Transportation Companies Form Transportation Company InformationCompany NamePhone Number:Email AddressContact Person InformationPhone Number:Email AddressFirst NameMiddle NameLast NameTitlePhysical AddressAddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweMailing AddressNumber/PO BoxStreet:Apt/Suite: AddressCityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe I have read and agree to the T & CPreviousNextTransportation Company Questionnaire SELECT ALL ANSWERS THAT PERTAIN TO YOU FOR EACH QUESTION IN THE ORDER FROM MOST IMPORTANT TO LEAST IMPORTANT.When would you like the driver to be available to start?TodayTomorrowOne Week10 Days2 WeeksMore Than 2 WeeksOtherCommentWhat do you offer: Local, Regional or Over the Road driving?LocalRegionalOver the Road drivingOtherCommentHow do you pay?HourlyPercentageBy the mileOtherCommentWhat do you offer in the way of Benefit Packages?WagesProfit SharingBonusesInsuranceSick LeaveOvernight Per Diem401K MatchingOtherCommentWhy are you looking to add drivers?Driver Left The CompanyRetirementDriver DeathDriver FiredOtherCommentHow do you prefer a driver obtains their CDL?Company TrainingCDL SchoolCDL Driver TrainedSelf TaughtOtherCommentHow much experience do you need a driver to have?1 Yr or Less2 Yrs3 Yrs4 to 6 Yrs6 to 9 Yrs10 Yrs or MoreOtherCommentWhat endorsements do you want a driver to have?(H)Hazardous Materials(N)Tank Vehicle(P)Passenger(T)Double/Triples(X)Tanker/Hazardous MaterialsOtherCommentWhat type of employee are you looking for?Team playerLoyalEfficientGreat Work EthicGets Things DoneReliableHigh AchieverOtherCommentPreviousNextDriving Personality Questions SELECT ALL ANSWERS THAT PERTAIN TO YOU FOR EACH QUESTION IN THE ORDER FROM MOST IMPORTANT TO LEAST IMPORTANT.How would you describe your driving record?ExcellentAbove AverageAverageBelow AverageOtherCommentWhy?What motivates you to get a load delivered on time and safely?Personal AccomplishmentCompany RecognitionJob DutiesOtherCommentWhat are your strengths?SkillsTraffic AwarenessMechanical AwarenessCommunicationAttitudeWork EthicOtherCommentWhat are your Weaknesses?SkillsTraffic AwarenessMechanical AwarenessCommunicationAttitudeWork EthicOtherCommentWhat are your hobbies and things you like to do on your off time?FishingHuntingWatching SportsFamily TimeWoodworkingRelaxingYard WorkOtherCommentWhat may cause you to miss work?SicknessDr. AppointmentFamily Issue or EmergencyTo Tired From Long HoursCar TroubleDeath of Love OneOtherCommentHow do you stay focused on the highway when driving?Commit To No Phone UsageRoute is GPS'dNo MultitaskingResting When NeededPre-Planed Play ListOtherCommentHave you ever caused an accident? Yes NoWhat caused the accident(s)?SpeedingDriver FatigueD.U.I.Distracted DrivingFollowing to CloseMaintenance IssueCargo Load SiftingOtherCommentWhat’s the most important steps to take if you are in an accident?Call 911Call DispatchGet a Medical EvaluationCheck Everyone For InjuriesObtain Witness Contact InformationSecure The Scene. Render First Aid if NeededNotify Police & CompanyOtherCommentDoes being stuck in traffic stress you out?YesBut Doesn't Affect My DrivingI Get Anxious & Need a BreakNoJust Part of the JobOtherCommentHow do you deal with late loads because of traffic or mechanical issues?Contact Customer to RescheduleContact Dispatch to Contact CustomerMake Up Time by Speeding SlightlyContinue After being SlowedOtherCommentIf you received incorrect information from dispatch how do you handle it?Call General Manager to ComplainCall Dispatch and ComplainCall Dispatch to Correct the MistakeOtherCommentHow do you keep in good standings with company customers?Always Be Friendly and PersonableNever Speak to ThemSearch them out to Say HelloOtherCommentWhat would you do if someone that you were working with was stealing?Confront the DriverTell ManagementTell the Other Drivers About itKeep to MyselfOtherCommentWhat vehicle Manufacturers have you driven?MackWester StarFreightlinerVolvoKenworthPeterbiltOtherCommentWhat transmissions have used?Automatic15 Speed13 SpeedOtherCommentWhat Trailers have Pulled?ContainersDoubles/TriplesTankerCurtain VanFlatbedDry VanOtherComment The verification of all questions on referral questionnaires are the responsibility of the hiring company Previous
