HOME/ ABOUT/ SHIPMENT TRACKING/ FUEL SURCHARGE/ CONTACT Office/Dispatch/Warehouse Application Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email Address * Phone * (###) ### #### Position seeking * Accounting/Rating Customer Service Dispatch Warehouse Other Preffered shift start time * Early AM AM Noon Afternoon Evening Open/Any Desired hours * Full Time Part Time Temporary Desired Salary Availability Date MM/DD/YYYY Previous employment * Include dates of employment. (last 7 years) Reason for leaving your last position. Are you willing to work overtime? * Yes No Occasionally Are you willing to work on weekends? * Yes No Occasionally Do you have reliable transportation? * Yes No Have you ever been convicted of a felony? * Yes No If you replied yes, please give details. Education or certificates earned Last School attended Anything else you would like to let us know about yourself? Call Action Courier today! (253) 395-3501 SEATTLE

HOME/ ABOUT/ SHIPMENT TRACKING/ FUEL SURCHARGE/ CONTACT Driver Application Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email Address * Phone * (###) ### #### Position Seeking * Driver (CDL A) Driver (Non-CDL) Other Preffered Shift * Early AM AM Noon Afternoon Evening Open/Any Desired Hours * Full Time Part Time Temporary/Seasonal Desired Salary Availability Date MM/DD/YYYY Are you willing to work overtime? * Yes No Occasionally Are you willing to work on weekends? * Yes No Occasionally Have you ever been denied a license, permit or privelege to operate a motor vehicle? * Yes No Do you have a DOT Medical Card? Yes No Are you over the age of 24? Yes No Do you have reliable transportation? * Yes No Do you have a TWIC Card or an STA Number? TWIC Card STA Number Neither Do you have previous experience driving a commercial vehicle? * Yes No If yes, what type of vehicle and approximate number of miles you have driven Driver's License * List each license held in the last three years. (Provide State, License Number, Endorsements, Expiration date) Has any license, permit or privelage ever been suspended or revoked? * Yes No Previous Employment * Include dates of employment. (last 7 years) Reason for leaving your last position. Education or certificates earned Last School attended Have you been involved in any accidents or received any tickets over the last three years? * Yes No Please list and explain. Have you ever been convicted of a felony? * Yes No If yes, please give details. Anything else you would like to let us know about yourself? Call Action Courier today! (253) 395-3501 SEATTLE