Application Form 1

Independent Contractor's Driver's

- Step 1 of 9

1. Personal Background Information

Date of Application

Confirm Email

Name

First

Middle

Last

Current Address

Address Line 1

City

State

Zip Code

Phone

Prior Address Within the Past Three (3) years

Address Line 1

City

State

Zip Code

Address

Address Line 1

City

State

Zip Code

Address (copy)

Address Line 1

City

State

Zip Code

Date of Birth

Social Security #

Are you legally authorized to work in the United Stated?

In Case of Emergency Notify

Name

First

Last

Phone

Relationship

More Information

Have you worked for this company before?

Date From

Date To

Start Date

Position

Reason for Leaving

Are you currently employed?

If not, how long since leaving last job?

Who referred you?

Amount of Compensation Expected?

During the past 10 years, have you ever been convicted of, or have you pled guilty or no contest to, a felony offense? if yes, please explain in the space provided below.

If yes, please explain

2. Employment History

ALL DRIVER APPLICANTS: TO DRIVE IN INTERSTATE COMMERCE, YOU MUST PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PRECEDING 3 YEARS. LIST COMPLETE MAILING ADDRESS, STREET NUMBER, CITY, STATE AND ZIP CODE. APPLICANTS TO DRIVE A COMMECIAL MOTOR VEHICLE* IN INTRASTATE OR INTERSTATE COMMERCE SHALL ALSO PROVIDE AN ADDITIONAL 7 YEARS INFORMATION ON THOSE EMPLOYERS FOR WHOM THE APPLICANT OPERATED SUCH A VEHICLE. (NOTE: LIST ALL EMPLOYERS IN REVERSE ORDER STARTING WITH THE MOST RECENT FIRST.) USE ADDITIONAL SHEETS AS NEEDED.

Employer 1

Name

Date From

Date To

Address

Address Line 1

City

State

Zip Code

Position Held

Salary / Wage

Contact Person

First

Last

Phone

Reason for Leaving

Did you operate a commercial motor vehicle?

Did you subject to the Federal Motor Carrier Safety (FMCSR) ** while employed?

Was your job designated as a safety sensitive function in any DOT related mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

Employer 2

Name

Date From

Date To

Address

Address Line 1

City

State

Zip Code

Position Held

Salary / Wage

Contact Person

First

Last

Phone

Reason for Leaving

Did you operate a commercial motor vehicle?

Did you subject to the Federal Motor Carrier Safety (FMCSR) ** while employed?

Was your job designated as a safety sensitive function in any DOT related mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

Employer 3

Name

Date From

Date To

Address

Address Line 1

City

State

Zip Code

Position Held

Salary / Wage

Contact Person

First

Last

Phone

Reason for Leaving

Did you operate a commercial motor vehicle?

Did you subject to the Federal Motor Carrier Safety (FMCSR) ** while employed?

Was your job designated as a safety sensitive function in any DOT related mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

2. Employment History Continued

Employer 4

Name

Date From

Date To

Address

Address Line 1

City

State

Zip Code

Position Held

Salary / Wage

Contact Person

First

Last

Phone

Reason for Leaving

Did you operate a commercial motor vehicle?

Did you subject to the Federal Motor Carrier Safety (FMCSR) ** while employed?

Was your job designated as a safety sensitive function in any DOT related mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

Employer 5

Name

Date From

Date To

Address

Address Line 1

City

State

Zip Code

Position Held

Salary / Wage

Contact Person

First

Last

Phone

Reason for Leaving

Did you operate a commercial motor vehicle?

Did you subject to the Federal Motor Carrier Safety (FMCSR) ** while employed?

Was your job designated as a safety sensitive function in any DOT related mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

Employer 6

Name

Date From

Date To

Address

Address Line 1

City

State

Zip Code

Position Held

Salary / Wage

Contact Person

First

Last

Phone

Reason for Leaving

Did you operate a commercial motor vehicle?

Did you subject to the Federal Motor Carrier Safety (FMCSR) ** while employed?

Was your job designated as a safety sensitive function in any DOT related mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

* Includes vehicles having a GVWR of 26,001 lbs or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding. ** The Federal Motor Safety Regulations (FMCRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 lbs. or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

3. Driving Record

State your accident record for the past 5 years. Indicate "None" if not applicable.

Accident Record 1

State

Date

Nature of Accident (Overturn, jack knife, rear end, etc.)

# Injured

# Fatalities

Commercial Vehicle?

Personal Vehicle?

Additional Comments

List all traffic convictions or forfeitures in the past 5 years (other than parking violations). (Attach additional sheets if more space is needed). Indicate "None" if not aplicable.

Traffic Convictions or Forfeitures 1

State

Date of Violation

Charge

Penalty (PTS)

Commercial Vehicle?

Personal Vehicle?

Traffic Convictions or Forfeitures 2

State

Date of Violation

Charge

Penalty (PTS)

Commercial Vehicle?

Personal Vehicle?

Additional Comments

4. Education

Mark which of the following you have received:

High School Diploma
GED
None

Have you ever attended a college or technical school? (This includes withdrawing from a college or university without obtaining a diploma or grade)

If yes, please list the following information regarding all previous colleges or technical schools attended:

College / School

City / State

Dates Attended

Graduated?

Do you have knowledge of the Federal Motor Carrier Safe Regulations?

5. Driver's License Information

Current license

State

License No.

