Full Driver Application In Compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability. Personal Details Name * First Name Middle Initial Middle Initial Last Name * Last Name Date of Birth * Drivers License Number * Phone Number * E-Mail Address * Contact Details Address * Address 2 City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY ZIP Code * If you have lived at the above address for less than 12 months, list the previous address: Do you have the legal right to work in the United States? * Yes No Can you provide proof of age? * Yes No Have you worked for Performance Corp before? * Yes No What dates did you work for Performance Corp? * At what rate of pay? * At what position? * Reason for leaving? * Are you now employed? * Yes No How long since last employment? * How did you hear about us? * Rate of pay expected? * Is there anything that might inhibit you from performing tasks related to the position you have applied for? * Yes No Please explain: * Notice to Applicant: Before you continue in filling out the remainder of this application we must inform you that the information you have provided so far, and any and all information you are about to disclose, in accordance with 49 CFR part 391.21(b)(10) of the Federal Motor Carrier Safety Regulations (FMCSR's) may be used, and your previous employers "will be"contacted for the purpose of investigating your safety performance history as required by 391.23(d), and 391.23(e) of the FMCSR's. If it has not already been provided for you, please ask for a written copy of your "due process rights" regarding any and all information obtained during the processing of your history as specified in 391.23(i).