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
Education
Your highest education
*
Less than high school
High school graduated or equivalent (GED)
College - 1 year
College - 2 year
College - 3 year
College - 4 year (Bachelor) or higher
Employment Record
Please list your employment history
Qualification & Background
Current License #
*
State
*
Expiration Date
*
-
Month
-
Day
Year
Date
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
Driving Experience
TRAFFIC CONVICTIONS
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 the event of employment, 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
Date
*
-
Month
-
Day
Year
Date
Signature
*
Submit
Should be Empty: