Quruz Driver Application

You are applying to be a representative of Quruz as an independent contractor, with the occupation of an Assigned Driver. Thank you for your interest in participating to provide safe, convenient, and professional transportation for the community.

Please give thorough answers to ALL questions applied. Incomplete answers will only slow, or stall the application process, our objective is to hire you quickly.

Let's Help The World Go Around!

Please Read: Working in the U.S.

Please Read: Driver Qualifications

Please Read: Publication 1779

Are you eligible to work in the U.S.?:

Are you older than 24 years of age, with two years registered driving experience (or 20 - 24 years old, with two years registered driving experience, and 1+ years transportation service experience)?:

Are you available to provide transportation to Ohio participants only?:

Do you understand you are applying to be a representative of Quruz as an independent contractor, with the occupation of an Assigned Driver?:

Do you understand you have to file with the IRS 1099 form, along with your personal tax form?:

Do you have any disabilities, or medical challenges?:

Other

How did you hear about us?:

Other

Full Name:

PrefixFirst NameMiddle NameLast NameSuffix

First Language:

Second Language:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Were you at this address 3 years or more?:

Please list the complete addresses from the past 3 years:

SSN:

Date of Birth:

MonthDayYear

Phone Number:

Area CodePhone Number

Email:

example@example.com

Have you ever been known by any other name?:

Please list name:

HIGH SCHOOL

Name, City & State of High School:

Did you graduate?:

Have you held a VALID US driver license for the past 36 months?:

Driver License Number:

State driver license was issued:

Driver license expiration date:

MonthDayYear

Vehicle Make, Model & Year:

Vehicle Make, Model, & Year

Does this vehicle need any repairs?:

Please list the repairs your vehicle needs:

Were you ever in the military?:

Branch of service:

Please list dates of enlistment:

Enlist date - Discharge date

Did you receive an honorable discharge?:

Have you ever studied commercial driving classes?:

Commercial driver class information:

School Name

Dates of attendance

CityState / Province

GPA if availableCountry

School phone number:

Area CodePhone Number

Did you graduate, or receive a certificate?:

Work History: Please list current, or most recent occupation first. (If you've worked for a passenger hauling company before please be sure to state it below.)

Have you ever worked for a transportation service before?:

Is this a transportation service occupation?:

Is this your current occupation?:

Start Date:

MonthDayYear

End Date:

MonthDayYear

Company's Name:

Place of Occupation

Company's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Position Held:

Number of miles driven with passengers in your vehicle, within the past year?:

Company's Phone Number (if available):

Area CodePhone Number

May we contact this company at this time?:

What was the reason for leaving?:

ADDITIONAL PRIOR WORK EXPERIENCE

Is this your current occupation?:

Is this a transportation service occupation?:

Start Date:

MonthDayYear

End Date:

MonthDayYear

Company's Name:

Place of Occupation

Company's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Position Held:

Number of miles driven with passengers in your vehicle, within the past year?:

Company's phone number (if available):

Area CodePhone Number

May we contact this company at this time?:

What was the reason for leaving?:

Upload a resume or other work history documents (optional):

Browse Files

If you need additional space for past employment, please enter it here and include ALL information previously asked for:

Where could you be available to travel?:

When are you available to provide transportation?:

Which pass(es) would you most frequently accept?:

Which plan(s) would you most frequently accept?:

Are you willing to wait more than five minutes at a passenger's location?:

What are the amount of miles you plan to travel per week?:

Miles

Number of passengers you are comfortable transporting per ride:

Has your driver's license been suspended within the last 36 months?:

Please give the month w/year each time it was suspended and length of suspension. List the reason why, city, county and state:

We must have complete information to satisfy insurance carrier requirements.

Have you had any moving violations within the last 36 months:

Please give the month w/year of each violation, list the city, county, state, & nature of offense:

We must have complete information to satisfy insurance carrier requirements.

Have you had any accidents within the last 36 months?:

Please give the month w/year of each accident, explanation, city, county, state and if you received a ticket/fine:

We must have complete information to satisfy insurance carrier requirements.

Have you ever had a DUI, DWI, or OVI?:

Please give the month w/year of each offense, explanation, city, county, state:

We must have complete information to satisfy insurance carrier requirements.

Have you ever been convicted of a felony?:

Please give the month w/year of each offense, city, county, state, and jail time served:

Please list everything asked for assurance.

Have you ever been convicted of a misdemeanor?:

Please give the month w/year of each offense, if you've received jail time, or probation, also the city, county, and state:

Please list everything asked for assurance.

Full Name:

First NameLast Name

Relationship to you:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email:

example@example.com

Phone Number:

Area CodePhone Number

Secondary Phone Number (if available):

Area CodePhone Number

Full Name:

First NameLast Name

Relationship to you:

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email:

example@example.com

Phone Number:

Area CodePhone Number

Secondary Phone Number (if available):

Area CodePhone Number

Any additional notes for our consideration?:

Disclosure Statement:

I certify that I personally completed this application and that all of the information is true and valid to the best of my knowledge.

Authorization to Release Records

I authorize Quruz "the carrier indicated on this application" to do a complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by Quruz and hold them harmless of all liability from the release of said information.

I hereby request and authorize to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other sources which may have knowledge concerning any such items of information. I have completed this application of my own free will and understand the Disclosure Statement.

Do you agree?:

Applicant Signature:

Full Name:

PrefixFirst NameMiddle NameLast NameSuffix

Quruz Driver Application

General Information

D.M.V. Information

OCCUPATION HISTORY

Availability

Additional Information

Emergency Contact Information.

Second Emergency Contact Information