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YANKEE FREIGHT SYSTEMS, LLC 12161 S CENTRAL AVE ALSIP, IL 60803

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex national origin, age marital status, or non-job related disability.

TO BE READ AND SIGNED BY APPLICANT

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigation my safety performance history as required by 49 CFR 391.23(d) and (e).

I also understand that I have the right to:

• Review information provided by previous employers

• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected

Information to the prospective employer, and

• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information

Drivers Name

Address

Street Address Phone Number / Cell Number / Fax Number City State / Province / Region Postal / Zip Code Country

SOCIAL SECURITY NUMBER*

CDL NUMBER / ST*

Date of Birth*

day

month

year

PREVIOUS ADDRESSES FOR THE PAST THREE (3) YEARS

Adress

City

State

Zip

From

1 year

2 year

3 year

Applicant Signature & Date :*