Did you graduate ? *

Year of Graduation *

If there's anything else you want to list, add it here (optional).

Employment General Info

Are you legally allowed to work in United States ? *

Do you have a TWIC Card ? *

Sorry you Don't Qualify to Work with Us.

Expiry Date *

Are you currently employed ? *

Employer Detailes

Employer *

Job Description *

Start Date *

End Date

Leave blank if you are still working there.

Supervisor Name *

Supervisor's Contact Info (Email/Phone) *

Do you currently hold a valid commercial driving license ? *

CDL Isssue Details

License# *

Issuing State *

Date of Issue *

Date of Expiry *

Endorsements *

Tanker
Double / Triples
X Endorsement
HAZMAT
Other
None

HAZMAT Date of Expiry

If you don't have any endorsements leave this field blank.

Have any of the above licenses ever been revoked or suspended ? *

for Model another

Explain Please *

Do you have experience to list ? *

Company Information *

Address Line 1

Address Line 2

City

State

Zip Code

Employment History Details

Position *

Equipment Driven *

Start Date *

End Date *

Reason For Leaving *

Supervisor Name and Number *

Want to add another experience ? *

Company Information 2 *

Address Line 1

Address Line 2

City

State

Zip Code

Employment History 2

Position *

Equipment Driven *

Start Date *

End Date *

Reason For Leaving *

Have you been unemployed at any time in the last 5 years ? *

Supervisor *

Explain please *

Total Driving Experience (In Years) *

Did a DOT alcohol test, conducted within the past two years, confirm a BAC (breath alcohol concentration) of 0.04 or greater? *

Please enter date of test *

Did you return to duty with your organization following evaluation by a Substance Abuse Professional (SAP)? *

Drug Test

Substance Abuse Professional details *

SAPs Phone *

Was follow up testing required and performed? *

Did a DOT Controlled Substance (drug) test within the past two years result in a confirmed “positive” result? *

Date Of Test *

Have you ever refused to be tested as required by the DOT regulations? *

Drug Refusal Details

Drug Testing Refusal details *

Type of Test *

Did you return to duty with your organization following evaluation by a Substance Abuse Professional (SAP)?

Have you had any accidents in the last three years? This includes accidents regardless of whether you were issued a ticket or not, and includes both personal and commercial vehicles. *

Accident Details

Date of Accident *

Country *

State *

City *

Number of Injuries *

Description of Accident *

Were you driving a truck? *

Did your company hold you responsible? *

Have you violated any motor vehicle laws or ordinances which resulted in conviction or forfeiture of bonds or collateral in the last three years? (For both commercial and personal vehicles) *

Traffic Convictions Details

Date of Conviction *

Country *

State *

City *

Number of Points *

Describe Violation *

Fine Ammount *

I'm applying for *

Are you applying for owner operator? *

Owner Operator Vehicle Info

Equipment *

Make *

Model *

Year *

Your tractor has to be newer than 2005.

VIN# *

Type of Truck *

Is this vehicle titled in your name? *

Is this vehicle registered and plated in your name? *

Are you interested in purchasing plate/registration through our company? *

Are you willing to drive ? *

Last DOT Inspection Date *

Have you filled 2290 tax for current year ? *

Are you driving for leased contractor? *

Contractor Information

Contractor Name *

Phone

Please provide information of the truck you will be driving

Make *

Model *

Year *

Your tractor has to be newer than 2005.

VIN# *

Type of Truck *

Last DOT Inspection Date *

Have you filled 2290 tax for current year ? *

Have you ever been convicted of a crime or do you have any criminal charges pending against you? *

Please provide specific information (dates/detail) of the circumstances of all incidents: *

In the past three (3) years, have you ever been convicted of any of the following offenses committed during on-duty time [49 C.F.R. 391.15 and 49 C.F.R. 395.2]: *

Driving a commercial motor vehicle with a blood alcohol concentration ("BAC") of .04 percent or more
Driving under the influence of alcohol, as prescribed by state law
Refusal to undergo drug and alcohol testing as required by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations
Driving a commercial motor vehicle under the influence of any 21 C.F.R. 1308.11 Schedule I identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug
Transportation, possession, or unlawful use of a 21 C.F.R. 1308.11 Schedule I identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while you were on duty driving for a motor carrier
Leaving the scene of an accident while operating a commercial motor vehicle
Or any other felony involving the use of a commercial motor vehicle
None

I certify that all information above has been answered truthfully, accurately and completely to the best of my knowledge. Furthermore, I understand that any incorrect or false statement or misinformation furnished by me, intended or otherwise, may subject me to discharge at any time.

Background Authorization

Applicant Signature *

Date *

MC# 1667243
DOT# 4286648

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United States

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Agreement Authorization

To be read and signed before completing the application.

Agreement Signature

Personal Info

Address

Address

Address 2

Address 2

Address 3

Address 3

Emergency Contact

Emergency Contact 1

Emergency Contact 2

Education 1

Education 2

Employment General Info

Employer Detailes

CDL Isssue Details

Employment History Details

Employment History 2

Drug Test

Drug Refusal Details

Accident Details

Traffic Convictions Details

Owner Operator Vehicle Info

Contractor Information

Please provide information of the truck you will be driving

Background Authorization

Company

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