Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Date of Birth
*
MM
DD
YYYY
Social Security Number or Employer Identification Number
*
What is your federal tax classification? Please select one option.
*
Individual/sole proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate
Limited liability company*
Other*
Are you authorized to work in the US without a sponsor visa?
*
Under penalties of perjury, I certify that: The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and I am a U.S. citizen or other U.S. person (defined below); and The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
*
Please enter most current employment first. Include all part-time jobs, periods of unemployment, and military service.
*
Enter employment history below. See example:
00/00/0000 to 00/00/0000 Name of Employer, City and State Job Title
If yes, how many years have you had your CDL?
What's your highest level of education?
*
Did you graduate?
*
Yes
No
Race and Ethnicity
*
Gender
*
Driver License Number
*
Driver License State
*
Driver License Expiration Date
*
MM
DD
YYYY
Do you have an F Endorsement?
*
Yes
No
Have you been ticketed for moving violations within the last three years? If no, please leave blank. If yes, please describe the infractions, below.
*
License Plate Number
State of Vehicle Registration
Have you been convicted for DWI/DUI of alcohol or drugs, or had your license suspended for moving violations, hit and run, reckless or negligent operation of vehicle, or driving while under suspension or revocation?
*
COVID-19: I agree not to drive for Lyons Logistics L.L.C. if I have tested positive for COVID-19 or have symptoms of COVID-19.
*
I will advise Lyons Logistics L.L.C. of any change in information provided on this form including, but not limited to, involvement in a car accident in which I am cited, any citations for moving violations, non-renewal of license, or termination of license.
*
First and Last Name
*
First Name
Last Name
Today's Date
*
MM
DD
YYYY
Please confirm you read and understand the statement below:
*
I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. This application also serves as an agreement between Lyons Logistics L.L.C. and the applicant. Your typed name above will serve as your signature to this agreement.
