Quruz Driver Preregistration Form

Driver Preregistration Form

You are preregistering 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 registration process, our objective is to hire you quickly.

Let's Help The World Go Around!
Driver Preregistration Form
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 preregistering 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 ConversationReferralOther
Referral Code:
General Information
Email:*
example@example.com
Date of Birth:*

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

YesNo
What is your vehicle's make, model & year?:*
Vehicle Make, Model, & Year
Does this vehicle need any repairs?:*

YesNo
Please list the repairs your vehicle needs:*
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

(Please list your most recent jobs)
Have you ever worked for a transportation company before:*

YesNo
Company's Name:*
Place Of Occupation
Is this your current occupation?:*

YesNo
Start Date:*

MonthDayYear
End Date:*

MonthDayYear
Position Held:*
Number of miles driven with passengers in your vehicle, within the past year?:*
Company 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
Company's Name:
Place Of Occupation
Is this your current occupation?:

YesNo
Is this a transportation service occupation?:

YesNo
Start date:

MonthDayYear
End date:

MonthDayYear
Position Held:
Number of miles driven with passengers in your vehicle, within the past year?:
Company 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?:*

NoOther
What are the amount of miles you plan to travel per week?:*
Miles
Number of passengers you are comfortable transporting per ride:*
Passenger Capacity
Additional Information
Has your driver 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.
Any additional information?:
Please list information not mentioned above.
Disclosure Statement:

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

Authorization to Release Records

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 employment ethics, 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
Should be Empty:

Driver Preregistration Form

General Information

D.M.V. Information

Occupation History

Additional Prior Work Experience

Availability

Additional Information