Western Express Driver Application

Applicant First Name *

Applicant Last Name *

Applicant Email *

Applicant Phone Number *

City*

State *

—Please choose an option—ALAZAKARCACOCTDEDCFLGAHIIDILINIAKSKYLAMDMAMEMIMNMSMOMTNENDNVNHNJNMNYNCOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip *

Years of Driving Experience *

—Please choose an option—0-3 mths3-6 mths6-12 mths1 yr1-2 yrs2-5 yrs5+ yrs

License Type *

Class A

Driver Type *

Company DriverLease PurchaseRecent Grad

Distance *

DedicatedRegionalOTR (Over-the-Road)

Preferred Haul Type (Dry Van, Flatbed)

Number of moving violations in the past 3 years *

—Please choose an option—0123+

Number of preventable accidents in the past 3 years *

—Please choose an option—0123+

DUI in the past 5 years? *

—Please choose an option—YesNo

“By submitting my information, I consent to receive calls, text messages and emails from the company, including information about my application, eligibility, opportunities, and other advertising and telemarketing messages. I agree that calls may be made using an automatic telephone dialing system and/or an artificial or prerecorded voice, and that messages and emails may be sent using automatic messaging systems. I understand that I may opt out at any time by pressing "0" during the calls, by texting "STOP" in response to the text messages, or by clicking the provided “unsubscribe” link in the emails. I additionally agree that Western Express, Inc.'s service provider receives in real time and logs your text messages and emails with Western Express, Inc..”