Owner Operator Application

APPLICATION FOR EMPLOYMENT

(OWNER-OPERATOR)


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, or non-job related disability. REQUIRED FIELDS (*).




First Name(*)

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Middle Initial

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Last Name(*)

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Date Of Birth(*)

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Address(*)

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City(*)

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State(*)

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Zip (*)

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Phone(*)

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E-mail Address(*)

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Have you ever worked for this company before?(*)

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If yes, Please list the from and to, dates.

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Position(s) held?

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Reason For Leaving?

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

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Are you currently employed?

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How did you hear about A.D. Transport?

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Is there any reason you might be unable to perform the functions on the job for which you have applied?(*)

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If yes, please explain:

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EMPLOYMENT HISTORY


All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 10 years of information on those employers for whom the applicant operated such vehicle.

* 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.





Please list current or most recent employer.




Current or most recent Employer:(*)

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Company Address (Street, city, state zip)

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Phone

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Position held?

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Please list the equipment operated with this employer.(*)

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Supervisor?

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Employed from?

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Employed to?

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Rate of pay

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Please list your duties.

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Reason for leaving?

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Please list 2nd most recent employer.




Previous Employer 2:

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Company Address (Street, city, state zip)

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Phone

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Position held?

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Please list the equipment operated with this employer.

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Supervisor?

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Employed from?

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Employed to?

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Rate of pay

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Please list your duties.

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Reason for leaving?

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Please list 3rd most recent employer.




Previous Employer 3:

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Company Address (Street, city, state zip)

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Phone

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Position held?

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Please list the equipment operated with this employer.

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Supervisor?

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Employed from?

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Employed to?

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Rate of pay

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Reason for leaving?

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Please list your duties.

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Please list 4th most recent employer.




Previous Employer 4:

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Company Address (Street, city, state zip)

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Phone

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Position held?

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Please list the equipment operated with this employer.

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Supervisor?

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Employed from?

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Employed to?

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Rate of pay

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Please list your duties.

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Reason for leaving?

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Please list 5th most recent employer.




Previous Employer 5:

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Company Address (Street, city, state zip)

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Phone

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Position held?

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Please list the equipment operated with this employer.

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Supervisor?

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Employed from?

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Employed to?

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Rate of pay

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Please list your duties.

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Reason for leaving?

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Please list 6th most recent employer.




Previous Employer 6:

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Company Address (Street, city, state zip)

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Phone

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Please list the equipment operated with this employer.

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Position held?

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Supervisor?

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Employed from?

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Employed to?

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Rate of pay

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Please list your duties.

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Reason for leaving?

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EXPERIENCE AND QUALIFICATIONS


Driver License #(*)

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Issuing state(*)

Select your issuing state

License type(*)

Enter your license type: CDL-A, CDL-B etc...

Expiration date(*)

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Do you have a Haz-Mat endorsement?(*)

You must indicate Haz-Mat status.

List all traffic convictions for the last 3 years. State, Date, Charge, Penalty

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A: Have You Ever Been Denied a License or Permit to Operate a Vehicle?(*)

You must select yes or no

B: Has Any License, Permit or Privilege Ever Been Suspended or Revoked?(*)

You must indicate wheather or not your license has ever been suspended or revoked.

C: Have you ever been convicted of a felony?(*)

You must answer this question.

IF THE ANSWER TO EITHER A, B OR C IS YES, GIVE DETAILS BELOW.

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D: Have you ever been involved in an accident either in a private vehicle or CDL vehicle in the last 3 years?(*)

You must make a selection

If so, Date of Accident, Location, result, amount of damages paid (at fault) or received (non fault):

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If you attended truck driving school, provide the name of the school, address, grad status and dates of attendance.

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

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ADDITIONAL INFORMATION


If you've ever had surgery for any reason, please list: where, when, the reason and the results.

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Have you ever had blackouts, blood pressure problems, diabetes symptoms, vision problems, hearing problems?(*)

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If so, list when, for what and the treatment prescribed.

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What is the average # of sick days that you use per year?

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Are you a caregiver for any family member or friend that would require regular time off to handle?(*)

You must answer this question.

Have you ever been off work longer than one week for medical problems of any kind? (*)

You must answer this question.

Have you ever been hospitalized for any reason?(*)

You must answer this question.

Have you ever been arrested for OUIL, OUID, ticketed for Reckless or Careless driving?(*)

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Have you ever received a warning from your state’s license division concerning your driving such as for number of points or for any violation?

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Are you now or have you ever been a party to a lawsuit from a traffic accident you were involved in?

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Have you ever changed your drivers license/CDL from one state to another for any reason

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Has your vehicle or truck insurance been cancelled or denied for any reason?

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Are you aware that the Federal Government does background checks on CDL applicants and renewals?

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Have you ever damaged a trailer or other objects while under load/dispatch OR while bobtailing?(*)

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Have you ever been charged for a hit and run accident or damage claim?

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Have you ever been citied for an at fault accident?(*)

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Have you ever paid damages for a claim caused by yourself?(*)

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Have you ever been injured or injured anyone in a crash?

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Have you ever been shutdown at a DOT stop/inspection?(*)

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In the last 3 years, how many times have you had a clean DOT inspection?(*)

You must indicate the number of clean inspections.

Are you aware that all inspection sheets must be directly turned in to your company?(*)

You must answer this question.

Have you failed a DOT Alcohol/Drug screen in the last 3 years(*)

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Please feel free to attach a resume or other documentation.



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Application Disclaimer: Submission of this application certifies that I (the applicant) personally completed this application and all the information contained in it is true and correct. I request that A.D. Transport and their agents review my background for employment purposes. As part of this review, the DOT requires companies to review my background and obtain consumer reports from DAC Services. Your consent for A.D. Transport to obtain a report from DAC is required in order for your application to be reviewed, but you can withhold your consent and A.D Transport will not consider your application. I have read this release agree for A.D. Transport to get consumer reports about me from DAC Services. By hitting the Submit button, you give A.D. Transport permission to obtain any and all reports necessary to verify your employment history.


(*)

You must accept this agreement to proceed.
By selecting the "I accept" button, you are signing this Application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Application.