Owner Operator Application

    Owner/Operator Application For Contract

    In Compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, genetic characteristic, or disability.

     
     
    Date of Application

    Name

    First

    Middle

    Last

    List your addresses of residency for the past 3 years.

    Current Address

    Street

    City

    State

    Zip Code

    Phone

    How long?
    Previous Address

    Street

    City

    State

    Zip Code

    How long?

    Street

    City

    State

    Zip Code

    How long?

    Street

    City

    State

    Zip Code

    How long?
    Do you have the legal right to work in the United States?

    Have you ever been convicted of a crime under your current or any other name, which has not been expunged from your record?

    Are you over the age of 18?

    Are you now employed or under contract with any other company?

    If not, how long since leaving last employment/contract?

    Who Referred you?

    Rate of pay expected?

    Are you able to perform the essential functions of the contract for which you have applied, with or without reasonable accommodations?

    Contract/Employment History

    All driver application to drive in interstate commerce made provide the following information on all work experience during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

    Applicants to drive a commercial motor vehicle in intrastate commerce shall also provide an additional 7 years information on those businesses or individuals for whom the applicant operated such vehicle. (Note: List employers in reverse order starting with most recent. Add another sheet as necessary.)

    Current Employer

    Company Name

    Address

    City

    State

    Zip

    Contact Person

    Phone No.

    From

    To

    Position Held

    Salary/Wage

    Reason For Leaving

    Second Last Employer

    Company Name

    Address

    City

    State

    Zip

    Contact Person

    Phone No.

    From

    To

    Position Held

    Salary/Wage

    Reason For Leaving

    Second Last Employer

    Company Name

    Address

    City

    State

    Zip

    Contact Person

    Phone No.

    From

    To

    Position Held

    Salary/Wage

    Reason For Leaving

    Third Last Employer

    Company Name

    Address

    City

    State

    Zip

    Contact Person

    Phone No.

    From

    To

    Position Held

    Salary/Wage

    Reason For Leaving

    Fourth Last Employer

    Company Name

    Address

    City

    State

    Zip

    Contact Person

    Phone No.

    From

    To

    Position Held

    Salary/Wage

    Reason For Leaving

    Fifth Last Employer

    Company Name

    Address

    City

    State

    Zip

    Contact Person

    Phone No.

    From

    To

    Position Held

    Salary/Wage

    Reason For Leaving

    Accident Record for Past 3 Years or More (Attached sheet if more space is needed) if none, Write None.

    Accident Dates
    Nature of Accident (Head on, Rear-End, Upset, etc)
    Fatalities
    Injuries
    Last Accident:
    Next Previous:
    Next Previous:

    Traffic Convictions For the Past 3 Years (Other Than Parking Violations) if none, Write None.

    Location
    Dates
    Charge
    Penalty

    Education

    What is your highest Education level completed?

    Last School Attended

    Name

    City
    List any Job Related Classes or Programs You Completed, Ana the dates you attended.

    Experience and Qualifications - Driver

    Driver Licenses

    State
    License No.
    Type
    Expiration Date
    A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

    B. Have any license, permit or privilege ever been suspended or revoked?

    If The answer to either A or B is yes, Attach statement giving details

    Class of Equipment
    Type of Equipment (Van, Tank, Flat, etc.)
    Date From
    Date To
    Approx No. of miles (Total)
    Straight Truck

     

     

     

     

    Tractor/Semi-Trailer

     

     

     

     

    Tractor - Two Trailer

     

     

     

     

    Motorcoach/School Bus

     

     

     

     

    Other:

     

     

     

     

    List states operated in for last five years

    Show special courses or training that will help you as a driver

    List safe driving awards you hold and from whom?

    Experience and Qualifications - Other

    Show any trucking, transportation or other experience that may help in your contracting for us

    List courses and training other than shown elsewhere in this application

    List special equipment or technical materials you can work with (other than those already shown)

    Vehicle

    Make

    Model

    Serial No.

    Shop Inspected due

    Remarks

    To be read and signed by applicant

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

    I authorize you to make such investigations and inquiries of my personal, employment, financial and other related matters as may be necessary in arriving at a contracting decision. I hereby release employers, businesses, schools and other persons from all liability in responding to inquires and releasing information in connection with my application.

    In the event I am under contract, I understand that false or misleading information given in my application or interview(s) may result in termination of the contract.. I understand, also, that I am required to abide by all rules and regulations of the Contractor, if a contract is offered.

    Email

    Date

    Applicant's Signature