Company Driver / Owner Operator

Online Application

Company Driver / Owner Operator application: Answer all questions. Waymore Transportation Inc. is an E.E.O. employer. In compliance with Federal and State equal employment laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status or non-job related disability.

Date of Application (required)

YYYY

Name (required)

First Name

Last Name

Middle Initial (required)

SSN # (required)

123-45-7890

Date of Birth (required for commercial driver)

YYYY

Home Phone # (required)

123-456-7890

Cell Phone #

Current Address (required)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

First Previous Address (required)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Second Previous Address (required)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Do you have the legal right to work in the United States? (required)

Can you provide Proof of age? (required)

Have you worked for Waymore Transportation Inc. before?

If So, Dates From

YYYY

If So, Dates To

YYYY

Are you employed now? (required)

If not, how long since leaving your last employment?

YYYY

Who referred you?

What is the desired rate of pay expected?

Education Section

How many completed years of college?

Name of Last School Attended

City of Last School Attended

Experience And Qualifications - Driver

Drivers License # (required)

Current State License (required)

Drivers License Type (required)

Class A (required)

Additional Endorsements

Drivers License Expiration Date (required)

YYYY

Have you ever been denied a license, permit or privilege to operate a commercial motor vehicle?

Has any licenses, permits or privilege ever been suspended or revoked? (required)

If answer to either A or B is yes, please explain.

List accident record (chargeable or non-chargeable) for the past 3 years (attach sheet if more space is needed) leave blank if you have none. Date 1

YYYY

Fatalities 1

If applicable enter the number of fatalities.

Injuries 1

If applicable enter the number of injuries.

Location of Injuries 1

If applicable, please select a state the injuries occurred in.

Nature of accident (head on, rear-end, up-set etc.) 1

List accident Date 2

YYYY

Fatalities 2

Injuries 2

If applicable, please enter the number of injuries.

Injuries Location 2

If applicable, please select the state the injuries occurred in.

Nature of accident (head on, rear-end, up-set etc.) 2

List of accident Date 3

YYYY

Fatalities 3

Injuries Location 3

If applicable, please select the state the injuries occurred in.

Nature of accident (head on, rear-end, up-set etc.) 3

Traffic Convictions and forfeitures for the past 5 years (other than parking violations) leave blank if none. Date 1

YYYY

Traffic Conviction Location 1

Type of Violation 1

Penalty 1

Traffic Convictions and forfeitures for the past 5 years (other than parking violations) leave blank if none. Date 2

YYYY

Traffic Conviction Location 2

If applicable, please choose the state of the traffic conviction.

Type of Violation 2

Penalty 2

Traffic Convictions and forfeitures for the past 5 years (other than parking violations) leave blank if none. Date 3

YYYY

Traffic Conviction Location 3

Type of Violation 3

Penalty 3

Driving Experience Section

Class of Equipment / Type of Equipment (van, flat, tank reefer)

Straight Truck

List all states operated in the last 5 years.

Class of Straight Truck From

YYYY

Class of Straight Truck To

YYYY

Class of Straight Truck Approximate Number of Miles

Tractor/Trailer

Tractor/Trailer From

YYYY

Tractor/Trailer To

YYYY

Tractor/Trailer Approximate Number of Miles

Refrigerated Trailer/Dry Van

Refrigerated Trailer/Dry Van From

YYYY

Refrigerated Trailer/Dry Van To

YYYY

Refrigerated Trailer/Dry Van Approximate Number of Miles

Employment History

Interstate Commerce driver applicants must provide complete mailing address, city, state and zip code on all employers during the preceding 3 years. Applicants to drive a commercial motor vehicle (which includes vehicles having a G.V.W.R of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placards) in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent.

Employer Name 1

Date From 1

YYYY

Date To 1

YYYY

Employer Address 1

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number 1

123-456-7890

Contact Person 1

Position Held 1

Safety Awards 1

Salary/Wage 1

Reason For Leaving 1

Were you subject to the rules of federal motor carrier safety regulation at this position? 1

Was this a D.O.T. safety sensitive function subject to alcohol & controlled substance testing? 1

Employer Name 2

Date From 2

YYYY

Date To 2

YYYY

Employer Address 2

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number 2

123-456-7890

Contact Person 2

Position Held 2

Safety Awards 2

Salary/Wage 2

Reason For Leaving 2

Were you subject to the rules of federal motor carrier safety regulation at this position? 2

Was this a D.O.T. safety sensitive function subject to alcohol & controlled substance testing? 2

Employer Name 3

Date From 3

YYYY

Date To 3

YYYY

Employer Address 3

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number 3

123-456-7890

Contact Person 3

Position Held 3

Safety Awards 3

Reason For Leaving 3

Salary/Wage 3

Were you subject to the rules of federal motor carrier safety regulation at this position? 3

Was this a D.O.T. safety sensitive function subject to alcohol & controlled substance testing? 3

Employer Name 4

Date From 4

YYYY

Date To 4

YYYY

Employer Address 4

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number 4

123-456-7890

Contact Person 4

Position Held 4

Safety Awards 4

Were you subject to the rules of federal motor carrier safety regulation at this position? 4

Salary/Wage 4

Reason For Leaving 4

Was this a D.O.T. safety sensitive function subject to alcohol & controlled substance testing? 4

Were you subject to the rules of federal motor carrier safety regulation at this position? 4

Employer Name 5

Date From 5

YYYY

Date To 5

YYYY

Employer Address 5

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number 5

123-456-7890

Contact Person 5

Position Held 5

Safety Awards 5

Salary/Wage 5

Reason For Leaving 5

Were you subject to the rules of federal motor carrier safety regulation at this position? 5

Was this a D.O.T. safety sensitive function subject to alcohol & controlled substance testing? 5

Employer Name 6

Date From 6

YYYY

Date To 6

YYYY

Employer Address 6

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number 6

123-456-7890

Contact Person 6

Position Held 6

Safety Awards 6

Salary/Wage 6

Reason For Leaving 6

Were you subject to the rules of federal motor carrier safety regulation at this position? 6

Was this a D.O.T. safety sensitive function subject to alcohol & controlled substance testing? 6

Select states operated in for the last 5 years

List special courses or training you have received that has helped you or will help you as a driver.

List any trucking, transportation or other experience that has helped you or will help you as a driver.

List courses or training other than shown elsewhere in this application.

Terms of Acceptance & Signature

I acknowledge that I have read, understood and accept the application terms and conditions. (required)

I have completed this application, and that all entries on the application and information on the application are true and complete to the best of my knowledge. I authorize Waymore Transportation Inc., safety department, to make such investigations and inquires of/to my personal, employment, DOT regulated records, including information related to accidents, drug & alcohol testing, financial or medical history and other related matters as may be necessary to arriving at an employment or contractor employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment or contractor employment has been extended.) I hereby release former and current employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with this application. In the event of employment or contractor employment, I understand that false or misleading information given in this application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of Waymore Transportation Inc.

Electronic Signature (required)

Please type your First and Last Name

I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance. (required)