Owner-Operator Form Owner/Operator InformationFirst NameMiddle NameLast NameDate of Birth:Age:Physical 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 SaharaYemenZambiaZimbabweContact InformationPhone Number:EmailEmergency Contact:Emergency Phone:Emergency Email: I have read and agree to the T & CPreviousNextOwner Operators Questionnaire SELECT ALL ANSWERS THAT PERTAIN TO YOU FOR EACH QUESTION IN THE ORDER FROM MOST IMPORTANT TO LEAST IMPORTANT.If agreed to start, when are you available to start?TodayTomorrow5 DaysOne Week10 Days2 WeeksMore Than 2 WeeksOtherCommentWhat do you prefer best Local, Regional or Over the Road driving?LocalRegionalOver the RoadOtherCommentHow do you preferred to be paid?HourlyPercentageBy the mileOtherCommentWhat are you looking for in a Benefit Package?Higher IncomeBonusesInsuranceOvernight Per Diem401K MatchingOtherCommentWhy are you looking to change companies?Higher WageBenefitsMore Family TimeHome Every NightWeekends OffOtherCommentWhat is your preferred annual income after cost of operations?$25,000 to $35,000$35,000 to $50,000$50,000 to $75,000$75,000 to $100,000$100,000 & MoreOtherCommentWhat endorsements do you have?(H)Hazardous Materials(N)Tank Vehicle(P)Passenger(T)Double/Triples(X)Tanker/Hazardous MaterialsOtherCommentWhat is the manufacturer?PeterbuiltKenworthVolvoFreightlinerMackOtherCommentWhat are the model(s) of your truck(s)?What are the Years(s) of your truck(s)?Do have plans to add more trucks? Yes NoIf so how many?1 to 23 to 45 to 10OtherCommentPreviousNextDriving 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 All entries on the questionnaire are true to best of my knowledge Previous
