Owner Operator Application

Owner Operator Application

Congratulations on your decision to join us! We take extreme pride to make sure we provide the best working environment possible. We value your dedication, teamwork, and commitment to the evolving world of transportation and logistics. It is an honor to include you in our network!

Please give complete answers to ALL questions as required - Incomplete answers will only slow or stall the onboarding process and our goal is to get you on the road quickly.

PLEASE DO NOT COMPLETE THIS APPLICATION IF:
1. YOU HAVE AN AUTHORITY (MUST WORK UNDER OUR AUTHORITY)
2. YOU DO NOT OWN A TRUCK 2000 OR NEWER
The following documents are required for onboarding:
- CDL (A and/or B)
- Physical Damage Insurance
- Bobtail Insurance
- MVR
- Cab Card
Thank you for your cooperation and we look forwarding to building a long lasting relationship!
General Information
Full Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Have you lived at this address 3 years or more?*

YesNo
If you answered NO please list your previous complete address.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Phone Number*
E-mail*
example@example.com
Do you have a CDL?*

YesNo
How long have you held a CDL?*
Explain ie; maiden name, name change
Upload proof of your current CDL*

Cancelof
Do you have your own authority?*

YesNo
Are you at least 23 years of age or older?*

YesNo
License Information
Have you held a VALID US license for the past 36 months?*

YesNo
License Class*
License Number*
State of Issue*
License expiration date*

MonthDayYear
Expiration date of DOT physical card

MonthDayYear
CDL Endorsements*

NoneTankerDoubles/TriplesHazmatX EndorsementTWIC
Hazmat expiration date

MonthDayYear
TWIC expiration date

MonthDayYear
Please list any licenses held in other states for the previous 5 years, include license numbers if you can.
Do you have an existing DOT or MC number?* If so, please provide your DOT or MC number here .
What type of equipment do you have?*

TractorReeferDryvanFlatbedOther
Please provide the year, make, model, VIN and tag for all equipment being offered.*
Does this truck require stickers or magnets for signage?*
Is your truck owned or financed? blanks* If it is financed, is there a co-signer? blank* Please Note: if there is co-signer, we will need permission from them and they will need to sign the lease agreement as well.
Value of each piece of equipment*
Any Service Restrictions location?*
Some business prefer not to support specific regions or locations. If you have no restrictions, select the NO Restrictions option.
If you selected YES please describe restrictions in the space below. If no type N/A*
Do you have a Motive ELD?*
Will you be using a fuel card?*
Please upload your physical damage and Bobtail insurance.*

Cancelof
Please upload your cab card.

Cancelof
Please upload your registration.

Cancelof
Please upload your MVR issued within the last 30 days.

Cancelof
Please upload your current medical card.

Cancelof
Please upload your current DOT inspection.

Cancelof
Please upload your most recent Roadside Inspection with the state.

Please reach out to your state DOT to schedule if do not have one.
Cancelof
Preferred Lanes
What states are you willing to run?*
How many days are you willing to be on the road?*
Additional Information
Have you had any moving violations in the last 5 years?*

YesNo
If yes, please list City, County and State, month, year and nature of offense and any fines involved
Please list miles over limit for speeding
Has your license ever been suspended?*

YesNo
If yes, please give date and length of supension. List reason why, city, county and state
List all details asked for
Have you had any accidents in the last 5 years?*

YesNo
If yes, please give date, explaination, city, county and state and if you received ticket/fine (amount)
Have you ever had a DUI, DWI, or OVI?*

YesNo
If yes, please list date of offense, jail time, fine and or suspension time.
We must have complete information to satisfy isusance carrier requirements.
Have you ever been convicted of a felony?*

YesNo
If yes, please give date and nature of offense, city, county, state and any fines and time served
Please list EVERYTHING asked for per isurance requirements
Have you ever been convicted of a misdemeanor?*

YesNo
If yes, please list date and nature of offense, city, county and state. also jail time, probation, or fines
Please list EVERYTHING asked for
Do you have a clearing house?*

YesNo
If you answered YES, what company do you use?
Bank Name and Address
Bank Account Number*
Bank Routing Number*
Social security number*
Client agrees to indemnify, defend and hold harmless QC Transport Group, LLC and it's officers, employees, affiliates and agents from and against any and all losses, liabilities, claims or damages asserted by third parties arising out of or in connection with QC Transport Group, LLC's performance of it's obligations under the Agreement, except to the the extent that such losses, liabilities, claims or damages are judicially determined to have resulted directly and primarily from the willful misconduct or gross negligence of QC Transport Group, LLC. Client agrees to strict no refund policy. Client further agrees to indemnify, defend and hold harmless QC Transport Group, LLC and its officers, employees affiliates and agents from and against any and all losses, liabilities, claims or damage asserted by third parties arising out of or in connection with any and all misrepresentations or false or misleading information made to any party, including Consulting, by Client or any of its officers, employees, affiliates or agents.

Agree
Additional Information
By signing I agree I have read the above statements
How did you hear about us?*
Should be Empty:

General Information

License Information

Additional Information

Additional Information