Date:
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Name:
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Address:
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Address 2:
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City:
| State:
| Zip:
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1. Do you have a valid driver's license?
Yes No |
2. Has your driver's license ever been suspended?
Yes No |
3. Have you been in an accident in the last three years?
Yes No
If so, how many?
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4. Have you been found guilty of a DUI while driving for another employer on the clock?
Yes No |
5. Can you provide proof of your driving record if needed?
Yes No |
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Signature
(checking the checkbox above is equivalent to a handwritten signature) |