Owner Operator Application Form
Fast Quality Expedite LLC
2067 Clay Stone Place, Reynoldsburg, Ohio 43068; Phone Number: 614-705-6334, Email: hr@fqexpedite.com An Equal Opportunity Employer
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Name
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First Name
Middle Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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Current Address
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Street Address
Street Address Line 2
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Do you have the legal right to work in the United States?
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Yes
No
Have you ever been convicted of a crime under your current or any other name, which has not been expunged from your record?
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Yes
No
Are you over the age of 18?
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Yes
No
Are you now employed or under contract with any other company?
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Yes
No
How long since leaving last employment / contract?
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Name of the person referred you
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First Name
Last Name
Are you able to perform the essential functions of the contract for which you have applied, with or without reasonable accommodations?
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Yes
No
Employment History
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Any accident record in the past?
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Yes
No
Describe the accident report if applicable?
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Any Traffic Convictions in the Past 3 Years?
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Yes
No
Describe any Traffic Convictions for the Past 3 Years
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Highest Level of Education
*
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No Education
High School
College
List Job Related Classes or Programs You Completed
Driver Licenses
*
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
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Yes
No
Have any license, permit, or privilege ever been suspended or revoke?
*
Yes
No
Please attach the statement giving details
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Equipment Information
*
Rows
Type of Equipment
Straight Truck
Cargo Van
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
*
Experience & Qualifications
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
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List special equipment or technical materials you can work with (other than those already shown)
*
Vehicle Information
Vehicle
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Make
Model
VIN Number
Last Inspection Date
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Month
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Day
Year
Date
Remarks
I, the applicant undersigned, agree with the following statements:
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This application was completed by me, and that all entries in it and information in itare true and complete to the best of my knowledge.
I authorize you to make such investigations and inquiries of my personal, employment, financial andother 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 inquiries 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 requiredto abide by all rules and regulations of the Contractor, if a contract is offered.
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