Regency Transportation

Driver Position Inquiry Form
Please complete all fields. The information you submit will remain confidential with Regency Transportation.

When you have completed the inquiry form, click on Submit . If you need to clear the form to start over,
click on Reset Form. Regency will review and contact qualified candidates when driving position become available.

First name

Last name

Street address

Address (cont.)

City

State/Province Zip/Postal code

Home Phone - -

Work Phone - -

E-mail

Confirm E-mail

Type of Position Desired
Date available to start //-- mm/dd/yy

Please list your previous driving jobs:

Present/Most Recent:

Employer

Dates of Employment / to /-- mm/yy

1st Previous:

Employer

Dates of Employment / to /-- mm/yy

2nd Previous:

Employer

Dates of Employment / to /-- mm/yy

* Please read Disclosure and Release below, and press Submit button at the bottom of page if you agree:

Disclosure Release
As part of our consideration of your application, the DOT requires us to investigate your employment
background. As part of this investigation, we may obtain consumer reports about you from DAC Services.
DAC is a consumer reporting agency.

Any decision we make not to hire you based on information contained in your consumer report will be our
decision alone. DAC does not make decisions concerning your employment with us and will not know the
specific reasons why we may decide not to hire you.

In the event you are not hired based on information contained in your consumer report, we will tell you.
We will also advise you of your right to obtain a free copy of the consumer report from DAC and your right
to dispute the accuracy or completeness of your report.

Your consent for us to obtain the report from DAC is required. Although you have a right to withhold your
consent, we will not consider your application if you do. Do we have permission to obtain consumer
reports about you from DAC?

For more information about Regency Transportation, please contact our
recruiting department.

Phone: 800-423-2208 x628

Email: jobs@regencytrans.com