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Eastex Crude Trucking Application

Full NameFirst - Middle - Last

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Date of Birth

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Address

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Length of Stay

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Email Address

email

Phone Number

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Previous Address

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Length of Stay

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EDUCATION: Select highest level of education completed.

Grade School

Junior High9th Grade10th Grade11th Grade12th GradeGED

College

Courses, No DegreeAssociates DegreeBachelors DegreeTrade Degree

Additional Training, Driver courses, etc..

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Last School Attended

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School City and State

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Have you ever been granted a waiver under section 391.49 federal motor carrier safety regulations pertaining to loss of a foot, leg, hand or arm?

YesNo

If Yes for waiver, please explain:

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Able to lift 50 lbs overhead safely?

YesNo

If No, for lifting 50 pounds, please explain:something more

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Are you an American citizen?

YesNo

If No, list your nationality here.something more

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Do you posses a valid work permit?

YesNoN/A

Work Visa Number if applicablefull name

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Did you work for Eastex previously?

YesNo

If Yes, when?

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Are you currently employed?

YesNo

If no, how long since last employed?

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Which position are you applying for?full name

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List all other names you have been known by other than the one on this form.

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Please list the names of any relatives who work or have worked in our company.

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How did you hear about Eastex, or who referred you?something more

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SignatureI agree to the terms and conditions

(Sign Here)

Clear Signature

SUBMIT SECTION 1: APPLICANT DETAILS

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*The application can be completed over multiple sessions. You will receive an email confirmation after completing each section.