Online Application
Please print and fax to 870-342-5121 or copy and paste in email to
cowboydispatch@windstream.net
Personal Information
First Name: * ___________________________________
Last Name: * ___________________________________
Email: ________________________________________
Home Address: *________________________________
City: * ________________________________________
State/Provience:*________________________________
Zip: * ____________________
Home Phone: * _____________________
Other Phone: ______________________
Pager: ___________________________
Date of Birth: * _____________________
SSN: *____________________________
CDL # *___________________________
CDL State * _______________________
Previous CDL? _____________________
Previous CDL #_____________________
Previous CDL State __________________
Doubles/Triples Endorsement? Yes No
Tank Endorsement? Yes No
Passenger Endorsement? Yes No
What type of experience do you have?
You can select more than one type.
*Student Training
*Van
*Car Hauling
*Flatbed
*Heavy_Haul
*Tanker
*Reefer
*Household Goods
*Other
*Amount Of OTR Experience: *
Owner/Operator Information
Do You Own Your Own Truck? Yes No
*Truck Make
*Truck Weight
*Fifth Wheel Height
*Wheel Base
*Mileage
*Do You Own Your Own Trailer? Yes No
*Trailer Type
I am interested in...
*Lease/Purchase
*Buy A Tractor
I would like to run...
*Solo
*Team
*Husband/Wife Team
Have you had any...
*Preventable Accidents/Incidents *
If yes how many?_____________
Have You Ever Had Any DWI/DUI's? *
*Number Of Moving Violations *
*Last 3 yrs.
Comments
*If you answered yes to any of the above, you are required to give
details before companies will give your application further
consideration.
Work History (Three years verifiable)
If you are a recent driving school graduate, list the driving school you
attended as one of your work experiences
*Company Name 1: * __________________________
*City 1: * ____________________________________
*State/Provience 1: *___________________________
*Phone 1:____________________________________
*Position Held 1:_______________________________
*From Date 1: * _______________________________
*To Date 1: * _________________________________
*Reason For Leaving 1:_________________________
____________________________________________
*Company Name 2:____________________________
*City 2:______________________________________
*State/Provience 2:_____________________________
*Phone 2:____________________________________
*Position Held 2:________________________________
*From Date 2: _________________________________
*To Date 2: ____________________________________
*Reason For Leaving 2:___________________________
______________________________________________
*Company Name 3:______________________________
*City 3: _______________________________________
*State/Provience 3: ______________________________
*Phone 3:______________________________________
*Position Held 3:_________________________________
*From Date 3:___________________________________
*To Date 3:_____________________________________
*Reason For Leaving 3:___________________________
______________________________________________
*Please List Any Additional Employers From The Last Three Years
Here. _______________________________________________
____________________________________________________
*Additional Comments
Education, Awards, Personal, etc. _________________________
____________________________________________________
*Almost Done
Date Available: _________________________________
**DISCLAIMER I certify that I personally completed this application and
that all of the information is true and correct. I hereby request and
authorize any company that receives this application to cause to be
conducted, at any time, an investigation of my background for
employment purposes, which may include, but is not limited to, any
information relating to my character, general reputation, personal
characteristics, mode of living, criminal history, past work experience,
educational background, alcohol or drug test results, or failure to
submit to an alcohol or drug test, or any other information about me
which may reflect upon my potential for employment gathered from any
individual, organization, entity, agency, or other source which may
have knowledge concerning any such items of information. I have
completed this application of my own free will and hold
LogginsLogistics.com harmless of all liability for providing this
application for my use.
cowboydispatch@windstream.net
Personal Information
First Name: * ___________________________________
Last Name: * ___________________________________
Email: ________________________________________
Home Address: *________________________________
City: * ________________________________________
State/Provience:*________________________________
Zip: * ____________________
Home Phone: * _____________________
Other Phone: ______________________
Pager: ___________________________
Date of Birth: * _____________________
SSN: *____________________________
CDL # *___________________________
CDL State * _______________________
Previous CDL? _____________________
Previous CDL #_____________________
Previous CDL State __________________
Doubles/Triples Endorsement? Yes No
Tank Endorsement? Yes No
Passenger Endorsement? Yes No
What type of experience do you have?
You can select more than one type.
*Student Training
*Van
*Car Hauling
*Flatbed
*Heavy_Haul
*Tanker
*Reefer
*Household Goods
*Other
*Amount Of OTR Experience: *
Owner/Operator Information
Do You Own Your Own Truck? Yes No
*Truck Make
*Truck Weight
*Fifth Wheel Height
*Wheel Base
*Mileage
*Do You Own Your Own Trailer? Yes No
*Trailer Type
I am interested in...
*Lease/Purchase
*Buy A Tractor
I would like to run...
*Solo
*Team
*Husband/Wife Team
Have you had any...
*Preventable Accidents/Incidents *
If yes how many?_____________
Have You Ever Had Any DWI/DUI's? *
*Number Of Moving Violations *
*Last 3 yrs.
Comments
*If you answered yes to any of the above, you are required to give
details before companies will give your application further
consideration.
Work History (Three years verifiable)
If you are a recent driving school graduate, list the driving school you
attended as one of your work experiences
*Company Name 1: * __________________________
*City 1: * ____________________________________
*State/Provience 1: *___________________________
*Phone 1:____________________________________
*Position Held 1:_______________________________
*From Date 1: * _______________________________
*To Date 1: * _________________________________
*Reason For Leaving 1:_________________________
____________________________________________
*Company Name 2:____________________________
*City 2:______________________________________
*State/Provience 2:_____________________________
*Phone 2:____________________________________
*Position Held 2:________________________________
*From Date 2: _________________________________
*To Date 2: ____________________________________
*Reason For Leaving 2:___________________________
______________________________________________
*Company Name 3:______________________________
*City 3: _______________________________________
*State/Provience 3: ______________________________
*Phone 3:______________________________________
*Position Held 3:_________________________________
*From Date 3:___________________________________
*To Date 3:_____________________________________
*Reason For Leaving 3:___________________________
______________________________________________
*Please List Any Additional Employers From The Last Three Years
Here. _______________________________________________
____________________________________________________
*Additional Comments
Education, Awards, Personal, etc. _________________________
____________________________________________________
*Almost Done
Date Available: _________________________________
**DISCLAIMER I certify that I personally completed this application and
that all of the information is true and correct. I hereby request and
authorize any company that receives this application to cause to be
conducted, at any time, an investigation of my background for
employment purposes, which may include, but is not limited to, any
information relating to my character, general reputation, personal
characteristics, mode of living, criminal history, past work experience,
educational background, alcohol or drug test results, or failure to
submit to an alcohol or drug test, or any other information about me
which may reflect upon my potential for employment gathered from any
individual, organization, entity, agency, or other source which may
have knowledge concerning any such items of information. I have
completed this application of my own free will and hold
LogginsLogistics.com harmless of all liability for providing this
application for my use.
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A Division of
Loggins Logistics Inc.
Loggins Logistics Inc.