Dispatch & Administrative Application

Personal Information

Full Name

Current Address

City

State

ZIP Code

Residence 3 years or longer at current address?

Yes No

Social Security Number

Date of Birth

Primary Phone

Email Address

Receive communication via text message?

Yes No

By participating you consent to receive text messages. Consent is not required for employment.

Have you ever been known by any other name?

Yes No

Other name(s) used

General Information

Position applying for

Location applying for

Desired employment type

Desired start date

Legally eligible to work in the United States?

Yes No

Currently employed?

Yes No

Date last employment ended

Do you read, write, and speak English fluently?

Yes No

Do you speak any additional languages?

Have you previously worked for Triple C Express?

Yes No

Dates, location, position, and reason for leaving

How did you hear about us?

Referring employee's name

Please explain

Education

High School / GED

School Name

City, State

Years Attended

Did you graduate / receive GED?

College / University

School Name

City, State

Years Attended

Degree / Major

Did you graduate?

Vocational / Trade / Other Training

School / Program Name

City, State

Years Attended

Certificate / Credential Earned

Additional education, coursework, or training relevant to this position

Certifications & Professional Skills

Do you hold any professional certifications? (check all that apply)

Certified Transportation Broker (CTB) Certified Dispatcher / Scheduling (CDS) Certified Customer Service Professional (CCSP) Notary Public OSHA 10-Hour OSHA 30-Hour First Aid / CPR Other (specify below)

Other certification(s) – name, issuing body, and expiration if applicable

Transportation Management System (TMS) experience

McLeod Software TMW Suite Samsara KeepTruckin / Motive Prophet 21 DAT Load Board Truckstop.com No TMS experience

Other TMS / dispatch software you have used

Microsoft Office proficiency

Typing speed (approximate WPM)

Years of experience in dispatch, logistics, or transportation

Describe any specific dispatch, logistics, or administrative skills relevant to this role

Employment History – Current / Most Recent Employer

I have never had previous employment

Company Name

Start Date

End Date (leave blank if current)

Address

City

State

ZIP

Country

Phone

Position / Title Held

Supervisor Name

Reason for leaving

Were you terminated / discharged / laid off?

Yes No

Please explain termination

Is this your current employer?

Yes No

May we contact this employer?

Yes No

Brief description of duties

Criminal Record

Have you ever been convicted of a crime?

Yes No

Do you have any deferred prosecutions?

Yes No

Do you have any criminal charges pending?

Yes No

Have you ever been convicted of a felony?

Yes No

Within the last five years, have you been convicted of a misdemeanor?

Yes No

Please provide details about any criminal history

Signature & Acknowledgment

By signing this application, I certify that:

This application was completed by me
All entries and information are true and complete to the best of my knowledge
I authorize Triple C Express, Inc. to verify all information provided
I authorize background checks and release of employment information as required by law
False or misleading information may result in rejection of my application or termination of employment

Full Name (type to sign electronically)

Date

I acknowledge that I have read and agree to the above statements, and I understand that this electronic signature is as legally binding as an ink signature

Triple C Express, Inc.

Personal Information

General Information

Education

Certifications & Professional Skills

Employment History – Current / Most Recent Employer

Criminal Record

Signature & Acknowledgment