Quruz Driver Application

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.?:*

YesNo
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)?:*

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

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

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

YesNo
Do you have any disabilities, or medical challenges?:*

NoOther
How did you hear about us?:*

AdSocial ConversationOtherOther
General Information
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?:*

YesNo
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?:*

YesNo
Please list name:*
HIGH SCHOOL
Name, City & State of High School:*
Did you graduate?:*

YesNo
D.M.V. Information
Have you held a VALID US driver license for the past 36 months?:*

YesNo
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?:*

YesNo
Please list the repairs your vehicle needs:*
Were you ever in the military?:*

YesNo
Branch of service:*
Please list dates of enlistment:*
Enlist date - Discharge date
Did you receive an honorable discharge?:*

YesNoOther
Have you ever studied commercial driving classes?:*

YesNo
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?:*

YesNo
OCCUPATION HISTORY
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?:*

YesNo
Is this a transportation service occupation?:*

YesNo
Is this your current occupation?:*

YesNo
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?:*

YesNo
What was the reason for leaving?:*
ADDITIONAL PRIOR WORK EXPERIENCE
Is this your current occupation?:*

YesNo
Is this a transportation service occupation?:*

YesNo
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?:*

YesNo
What was the reason for leaving?:*
Upload a resume or other work history documents (optional):

Browse Files

Cancelof
If you need additional space for past employment, please enter it here and include ALL information previously asked for:
Availability
Where could you be available to travel?:*
When are you available to provide transportation?:*
Which pass(es) would you most frequently accept?:

Trip Service Pass (One Destination)Trip Service Pass (Two+ Destinations)Shuttle Service Pass (One Destination)Shuttle Service Pass (Two+ Destinations)
Which plan(s) would you most frequently accept?:

Daily Service PassThree Services PassFive Services PassSeven Services PassWeekly Service PassBiweekly Service PassMonthly Service Pass
Are you willing to wait more than five minutes at a passenger's location?:

YesNo
What are the amount of miles you plan to travel per week?:
Miles
Number of passengers you are comfortable transporting per ride:
Additional Information
Has your driver's license been suspended within the last 36 months?:*

YesNo
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:*

YesNo
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?:*

YesNo
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?:*

YesNo
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?:*

YesNo
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?:*

YesNo
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.
Emergency Contact Information.
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
Second Emergency Contact Information
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?:*

I agreeI do not agree
Applicant Signature:

Clear
Full Name:*

PrefixFirst NameMiddle NameLast NameSuffix
Should be Empty:

Quruz Driver Application

General Information

D.M.V. Information

OCCUPATION HISTORY

Availability

Additional Information

Emergency Contact Information.

Second Emergency Contact Information