Driver Qualification Request
Allied Van Lines Inc.
101 E Washington Blvd Ste 1100
Fort Wayne, IN 46802
Personal Information
Fill out personal information in its entirety. Every section is required.
Personal Information
Note: Enter full legal name of the applicant (Enter 'none' if middle name does not exist)
First Name: Middle Name: Last Name: Suffix:
Ex.( Jr., Sr., I, II etc.)
Social Security Number: - -
Retype SSN: - - Gender:
Date of Birth:
Important:  Please make sure the details in the above section are ACCURATE. You will NOT be able to make changes to them once you pass this page.

Password
Create a password for your application.
Password: eye
Confirm Password: eye
 
Security Question:
Security Answer: eye
Confirm Security Answer: eye

Agency Information
Enter the agency code you're applying for. If you're unsure of the agency code, click 'Lookup' to search for it.
Agency Code:
(Ex: 1234000)
Agency Contact:

Contact
Home Phone Number:
- -
Cell Phone Number:
- -
 
(Ex: 123-123-1230)
  
Email Address:
Confirm:

Address
Address:
City: State/Province: ZIP Code:
How long have you lived at this residence?  years  months

Mailing Address  (Copy from Above)
Mailing Address:
City: State/Province: ZIP Code:

Previous Affiliation
 Have you ever applied for a position with Allied Van Lines or North American Van Lines or with an agent of Allied Van Lines or North American Van Lines?

Citizenship
 Are you a United States citizen?

Ethnicity
Are you considered one of these five groups?
(This is for statistical information only and is VOLUNTARY)



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