Mini App


First Name*
Last Name*
Email
Cell Phone Number*
Home Phone Number
DOB*
Address
City
State
Zip Code
Last 4 Digits of SSN*
Have you ever failed or refused a DOT drug screen?	Yes No
Have you had a DUI or DWI in the last 5 Years?	Yes No
How much OTR experience have you had in the last 3 years?
Do you have any traffic or CSA violations in the last 6 years?	Yes No
Total # Preventable Violat ions in the Past 6 Years?
Have you been involved in any accidents or incidents in the last 6 years?	Yes No
Total # Preventable Accidents/Incidents in the Past 6 Years?
Do you authorize Melton Truck Lines to contact you by phone, e-mail or text/SMS message?	Yes No