Driver Application Form

BRAVO MOTOR CARRIERS INC.

9009 North Loop East Suite #200, Houston TX 77029. (281) 768-8843
Driver Information Sheet

Answer all questions please
Please Select

LTL Intermodal Flatbed Heavy Haul
PLEASE SELECT ONE OF THE FOLLOWING

Company Driver Owner Operator
Date of application

Mes Día Año
Name
First, Middle, Last
Social Security Number
Address
Street, City, State, Zip
Country of Birth:
Home Phone Number
Alternate Phone Number
Favor ingrese un número de teléfono válido.
E-Mail
ejemplo@ejemplo.com
Address for Past Thee Years
Address #1
Street City State & Zip
How Long?
Address #2
Street City State & Zip
How Long?
Do You Have Legal Right To Work in The United States?
Date of Birth

Mes Día Año
Can You provide Proof of Age?
Have you worked at BRAVO MOTOR CARRIERS INC. previously?
Where?
Dates: From

Mes Día Año
Dates: To

Mes Día Año
Position
Reason for leaving
Are You Now Employed?
If not, how long since leaving last employment?
Who referred you to This carrier?
Is there any reason you might be unable to perform the functions of the job for which you have applied?
If yes, please explain.

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Please provide employment history for the proceeding preceding 10 years. (NOTE: List all employers in order starting with the most recent. Add another

Also, please explain any lapses in employment history.
Employer Name #1
Date From
Date To
Address

Address

Street Address Line 2

City
Position Held
Salary/Wage
Phone Number
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations at your previous employer? YES NO
Was this position designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49 CFR, Part 40? YES NO
MAY WE CONTACT YOUR CURRENT EMPLOYER? YES NO N/A PLEASE CIRCLE ONE
EMPLOYER 2
Employer Name #2
From
To
Address

Address

Street Address Line 2

City
Position Held
Salary/Wage
Phone Number
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations at your previous employer? YES NO
Was this position designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49 CFR, Part 40? YES NO
MAY WE CONTACT YOUR CURRENT EMPLOYER? YES NO N/A PLEASE CIRCLE ONE
EMPLOYER 3
Employer Name #3
From
To
Address

Address

Street Address Line 2

City
Position Held
Salary/Wage
Phone Number
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations at your previous employer? YES/NO
Was this position designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49 CFR, Part 40? YES NO
MAY WE CONTACT YOUR CURRENT EMPLOYER? YES NO N/A PLEASE CIRCLE ONE
EMPLOYER 4
Employer Name #4
From
To
Address

Address

Street Address Line 2

City
Position Held
Salary/Wage
Phone Number
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations at your previous employer? YES/NO
Was this position designated as a safety sensitive function subject to alcohol and controlled substances testing requirements as required by 49 CFR, Part 40? YES NO
MAY WE CONTACT YOUR CURRENT EMPLOYER? YES NO N/A

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ANNUAL CERTIFICATE OF VIOLATIONS AND REVIEW OF DRIVING RECORD
Driver Name
License
ST
I certify that the following is a true and complete list of traffic violations (other than parking violations) far which I have been convicted or forfeited bond or collateral during the past 12 months

Violations are as listed below. I have had no violations

	Date of Conviction	Offense	Location	Type of Motor Vehicle

lf no violations are listed above, I certify that I have not been convicted or forfeíted bond or col!ateral on account of any víolation required to be listed during the past 12 months.
Date of Certification

Mes Día Año
Fecha
Driver Signature
Reviewed By
Title
ANNUAL REVIEW OF DRIVING RECORD

In accordance with 49 Code of Federal Regulations Section 391.25, (Federal Motor Carríer Safety Regulations), al! information pertínent to the above driver's safety of operation, including the líst of violations furnished by him in accordance with 49 CFR Section 391.27, has been reviewed for the past 12 months.
Reviewer
Date

Mes Día Año
Fecha

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List all accidents that you have been involved in that resulted in vehicles being towed, individuals transported from the scene via ambulance seeking medical treatment, or if a fatality was involved. (10 Years or More Attach Sheet if More Space is Needed)

	DATES	NATURE OF ACCIDENT	FATALITIES	INJURIES

Traffic Convictions and Forfeitures for the past 3 years (Other than parking violations)

	LOCATION	DATE	CHARGE	PENALTY

EDUCATION
Circle Highest Grade Completed
High School
College
Last School Attended
Name City/State

EXPERIENCE AND QUALIFICATIONS – DRIVER

	CLASS OF EQUIPMENT	TYPE OF EQUIPMENT	FROM	TO	APPROX. NO. OF MILES

List states operated in for last 5 years
Show special courses or training that will help you as a driver
Which safe-driving awards do you hold and from whom?

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DRIVERS LICENSE INFORMATION

	STATE	LICENSE NUMBER	TYPE	EXPIRATION DATE
1
2
3

Have you ever been denied a license, permit or privilege to operate a motor vehicle?
Has any license, permit, or privilege been suspended or revoked?
Have you ever been CONVICTED of a felony?

