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.
List your addresses of residency for the past 3 years.
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.)
Accident Record for Past 3 Years or More (Attached sheet if more space is needed) if none, Write None.
Nature of Accident (Head on, Rear-End, Upset, etc)
Traffic Convictions For the Past 3 Years (Other Than Parking Violations) if none, Write None.
List any Job Related Classes or Programs You Completed, Ana the dates you attended.
Experience and Qualifications - Driver
If The answer to either A or B is yes, Attach statement giving details
Class of Equipment
Type of Equipment (Van, Tank, Flat, etc.)
Approx No. of miles (Total)
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)
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.