FOX TRANSPORTATION, INC. HOME DRIVER APPLICATION CONTACT US (570) 668-4189 CONTACT US OUR LOCATION 135 Tilde Rd Tamaqua, PA 18252 FOX TRANSPORTATION, INC. (570) 668-4189 135 Tide Rd Tamaqua, PA 18252 rfox@foxtransportation.com

FOX TRANSPORTATION, INC. HOME DRIVER APPLICATION CONTACT US (570) 668-4189 DRIVER APPLICATION WHY WORK FOR FOX TRANSPORTATION? As an employee, you are one of our most valuable assets. Our corporate culture depends on our staff being appreciated for their contributions, and in turn, we show our appreciation. Fox offers competitive pay, flexible schedules and generous benefits packages. We are a team-oriented company that takes pride in providing on-going education on all phases of the transportation industry, with the end goal of making us the best in the business. CONTACT INFORMATION First Name Last Name Social Security Number Phone Number Date of Birth Email Address Position Applied Rate of Pay Expected Are you now employed? YesNo How long since last employment? Convicted of felony? YesNo If yes, explain about conviction: CURRENT ADDRESS How long have you been at this address? PREVIOUS ADDRESS How long have you been at this address? CURRENT EMPLOYER Employer's Name Employer's Phone Number Contact Person Current Position Date Worked From Date Worked To Wage Was a CDL required? YesNo Reason for Leaving: PAST EMPLOYER (1) Employer's Name Employer's Phone Number Contact Person Current Position Date Worked From Date Worked To Wage Was a CDL required? YesNo Reason for Leaving: PAST EMPLOYER (2) Employer's Name Employer's Phone Number Contact Person Current Position Date Worked From Date Worked To Wage Was a CDL required? YesNo Reason for Leaving: PAST EMPLOYER (3) Employer's Name Employer's Phone Number Contact Person Current Position Date Worked From Date Worked To Wage Was a CDL required? YesNo Reason for Leaving: LAST ACCIDENT Date Nature of Accident Were there fatalities? YesNo If yes, how many?: Were there injuries? YesNo If yes, how many?: PREVIOUS ACCIDENT (1) Date Nature of Accident Were there fatalities? YesNo If yes, how many?: Were there injuries? YesNo If yes, how many?: PREVIOUS ACCIDENT (2) Date Nature of Accident Were there fatalities? YesNo If yes, how many?: Were there injuries? YesNo If yes, how many?: 1ST CONVICTION 2ND CONVICTION 3RD CONVICTION LICENSE Have you ever been denied a license? YesNo If yes, give details?: Has your license ever been suspended? YesNo If yes, give details?: FOX TRANSPORTATION, INC. (570) 668-4189 135 Tide Rd Tamaqua, PA 18252 rfox@foxtransportation.com