No Yes
If yes, Date

Mes Día Año

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TO BE READ AND SIGNED BY APPLICANT
I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize BRAVO MOTOR CARRIERS INC. to make such investigations and inquiries of my personal, employment, financial, medical, criminal histories and other related matters. I have the full understanding that BRAVO MOTOR CARRIERS INC. reserves the right to arrive at a decision based on any information obtained from such inquiries and investigations. 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 false or misleading information given in my application or interview(s) may result in termination of contract. I understand that I am required to abide by all of the policies and procedures of BRAVO MOTOR CARRIERS INC. and regulations set forth by the Federal Motor Carrier Safety Administration.
X

Clear
Date Signature

Mes Día Año
Fecha

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Previous Pre-Employment Employee Alcohol and Drug Test Statement
Sec. 40.25(j) As the company, you must ask the contractor whether her or she has tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the contractor applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If the contractor admits that he or she had a positive test or refusal to test, you must not use the contractor to perform safety sensitive functions for you until and unless the contractor documents successful completion of the return-to duty process (see Sec. 40.25(b5) and (e).

BRAVO MOTOR CARRIERS INC.

9009 NORTH LOOP EAST STE 200 HOUSTON, TX 77029
Prospective Driver’s Name
SSN
The prospective driver is required by Sec. 40.25(j) to respond to the following questions:
(1) Have you ever tested positive or refused to test, on any pre-employment drug or alcohol 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 during the past three years?

YES NO
(2) If you answered YES, can you provide/obtain proof that you have successfully competed the DOT return-to-duty requirements?

YES NO NA
Prospective Driver's Signature

Clear
Prospective Driver’s Signature Date

Mes Día Año
Fecha
Company Representative
Company Representative Date

Mes Día Año
Fecha

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FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT
I authorize you, BRAVO MOTOR CARRIERS INC. (CARRIER), to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) 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.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) 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 employer; and
- Have errors in the information corrected by previous employers and for those 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.
Applicant Printed Name
Date

Mes Día Año
Applicant Signature

Clear
Applicant Social Security Number

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General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA)
Drug and Alcohol Clearinghouse
I,
Please type your full name
, hereby provide consent to Bravo Motor Carriers to conduct a

limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse ("Cleaiinghouse") to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand and agree that such consent will remain valid at all times while I continue to operate vehicles under either Company's motor carrier authority.

I understand that if the limited query conducted by Bravo Motor Carriers indicates that drugor alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Bravo Motor Carriers without first obtaining additional specific consent from me

I further understand that if I refuse to provide consent for Bravo Motor Carríers to conducta limited query of the Clearinghouse, the Company requesting consent must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.
Signature

Clear
Printed
Dated

Mes Día Año
Fecha

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BRAVO MOTOR CARRIERS
ACKNOWLEDGEMENT & DRIVER/OWNER OPERATOR COMMITMENT
1) DRUG AND ALCOHOL POLICY 2} DRIVER QUALIFICATION POLICY 3} DRIVER'S PROCESSING PROCEDURE 4) HOURS OF SERVICE- DRIVER'S RESPONSIBILITIES- LOG VIOLATIONS 5) DISCIPLINARY POLICY 6) VEHICLE AND ROADSIDE INSPECTIONS 7) MAINTENANCE POLICY 8) ACCIDENT AND INCIDENT PROCEDURES AND REPORT 9} SAFETY POLICY 10} SAFETY MEETINGS 11) THE PROFESSIONAL TRUCK DRIVER 12) NO RIDER POLICY 13} CELL PHONE USE/TEXTING

I, the undersigned, certify that I have read and understand BRAVO MOTOR CARRIERS Statement of Policies and Procedures outlined above.

I understand that my failure to honor the terms of this Agreement will be grounds for the termination of my leased services or the consideration of my application for leased services.
Contractor Signature

Clear
(Contractor Printed Name)
Date

Mes Día Año
Fecha
Should be Empty:

	Date	Location	# Injuries	# Fatalities	Hazmat Spil
1
2
3

BRAVO MOTOR CARRIERS INC.

Driver Information Sheet

Address for Past Thee Years

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EMPLOYER 2

EMPLOYER 3

EMPLOYER 4

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Page 4/13

EDUCATION

Page 5/13

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TO BE READ AND SIGNED BY APPLICANT

Page 7/13

Previous Pre-Employment Employee Alcohol and Drug Test Statement

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FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

Page 9/13

SAFETY PERFORMANCE HISTORY RECORDS REQUEST

Page 10/13

PART 3: TO BE COMPLETED BY PREVIOUS EMPLOYER

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Drug and Alcohol Clearinghouse

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BRAVO MOTOR CARRIERS

ACKNOWLEDGEMENT & DRIVER/OWNER OPERATOR COMMITMENT