COMPLETE DRIVER APPLICATION & QUALIFICATION PACKAGE

COMPLETE DRIVER APPLICATION & QUALIFICATION PACKAGE
IMPORTANT INSTRUCTIONS / INSTRUCCIONES IMPORTANTES English: All fields must be completed. Do not leave any field blank. If a question does not apply to you or you do not know the answer, enter “N/A” (Not Applicable). Español: Todos los campos deben completarse. No deje ningún campo en blanco. Si una pregunta no aplica a usted o no conoce la respuesta, escriba “N/A” (No Aplica).
Driver Application • Qualification • Safety Screening • Internal Safety Review

Motor Carrier / Company	CROWN LOGISTICS INC.
USDOT / MC	USDOT# 1063121 \| MC# 443091
Company Location	Naples, Florida 34120

Applicant / Driver Name

First NameLast Name
Application Date / Safety Reviewer
IMPORTANT USE NOTE: This package combines applicant-completed forms with Crown Safety/Compliance forms. Items identified as COMPANY POLICY are internal controls and are not presented as separate federal requirements. Drug/alcohol and consumer-report records must be handled with appropriate confidentiality and separate consents where required.
MASTER ONBOARDING CHECKLIST CROWN SAFETY — INTERNAL USE

MASTER ONBOARDING CHECKLIST CROWN SAFETY - INTERNAL USE

Rows	AUTHORITY / TYPE	STATU S
Driver Application completed and signed
CDL / license copy and status verified
Medical qualification / CDLIS status
Initial MVR(s) - states held in prior 3 years
Previous-employer safety performance investigation
Driver rights notice / release
Clearinghouse pre-employment full query
Pre-employment controlled-substances test / exception
Pre-employment drug/alcohol questionnaire
Road test + certificate OR lawful equivalent
7-day HOS statement - first-time/intermittent
PSP authorization/report (if used)
Background screening authorization/report (if used)
Driver safety policies / acknowledgments
Tax / payee setup + W-9
Safety approval / Dispatch release

Applicant Initials

CROWN LOGISTICS INC.
Applicant Initials
CROWN LOGISTICS INC. | MC# 443091 | USDOT# 1063121 | Naples, FL 34120 | (239) 356-4538 | Fill electronically in Microsoft Word or print and complete in ink.

DRIVER'S APPLICATION FOR EMPLOYMENT / CONTRACT DRIVING SERVICES
A. APPLICANT INFORMATION
Full Legal Name

First NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Format: (000) 000-0000.
Date of Birth / Social Security Number
Application Date / Position

Other Specify
RESIDENCES DURING PREVIOUS 3 YEARS

RESIDENCES DURING PREVIOUS 3 YEARS

Rows	FROM	TO
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Applicant Initials
B. DRIVER LICENSES / PERMITS

B. DRIVER LICENSES / PERMITS

Rows	LICENSE / CDL NUMBER	CLASS / ENDORSEMENTS	EXPIRATION
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Applicant Initials
License / permit / driving privilege ever denied, revoked, suspended, canceled or disqualified?
If YES, explain:

DRIVING EXPERIENCE & HISTORY
Continuation of Driver Application
C. DRIVING EXPERIENCE

C. DRIVING EXPERIENCE

Rows	TYPE/SIZE	FROM-TO	APPROX. MILES
Straight Truck / Van
Tractor-Semitrailer
Doubles / Triples
Bus / Passenger
Other

D. MOTOR VEHICLE ACCIDENTS — PREVIOUS 3 YEARS If none, write NONE.
Applicant Initials

D. MOTOR VEHICLE ACCIDENTS - PREVIOUS 3 YEARS If none, write NONE.

Rows	NATURE/LOCATION	FATALITIES	INJURIES	TOW / CITATION?
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E. TRAFFIC CONVICTIONS / BOND FORFEITURES — PREVIOUS 3 YEARS Exclude parking violations. If none, write NONE.

E. TRAFFIC CONVICTIONS / BOND FORFEITURES - PREVIOUS 3 YEARS Exclude parking violations. If none, write NONE.

Rows	STATE	VIOLATION	DISPOSITION
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CROWN LOGISTICS INC. | MC# 443091 | USDOT# 1063121 | Naples, FL 34120 | (239) 356-4538 | Fill electronically in Microsoft Word or print and complete in ink.

