Raider Express - Apply Online

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Apply Online

If you would like to Apply Online, fill out the form below and click Submit.

MUST BE A U.S. RESIDENT
All Fields with an asterisk (_*) are required.

CONTACT INFORMATION

*First Name:

*Address:

Middle Name:

*Last Name:

*City:

Email:

*State

*Day Phone:

*Zip/Postal Code:

*Night Phone:

*Date of Birth:

*Best Time to Call:

*Social Security No.:

*How did you hear about us?:

CURRENT DRIVER LICENSE INFORMATION

License Number:

License Class:

Class A Class B Class C

*State Issued:

Endorsements:

Hazmat Double/Triple Tanker

*Expiration Date:

DRIVING INFORMATION

I prefer to run (check all that apply):
Southeast Southwest Midwest
Northeast Northwest Local

Experience:
HHG    Tanker    Flatbed
Van    Reefer    Specialized
Auto Carrier    Hazmat    Double/Triple

Years of Tractor Trailer Driving Experience:

Driver School Graduate:
Yes No

Traffic Convictions:
(past five years, other than parking violations)

Number of Accidents:
(past five years)

I am now a(n):
Owner Operator Company Driver Student

I Prefer to Pull:
HHG    Tanker    Flatbed
Van    Reefer    Specialized
Auto Carrier    Hazmat    Double/Triple

I would like to run:
Single Team Husband/Wife

I am interested in leasing/buying a Tractor with a Carrier Plan:
Yes No

EMPLOYMENT INFORMATION

Current Employer:

Street / City / State / Zip:

Starting Date:

Phone Number:

Past Employer 1:

Street / City / State / Zip:

Starting Date:		Ending Date:

Phone Number:

Past Employer 2:

Street / City / State / Zip:

Starting Date:		Ending Date:

Phone Number:

Past Employer 3:

Street / City / State / Zip:

Starting Date:		Ending Date:

Phone Number:

Past Employer 4:

Street / City / State / Zip:

Starting Date:		Ending Date:

Phone Number:



CRIMINAL RECORD (if any):

Have you ever been convicted of a felony?	Yes No	Date:

Have you ever been convicted, or are any charges pending, for driving while under the influence of alcohol, a narcotic drug, amphetamines or derivatives thereof?	Yes No	Date:

Have you ever been denied a license, permit or privilege to operate a motor vehicle?	Yes No	Date:

Has any license, permit or privilege ever been suspended or revoked?	Yes No	Date:

Have you ever been convicted, or are any charges pending, for reckless or careless operation of a motor vehicle?	Yes No	Date:

Have you ever been convicted, or are any charges pending, for possession, sale or use of a narcotic drug, amphetamines, or derivatives thereof?	Yes No	Date:

Have you ever been refused any type of insurance or been denied bonding?	Yes No	Date:

Have you ever been discharged or suspended?	Yes No	Date:

Additional Comments:

Click here to read the full terms.

You affirmatively consent to the use of this electronic form ("e-form") and acknowledge your right, or option, to complete this Contractor/Driver Information Sheet in a non-electronic form. Your consent to use this electronic Contractor/Driver Information Sheet may be subsequently withdrawn through written notice to Raider Express. Your execution of this Contractor/Driver Information Sheet, by electronic signature, affirms the foregoing information is true and correct to the best of your knowledge.

By checking the following box and typing your name, you are electronically signing all disclosure agreements and are in full agreement with the terms.

* (check this box to agree with the terms)

Full Name: * (please type your full name)

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