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Owner / Operator Application

BUSINESS/OWNER INFORMATION

If applying in the name of a business:

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

Yes

EQUAL OPPORTUNITY EMPLOYER

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, veteran status, non-job related disability, or other protected group status.

You (as a prospective owner operator) have the following due process rights regarding the investigative information that you provide.

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

DRIVER APPLICANT ACKNOWLEDGMENT (To be read and signed by Applicant)

I certify that this application was completed by me, and that all of the information in it is true and complete to the best of my knowledge. I understand that any misrepresentation of facts or any false or misleading information provided by me in my application or during the interview process may result in the Company’s refusal to hire me, or if already hired, in the company’s immediate termination of my employment.
I understand that the Company may contact any prior employer or company with which I previously contracted for purposes of investigating my background. I authorize all persons, prior employers, schools, companies, corporations, law enforcement agencies and credit bureaus to release any information to the Company or any authorized agent of the Company.
I understand that nothing in this application or in an offer and/or acceptance of employment constitutes an employment contract between the Company and me, and that should I be hired, my employment would be for no fixed duration, and could be terminated by the Company or by me at any time, with or without cause or notice.
I acknowledge that the Company is subject to Department of Transportation regulations regarding drug and alcohol testing and agree to submit to any required testing and/or physical examinations mandated by these regulations or other applicable federal or state law.
I agree to furnish such information and complete such examinations as may be required to complete my qualifications file.

EMPLOYMENT HISTORY

All driver applications to drive in interstate commerce must provide the following information on ALL employers during the preceding 3 years (2years for Drug and Alcohol questions). List complete mailing address, street number, city, state and zip code. Provide an additional 7 years’ information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent.)

If you need to provide additional information, please provide it at the end of this application, in the "additional information" section. You may also upload any additional documents or files there as well.

Previous Employer #1 (most recent)

Previous Employer #2

Previous Employer #3

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE
If none, simply write "NONE" in first box

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)
If none, simply write "NONE" in first box

Driving Experience

Straight Truck YesNo

Type(s) of equipment Van Tank Flat Dump Refer

Tractor and Semi-trailer YesNo

Type(s) of equipment Van Tank Flat Dump Refer

Tractor - Two Trailers YesNo

Type(s) of equipment Van Tank Flat Dump Refer

Tractor - Three Trailers YesNo

Type(s) of equipment Van Tank Flat Dump Refer

DRIVER LICENSE INFORMATION

CONVICTIONS STATEMENT

Have you ever been convicted of, or forfeited bond or collateral for any of the following offenses:

A felony involving the use of motor vehicle?

Yes

A crime involving the manufacturing, knowing transportation, knowing possession, sale or habitual use of amphetamines, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug?

Yes

Operation of a motor vehicle under the influence alcohol, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug?

Yes

Leaving the scene of an accident, if the accident resulted in personal injury or death? YesNo

Any other motor vehicle law violations, INCLUDING ALL CARELESS-RECKLESS DRIVING VIOLATIONS?

Yes

Have you ever had any license to operate a motor vehicle denied, revoked, or suspended?

Yes

ALCOHOL AND DRUG TEST STATEMENT

As per section 40.25(j0 have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules?

Yes

If you answered YES, can you provide/obtain proof that you have successfully completed the DOT return-to-duty requirements?

Yes

Are you currently late on your IRS 941 payroll taxes?

Yes

N/A

Are there County, State, or Federal business tax liens?

Yes

Are there County State, or Federal personal tax liens?

Yes

I authorize Force Freight Transport, a Potential Lessor, to access the FMCA Pre-Employment Screening Program (PSP) system to seek information regarding commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous (5) years and inspection history from the previous (3) years. I understand and acknowledge that this release of information may assist the Prospective Lessor to make a determination regarding my suitability as a Potential Lessee.

I hereby authorize Force Freight Transport, LLC or its agents to verify and investigate any or all of the foregoing statements, including but not limited to my/our credit worthiness and financial responsibility, in any way they may choose, including a personal and commercial background check.

I certify that I have read and understand all of this application. It is agreed and understood that the Lessor or the agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and other persons named herein from all liability for any damages on account of the furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job.

It is also agreed and understood that under Fair Credit Reporting Act, Public La 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation, personal characteristics and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired, I agree to abide by all the rules and policies of the Lessor.

This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.

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Timestamp

Audit

January 27, 2017 11:49 am MST

Owner / Operator Application Uploaded by Kristen Bond - [email protected] IP 70.176.201.215

September 10, 2021 4:06 pm MST

Document owner [email protected] has handed over this document to [email protected] 2021-09-10 16:06:22 - 70.176.201.215