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feet
inches
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lbs
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Type of Driving Work
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Area of Driving Work
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Truck Model
 
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Type of Trailer:
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Estimate your average daily miles
 
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Please estimate your income
 
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If yes, how often do you exercise?
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Do you use tobacco products?
 
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If yes, what type of tobacco products do you use?
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Health Questions: Do you have any of these diseases, disorders, or conditions?
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Please estimate your CSA Points
 
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What are your biggest concerns in the trucking industry?
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Are you currently a member of any union?
 
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Will you join a new truck drivers union?
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If you join, will you financially support the union?
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What would you like the union to do?
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In a scale of 1-10, how satisfied are you?
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Comment: