Old Dominion Truck Leasing

Online Application

If you prefer, you may download the form and fill it out by hand.

Fax your completed application to:
804-275-0482

or mail it to:
Credit Application
Old Dominion Truck Leasing
Post Office Box 730
Chesterfield, VA 23832

Old Dominion is an equal opportunity and affirmative action employer.
* denotes a required field

Date:

Position you are interested in:

*Name:

Last

First

Middle

*Present Address:

City

State

Zip

*Are you at least 18 years of age?

*Telephone #:

Alternate #:

*Best time to call:

*Desired Wage:

*Have you worked for us before?:

Employment History
Please give five year history. If you need more space, go to ADDITIONAL COMMENTS at the end of this form

*Current Employer:

*From *To

*Street Address:

City

State

Zip

*Contact Person:

Phone::

*Job Description:

*Reason for Leaving:

*Starting wage:

*Ending Wage:

*May we contact your current employer?

Previous Employer:

From To

Street Address:

City

State

Zip

Contact Person:

Phone::

Job Description:

Reason for Leaving:

Starting wage:

Ending Wage:

Previous Employer:

From To

Street Address:

City

State

Zip

Contact Person:

Phone:

Job Description:

Reason for Leaving:

Starting wage:

Ending Wage::

Have you ever been convicted of a crime?

If yes, please explain:

Educational Background

*Last school attended:

*School City:

*School State:

*Highest Grade Completed:

Military Status

Have you ever served in the armed forces?

Branch:

From To

Rank at discharge:

Date of discharge:

Type:

Driver's License
List ALL States in which you have been licensed in the last three years

*State:

*License #:

*Type:

*Expiration:

*State:

*License #:

*Type:

*Expiration:

*State:

*License #:

*Type:

*Expiration:

*State:

*License #:

*Type:

*Expiration:

Accident Review for the Past 5 Years
(Complete if employment will require operating licensed company equipment)

List all Preventable and Non Preventable

.	Date	Nature of Accident (Head-On, Rear-end, Upset..etc)	Fatalaties	Injuries

Last Accident
Next Previous
Next Previous
Next Previous
Next Previous
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Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Has any license, permit, or privilege ever been suspended or revoked?

Have you been convicted during the past 5 years of DWI, DWAI, DUI, or driving under the influence of an illegal substance?

Do we have authorization to run your MVR?

Management Qualifications

1. List all specialized training programs you have completed:

2. List all previous employers for whom you help in supervisory or managerial positions:
(Please give start and end dates where applicable)

3. Describe positions held in No. 2 and areas of responsibility:

4. Number of people you directly supervised in No.2:

Additional Comments:

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