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Independent Contractor Driver Application

Personal Information  
 
First Name:
     		 Middle Name:
     		 Last Name:
     
  Address:
 
City:
     		 State:
     		 Zip Code:
      
 
Home Phone:
     		 Other Phone
     		      
 
Pager
Ext.
 
Social Security:
-  -       		 E-mail Address:
     
  Years Verifiable Experience:
 
EQUIPMENT PROFILE:
  Tractor Make
 		 
  Year Of Tractor
 		 
  Sliding Fifth Wheel YES NO
  Fifth Wheel Height
 
  Tractor Weight
 
  Wheelbase Length
 
 
Driver License Information  
 
License Number:
     		 State Issued:
     		 Country:
     		 Expires:
 
Birth Date:
Month
      		 Day
     		    
19       
 
Endorsements
Please check all the boxes pertaining to your license.:
  What Is Your Current CDL License Class: A B C None
  Do You Have A Hazardous Material Endorsement:    YES NO
  Do You Have A Double/Triple Trailer Endorsement:  YES NO
 
Safety Record  
  Have You Had Any Accidents In The Last 3 Years?:  YES NO
  Have You Had Any Tickets In The Last 3 Years?:  YES NO
  Have You Had A DWI or DUI?:  YES NO
  Have You Ever Been Convicted Of A Felony?:  YES NO
  Have You Ever Had Your License Revoked or Suspended?:  YES NO
  Have you EVER been disqualified to drive by Federal Regulations? YES NO


If the answer to ANY question is yes, state details, circumstances, and date:
 
Personal Preferences
  I Want To Run Solo  Team 
 
Employment History  
  Present Employer: 
 

Company Name:

  Address:
 
City:
     		 State:      
 Zip Code:
     
  Phone:
  Contact:
 
Employment Dates:     
 To:
     
Previous Employer  
  Previous Employer 1: List Most Recent Previous Employer First
  Company Name:
  Address:
 
City:
     		 State:     
Zip Code:
           Phone:
  Contact:
 
Employment Dates:     
 		To:
     
Previous Employer  
  Previous Employer 2: 
  Company Name:
  Address:
 
City:
     		 State:      
 		Zip Code:
      
  Phone:
  Contact:
 
Employment Dates:      
To:
   
Comments 
 

 

 

 

 
I Have Read The DAC Form And Authorize A DAC Background Check Yes    No


   
DISCLAIMER

I certify that I personally completed this application and that all of the information is true and correct.  I hereby authorize Jevic Transportation to conduct, 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, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold JEVIC & Jevic.com  harmless of all liability for providing this application for my use. 


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