APPLICATION CERTIFICATION & AUTHORIZATIONS
Driver signature required
G. APPLICATION CERTIFICATION & DRIVER RIGHTS
I certify that this application was completed by me and that all entries and information are true and complete to the best of my knowledge. I understand that material falsification, omission, or misrepresentation may result in denial of qualification or termination of the driving relationship, subject to applicable law. I understand that Crown Logistics Inc. will investigate prior-employer safety performance as applicable and that I may have rights to review information received, request correction from the previous employer, and submit a rebuttal statement when permitted.
Prior-employer safety performance information request options
H. DRIVER AUTHORIZATION FOR SAFETY PERFORMANCE HISTORY RELEASE
I authorize former employers to release safety performance information lawfully requested by Crown Logistics Inc., including employment verification and accident history. Where a prior DOT-mode drug/alcohol inquiry is legally applicable, I authorize release to the extent permitted by applicable law. FMCSA Clearinghouse requirements and separate electronic consent remain separate.
Driver Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Printed Name

First NameLast Name
Applicant Initials
CDL State / Number
I. DRIVER RECORDS & SCREENING AUTHORIZATION ACKNOWLEDGMENT

I. DRIVER RECORDS & SCREENING AUTHORIZATION ACKNOWLEDGMENT

RECORD	AUTHORIZATION / CONDITION
Motor Vehicle Record (MVR)	Initial Annual / periodic as authorized
FMCSA Clearinghouse	Pre-employment full query - electronic consent handled in Clearinghouse
Background / Consumer Report	Only after any required separate FCRA disclosure / authorization
PSP	If used, official PSP disclosure / authorization maintained separately
Previous Employer Safety Performance	Authorized as applicable

I understand this acknowledgment does not replace any separate consent required by the Clearinghouse, PSP, FCRA, or other applicable law.
Driver Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Printed Name

First NameLast Name
CDL State / Number

4. FORMER EMPLOYER CERTIFICATION / CROWN GOOD-FAITH ATTEMPTS
Name / Title

First NameLast Name
Signature / Date
Phone / Email
Attempt 1 — Date / Method / Result
Attempt 2:
Attempt 3:

Applicant Initials
PRE-EMPLOYMENT DRUG / ALCOHOL & HOS FORMS
A. PRE-EMPLOYMENT DRUG & ALCOHOL QUESTIONNAIRE — 49 CFR §40.25(j)
During the past two (2) years, have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT drug and alcohol testing rules?

Rows	Click or tap here to enter text.
Type
SAP / Return-to-Duty Documentation

I certify that my answer is true and complete and understand that any required return-to-duty process must be completed before performing safety-sensitive functions.
Driver Signature
Safety Reviewer
Driver completes applicable sections
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Clearinghouse Full Query Date / Result
Applicant Initials

B. HOURS OF SERVICE RECORD — FIRST TIME / INTERMITTENT DRIVER — 49 CFR §395.8(j)(2)
Driver Name / Date Work Begins

First NameLast Name
Carrier Crown Logistics Inc.

Rows	DRIVING	OTHER ON-DUTY	TOTAL ON-DUTY
1. Date:
2. Date:
3. Date:
4. Date:
5. Date:
6. Date:
7. Date:

Total On-Duty — Preceding 7 Days
Last Relief From Duty Began

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Returned to Duty / Relief Ended

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I certify the HOS information above is true and complete and includes compensated work/on-duty time that must be considered.
Driver Signature / Date
Safety / Dispatch Reviewer / Date
Applicant Initials

DRIVER'S ROAD TEST FORM
Complete when road test is required
Driver

First NameLast Name
Examiner

First NameLast Name
Date / Time

MonthDayYear
Start
End
Miles
Power Unit / Unit#
Trailer / #

Rows	S	NI	N/O	COMMENTS
Pre-trip inspection / equipment familiarity
Coupling / uncoupling (if applicable)
Placing vehicle in operation / start-up
Controls / emergency equipment
Backing and parking
Turning / lane control / clearance
Shifting / speed management
Braking / stopping / following distance
Intersection / railroad crossing procedures
Mirrors / observation
Passing / being passed
Downgrades / upgrades (if applicable)
Traffic signs / signals / roadway compliance

Rows text.
Examiner Conclusion:
Applicant Initials
Route / Conditions / Notes:
Examiner Signature / Date
Driver Signature / Date
CERTIFICATE OF DRIVER ROAD TEST / EQUIVALENT
Driver

First NameLast Name
Power Unit
Trailer(s)
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Miles
Start/End
Equivalent Basis (if applicable)
I certify that the above-named driver was given a road test under my supervision and, in my considered opinion, possesses sufficient driving skill to safely operate the type of CMV identified above.
Examiner Signature / Date
Title / Organization

PAYEE INFORMATION & PERSONAL REFERENCES
Administrative / company forms
A. DRIVER TAX / PAYEE INFORMATION — COMPANY ADMINISTRATIVE FORM
Worker classification is determined by the actual relationship and applicable law, not merely by a 1099 label. Obtain an official IRS Form W-9 for contractor payee setup.
PAYMENT TYPE SELECTION
Individual — Legal Name / TIN

First NameLast Name
Applicant Initials
Mailing Address / Phone / Email
Business — Legal Name / DBA
EIN / Entity Type

