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20
Questions
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1
Name
*
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First Name
Last Name
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2
Email
*
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example@example.com
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3
Phone Number
*
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Please enter a valid phone number.
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4
(City, State)
*
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5
Do you have a valid CDL?
*
This field is required.
YES
NO
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6
CDL Class
*
This field is required.
A
B
C
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7
Years of Driving Experience
*
This field is required.
Less than 1 year
1-3 years
3-5 years
5+ years
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8
Do you own your truck?
*
This field is required.
YES
NO
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9
MC Number
*
This field is required.
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10
Type a question
*
This field is required.
Dry Van
Reefer (Refrigerated)
Flatbed
Box Truck
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11
Is your truck(s) active and ready to haul?Β
*
This field is required.
YES
NO
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12
Do you have your own insurance?Β
*
This field is required.
YES
NO
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13
Preferred Haul Distance π£οΈ
*
This field is required.
Select all that apply
Local (0-150 mi)π΅
Short (150-350 mi)π°
Medium (350-750 mi)π°π°
Long (750+ mi)π°π°π°
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14
Preferred regions/states to drive in
*
This field is required.
select all that apply
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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15
Preferred regions/states you DO NOT want to drive in
*
This field is required.
select all that apply
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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16
Days Available
*
This field is required.
Select all that apply
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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17
Hours available
*
This field is required.
select all that apply
12 AM β 4 AM
4 AM β 8 AM
8 AM β 12 PM
12 PM β 4 PM
4 PM β 8 PM
8 PM β 12 AM
24/7 Availability
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18
Rate expectations (if any):
*
This field is required.
select all that apply
No preference / Open to market rates
$1.50 - $1.75 per mile
$1.76 - $2.00 per mile
$2.01 - $2.25 per mile
$2.26 - $2.50 per mile
Above $2.50 per mile
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19
Emergency Contact
*
This field is required.
First Name
Last Name
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20
Emergency Phone Number
*
This field is required.
Please enter a valid phone number.
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