Eastex Crude Trucking Application
Full NameFirst - Middle - Last
Date of Birth
Length of Stay
Phone Number
Previous Address
Length of Stay
EDUCATION: Select highest level of education completed.
Grade School
Additional Training, Driver courses, etc..
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Last School Attended
School City and State
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?
If Yes for waiver, please explain:
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Able to lift 50 lbs overhead safely?
If No, for lifting 50 pounds, please explain:something more
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Are you an American citizen?
If No, list your nationality here.something more
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Do you posses a valid work permit?
Work Visa Number if applicablefull name
Did you work for Eastex previously?
If Yes, when?
Are you currently employed?
If no, how long since last employed?
Which position are you applying for?full name
List all other names you have been known by other than the one on this form.
Please list the names of any relatives who work or have worked in our company.
How did you hear about Eastex, or who referred you?something more
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*The application can be completed over multiple sessions. You will receive an email confirmation after completing each section.