Other
Business Address / Contact
W-9 Status
If lawfully classified and paid as an independent contractor, I understand contractor payments may be reported on the applicable IRS information return and that this administrative form does not waive non-waivable rights or override worker-classification law.
Driver / Contractor Signature / Date
Carrier Representative
B. PERSONAL / PROFESSIONAL REFERENCES — COMPANY POLICY
Reference 1 — Name / Relationship

First NameLast Name
Company / Phone / Email (Reference 1)
Reference 2 — Name / Relationship

First NameLast Name
Company / Phone / Email (Reference 2)
Reference 3 — Name / Relationship

First NameLast Name
Applicant Initials
Company / Phone / Email (Reference 3)

CROWN SAFETY — QUALIFICATION CONTROL
Internal Safety / Compliance Use Only
FOR CROWN LOGISTICS USE ONLY — Crown signs after applicant submission.
A. ANNUAL DRIVER QUALIFICATION REVIEW — 49 CFR §391.25
Driver / CDL

First NameLast Name
Review Period / Annual MVR Date
MVR Source / State
Status Checks
Reviewer Determination
Notes / Corrective Action
Safety Reviewer / Signature / Date
Driver Acknowledgment (Company Policy) / Date

B. SAFETY APPROVAL & DISPATCH RELEASE - FINAL ONBOARDING AUTHORIZATION

Rows	STATUS
Application signed / complete
CDL verified
Medical status verified
MVR reviewed / insurance criteria checked
Previous-employer verification / good-faith process
Clearinghouse pre-employment full query
Pre-employment drug test / exception
$40.25(j) questionnaire
7-day HOS statement
Road test / equivalent
PSP / background if used
Driver policies / authorizations
Tax / W-9 setup

CROWN LOGISTICS INC. | MC# 443091 | USDOT# 1063121 | Naples, FL 34120 | (239) 356-4538 | Fill electronically in Microsoft Word or print and complete in ink.

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COMPLETE DRIVER APPLICATION & QUALIFICATION PACKAGE

Driver Application • Qualification • Safety Screening • Internal Safety Review

MASTER ONBOARDING CHECKLIST CROWN SAFETY — INTERNAL USE

CROWN LOGISTICS INC.

DRIVER'S APPLICATION FOR EMPLOYMENT / CONTRACT DRIVING SERVICES

A. APPLICANT INFORMATION

RESIDENCES DURING PREVIOUS 3 YEARS

B. DRIVER LICENSES / PERMITS

DRIVING EXPERIENCE & HISTORY

C. DRIVING EXPERIENCE

D. MOTOR VEHICLE ACCIDENTS — PREVIOUS 3 YEARS If none, write NONE.

E. TRAFFIC CONVICTIONS / BOND FORFEITURES — PREVIOUS 3 YEARS Exclude parking violations. If none, write NONE.

F. ADDITIONAL DRIVER QUALIFICATION QUESTIONS

EMPLOYMENT HISTORY

Previous 3 years + additional CMV history when applicable

EMPLOYER 1

EMPLOYER 2

EMPLOYER 3

EMPLOYMENT HISTORY — CONTINUED

EMPLOYER 4

EMPLOYER 5

EMPLOYER 6

APPLICATION CERTIFICATION & AUTHORIZATIONS

G. APPLICATION CERTIFICATION & DRIVER RIGHTS

H. DRIVER AUTHORIZATION FOR SAFETY PERFORMANCE HISTORY RELEASE

I. DRIVER RECORDS & SCREENING AUTHORIZATION ACKNOWLEDGMENT

SAFETY PERFORMANCE HISTORY / EMPLOYMENT VERIFICATION REQUEST

CROWN SAFETY — send to each applicable previous employer

1. EMPLOYMENT VERIFICATION

2. ACCIDENT / SAFETY PERFORMANCE HISTORY — PREVIOUS 3 YEARS

3. DOT DRUG & ALCOHOL INFORMATION — COMPLETE ONLY WHEN LEGALLY APPLICABLE

4. FORMER EMPLOYER CERTIFICATION / CROWN GOOD-FAITH ATTEMPTS

PRE-EMPLOYMENT DRUG / ALCOHOL & HOS FORMS

A. PRE-EMPLOYMENT DRUG & ALCOHOL QUESTIONNAIRE — 49 CFR §40.25(j)

Driver completes applicable sections

B. HOURS OF SERVICE RECORD — FIRST TIME / INTERMITTENT DRIVER — 49 CFR §395.8(j)(2)

DRIVER'S ROAD TEST FORM

CERTIFICATE OF DRIVER ROAD TEST / EQUIVALENT

PAYEE INFORMATION & PERSONAL REFERENCES

A. DRIVER TAX / PAYEE INFORMATION — COMPANY ADMINISTRATIVE FORM

B. PERSONAL / PROFESSIONAL REFERENCES — COMPANY POLICY

CROWN SAFETY — QUALIFICATION CONTROL

A. ANNUAL DRIVER QUALIFICATION REVIEW — 49 CFR §391.25