Owner Operator Sub Contractor Application Form
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long at this address?
Company and Vehicle information
NAME OF COMPANY
DOT NUMBER MC NUMBER
What type of vehicle do you have?
How many Trucks does your company own?
How many drivers does your company have?
Company Phone number
Please enter a valid phone number.
Company Email
example@example.com
Qualification & Background
Current License #
State
Expiration Date
-
Month
-
Day
Year
Date
Class of Driver's license
Endorsements
Please answer following questions:
Yes
No
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Has any license, permit, privilege ever been suspended or revoked?
Have you ever been disqualified subject to any section of the Federal Motor Carrier Safety Regulations?
Have you ever been convicted of a Felony OR are charges currently pending against you?
If your answer is yes to any questions, please explain in detail
Additional Notes?
Agreement
I, the applicant undersigned, agree with the following statements:
I authorize the company I am applying to make investigations and inquire of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at a contract decision.
I hereby release employers, schools, health care providers and other persons from all liability in responding to inquires and releasing information in connection with my application.
In this event, I understand that false or misleading information given in my application or interview(s) may result in discharge or contract termination.
I understand that I am required to abide by all rules and regulations of the Company. If I terminate my contract by my own choice within 90 days, I agree to be responsible for the cost of the Drug Test and other associated fees involved in my background check.
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
During the term of this agreement and for a period of [specify duration, e.g., two years] thereafter , the subcontractor agrees not to directly or indirectly solicit, induce, or attempt to solicit or induce any client, customer, or business partner of JM3 Logistics INC for the purpose of providing services similar to those offered by JM3 Logistics INC. This includes, but is not limited to, any individual or entity with whom JM3 Logistics INC has a current or prospective business relationship. The sub-contractactor further agrees not to disclose or use any confidential information obtained from JM3 Logistics for the purpose of soliciting or providing services to any such client, customer, or business partner."
Date
-
Month
-
Day
Year
Date
Signature
Submit
Submit
Should be Empty: