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Commercial Driver Application

Complete all sections below in order. Your information will be automatically filled across all required forms.

Motor Vehicle Record Disclosure and Release Form

In connection with my ongoing employment or my application for employment, should I have or secure a position with Highway Trucking LLC, I understand that a motor vehicle record, which contains public record information, may be requested.
I authorize, without reservation, any party or agency contacted to furnish the above mentioned information to Highway Trucking LLC or its agent.

Personal Information


COMMERCIAL DRIVER APPLICATION

Company: Highway Trucking LLC

Applicant Information

Your name, address, phone, emergency phone, date of birth, and SSN from above will be used here automatically.

CURRENT & PREVIOUS THREE YEARS ADDRESSES

Your current address from above will be used automatically. List previous addresses if you moved in the past 3 years.

Previous Address 1 (if applicable)

HAVE YOU WORKED FOR THIS COMPANY
BEFORE?

If yes, give dates:

EDUCATION HISTORY

Please circle the highest grade completed

Grade School (1-12) *
Grade College (1-4)

EMPLOYMENT HISTORY

Give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self employment periods, and all commercial driving experience for the past ten (10) years.

Present or Last Employer

Additional Employment History

If you have additional employers beyond your present or last employer, click the button below to add them.

DRIVING EXPERIENCE

Class of Equipment From To Approximate Number of Miles
Tractor & Semi trailer

Accident Record for past three (3) years

Complete the following for any accidents that the applicant was involved in the last 3 years prior to the application date shown above. If none please check the box.

Date of Accident Nature of Accidents
(Head on, rear end, etc)		 Location of
Accident		 # of
Fatalities		 # of People
Injured		 Action

Driver's License (list each driver's license held in the past three(3) years)

State License Type Endorsements Exp Date Action

Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations)

Date Location Charge Penalty Action

Background Information

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

Has any license, permit or privilege ever been suspended or revoked?

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?

Have you ever been convicted of a felony?

JOB REFERENCES

List persons for references, other than family members, who have knowledge of your safety habits.

Reference 1

To be Read and Signed by Applicant

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant's background to obtain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of his furnishing such information.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Employment Eligibility Verification

Department of Homeland Security

U.S. Citizenship and Immigration Services

USCIS Form I-9

OMB No. 1615-0047 | Expires 10/31/2022

►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form.

Your personal information from above will be used here automatically.

Citizenship Status

PSP AUTHORIZATION

IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

Highway Trucking LLC

I authorize Highway Trucking LLC ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years.

I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov.

If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.

I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's consent.

The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of "employee" contained at 49 C.F.R. 383.5. LAST UPDATED 12/22/2015

Your name and signature date from below will be used automatically.

HIGHWAY TRUCKING, LLC.

INDEPENDENT CONTRACT DRIVER AND POLICY AGREEMENT

Please read each section carefully and provide your initials to acknowledge understanding.

1. Independent Contract Driver Status. I understand that I am an independent Contract Driver. This Agreement shall remain in full force and effective for a 1-year period beginning on the date first written above and continuing thereafter on a year-to-year basis. Either party may terminate this Agreement at any time, with or without cause. Contractor initials *:
2. Equipment Responsibility. I understand that I am responsible for any of Highway Trucking Equipment in which I will be using and or assigned to me to provide my services. Contractor initials *:
3. Contract Modifications. I understand that additions and deletions can be made at any time to this contract policy agreement by Highway Trucking, LLC. and I will be provided with a new copy to review and understand in a timely manner before signing. Contractor initials *:
4. Right to Refuse Jobs and Termination. I understand as a contract driver, I have a right to refuse any job offered and terminate contract at any time. If I decide to terminate contract while I have an open load already scheduled to deliver or pick up, I will be responsible all cost or fines occurring related to matter. Highway Trucking, LLC. has a right to hold my funds in account receivables. Contractor initials *:
5. Tax Responsibility. I understand that I am responsible for filing my own taxes with the Internal Revenue Service and Resident State Revenue Department. Highway Trucking, LLC will provide me with a 1099 form. Contractor initials *:
6. No Guarantee of Loads or Revenue. I understand that Highway Trucking, LLC. Does not guarantee, nor am I obligated to haul a specific amount of loads or earn amount of revenue. Contractor initials *:
7. DOT and FMCSA Regulations. I agree to follow up and uphold all regulations set by the Department of Transportation and Federal Motor Carrier Safety Administration. Contractor initials *:
8. Zero Tolerance Policy. I understand that Highway Trucking, LLC. Has a zero tolerance policy and does not permit anything that is deemed contraband or illegal by the laws of the United State of America and accept full responsibility and penalties due to my own actions regarding this policy. Contractor initials *:
9. Damage Deductible. I understand contractor is responsible for the first $1,000 deductible in case of damage to tractor and trailer. Contractor initials *:
10. Authorized Trip Routes. I understand taking the tractor and trailer anywhere other than authorized trip origin route and destination or my personal places of residence requires written authorization. (electronic messages accepted). Contractor initials *:
11. Truck Service Requirements. I understand that the truck must be serviced every 15,000-20,000 miles and receipts will be required. Contractor initials *:
12. Random Vehicle Inspection. I understand that Highway Trucking LLC. At any time can request a random viewing of the truck or trailer. Contractor initials *:
13. Equipment Return Requirements. I understand that the truck and trailer assigned to me must be returned in a timely manner and in clean and working operating condition at the request of Highway Trucking, LLC. Contractor initials *:
14. Abandonment and Recovery Expenses. I understand if I do not return the truck and trailer assigned to me to Highway Trucking, LLC. Upon their request, this is considered abandonment and I will be liable for any and all recovery expenses that Highway Trucking, LLC. Incurs getting the truck returned to them. Contractor initials *:
15. Two Weeks' Notice Requirement. I understand If I the Contractor Do not give a 2 weeks' notice before quitting I agree to forfeit my remaining pay. Contractor initials *:
16. Damage Liability. I understand if any damages are caused to the Truck or Trailer by the Contractor, I will be held liable for repair costs and will be deducted from my pay. Contractor initials *:
17. Abandonment Defense Waiver. I understand that due to my abandoning truck and trailer I waive the right to use the trucking phrase “abandonment” as my defense if the units are stolen as a result of abandonment. I understand that it is my responsibility to return the assigned truck and trailer to Highway Trucking, LLC. and that criminal charges can and will be brought against me for commercial vehicle theft by the City of Akron, Akron Police Department if I fail to do so. Contractor initials *:
18. Document Retention Responsibility. It is my responsibility to make and keep copies of the Vehicle Trip Report, Vehicle Expense Reports, Bill of Lading and all receipts of each trip until Highway Trucking LLC. Has been paid by the broker or shipper and I have been paid by Highway Trucking, LLC. If the original copies are lost in the mail or due to negligence and I cannot provide copies I will be responsible for all expenses and lost earnings to Highway Trucking, LLC. As well as my loss of pay for the said load. Contractor initials *:

Final Agreement Statement:

Contract Driver: I understand and agree to the terms in this contract.

Your signature and date from the Final Signature section below will be used to complete this agreement.

Applicant Signature and Certification

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Electronic Signature Consent and Legal Notice

By signing this application electronically, you acknowledge and agree that:

  • Your electronic signature has the same legal effect as a handwritten signature
  • You have read and understand all terms and conditions of this application
  • You consent to the use of electronic signatures in lieu of paper-based signatures
  • You understand that your signature will be permanently associated with this document
  • You have the legal authority to sign this document on your own behalf
This electronic signature is governed by the Electronic Signatures in Global and National Commerce Act (ESIGN Act) and the Uniform Electronic Transactions Act (UETA). Your signature, along with metadata including timestamp, IP address, and device information, will be recorded as part of the audit trail for this document.
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