Type

Expiration Date

Endorsements

Other licenses held in the last 10 years

State

License No.

Type

Expiration Date

Endorsements

State

License No.

Type

Expiration Date

Endorsements

State

License No.

Type

Expiration Date

Endorsements

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

B. Has your license, permit or privilege to operate a motor vehicle ever been denied, suspended or revoked?

C. If the answer to either A or B is yes, give please explain in detail below

I hereby certify that I do not have more than one driver's license.

Applicant's Signature

6. Driving Experience

Type of Equipment

Date From

Date To

Approximate Total Miles

States

Type of Equipment

Date From

Date To

Approximate Total Miles

States

Type of Equipment

Date From

Date To //

Approximate Total Miles

States

List States operated in for the last five (5) years:

List special courses or training:

List safe driving awards you have received:

Show any trucking, transportation or other experience that may help you in your work for the company:

List of courses and training other than shown elsewhere in this application

List special equipment or technical materials you can work with other than already shown:

Other remarks or information you wish to provide

APPLICANT MUST READ AND SIGN BEFORE SUBMITTING APPLICATION

I authorize you to make such investigation and inquiries of my personal, employment, medical history and other related matters as may be necessary in arriving at a hiring decision. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

I understand that information I provide regarding current and / or previous employers pursuant to 49 CFR 391.21(b)(10) may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

Review information provided by previous employers;
Have errors in the information corrected by previous employers and for those previous employers to resend the corrected information to the prospective employers; and
Have rebuttal statement attached to alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

I agree to famish such information and complete such examinations as may be required to complete my application.

This further certifies that this application was submitted by me and that all entries on it and information in it are true and complete to the best of my knowledge.

Date

Print Name

Signature

DRIVER STATEMENT OF ON-DUTY HOURS

Instructions Motor carriers, when using a driver for the first time or intermittently. Shall obtain from the driver a signed statement giving the total time on duty during the immediately preceding seven days and time at which the driver was last relieved from duty prior to beginning work for the motor carrier as per Part 395.8(j)(2) Federal Motor Carrier Safety Regulations (FMCSR).

Note: Hours for any compensated work during the preceding seven days, including work for a non-motor carrier entity, must be recorded on this form.

Driver's Name (Print)

Drive's License Number

Class

Endorsement(s)

Restriction(s)

Type of License

Issuing State

Day 1 / Date (Yesterday):

Hours Worked

Day 2 / Date:

Hours Worked

Day 3 / Date:

Hours Worked

Day 4 / Date:

Hours Worked

Day 5 / Date:

Hours Worked

Day 6 / Date:

Hours Worked

Day 7 / Date:

Hours Worked

Total Hours

I hereby certify that the information given above is correct to the best of my knowledge and belief and that I was last relieved from work at:

Time

Driver's Signature

Date

Instructions: When employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2(8)(9) of the FMCSRs includes time performing any other work in the capacity of, or in the employ or service of, a common contract or private motor carrier, also performing any compensated work for any non-motor carrier entity.

Are you currently working for another employer?

At this time, do you intend to work for another employer while still employed by this company?

I hereby certify that information given above is true. I understand that once I become employed with this company. if I begin working for any additional employers for compensation, I must inform this company immediately of such employment activity.

Driver's Signature

Date / Time

Authorization / Specific Written Consent

Name

First

Middle

Last

Social Security Number:

Date of Birth

hereby authorize:

Previous employer:

Address

Address Line 1

City

State

Zip Code

Telephone

Fax number

to release and forward information requested within this document concerning my Alcohol & Drug Testing records under 49 CFR Part 40 within 3 years from:

Date of employment application

To:

Prospective employer

Attention

Telephone

Address

Address Line 1

City

State

Zip Code

In compliance with §40.25(g) and §391.23(h), release of this information must be made in a written form that ensures confidentiality (i.e., fax, email, or letter).

Prospective employer's confidential fax number

Prospective employer's confidential email address

Applicant's Signature

Date

Comment

5,010 +

Delivered Goods

643,543 +

Miles per Year

87,675 +

Tons of Goods

4,987 +

Satisfied Clients

Features

CORE FEATURES

Features

TRANSPARENT PRICING

Reliable and On-Time Logistics Services at Affordable Prices. We’re a carrier That Knows the Meaning of Attentive Service.

REAL-TIME TRACKING

We manage our fleet with live vehicle tracking, reducing route inquiries by letting customers track route progress and receiving automatic ETA alerts. Providing a superior customer experience and keep call volume down by proactively sharing arrival times and delays.

Here We Are

Independent Contractor's Driver's

1. Personal Background Information

In Case of Emergency Notify

More Information

2. Employment History

Employer 1

Employer 2

Employer 3

2. Employment History Continued

Employer 4

Employer 5

Employer 6

3. Driving Record

Accident Record 1

Traffic Convictions or Forfeitures 1

Traffic Convictions or Forfeitures 2

4. Education

5. Driver's License Information

6. Driving Experience

APPLICANT MUST READ AND SIGN BEFORE SUBMITTING APPLICATION

DRIVER STATEMENT OF ON-DUTY HOURS

Authorization / Specific Written Consent

hereby authorize:

To:

CORE FEATURES

Features

TRANSPARENT PRICING

REAL-TIME TRACKING

Send us a Message or Give us a Call: (832) 292-3651

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