Click Here, If you wish to download the application to your desktop, print it out, and fax it to Summit Express, Inc (260-471-7464).
Applicants are considered for positions without regard to race, color, religion, creed, age, sex, handicap, or national origin. All areas of application must be accurately completed. Thank you.
Step 1: Complete the owner-operator application
* - Required Fields
1. PERSONAL INFORMATION
Today's Date:
*Full Name:
Maiden Name (if any):
*Home Phone Number
Cellular Phone Number:
*E-mail Address:
*Current Address:
Addresses For Past Three Years:
*Emergency Contact:
*Date Of Birth**:
**The U.S. Dept. of Transportation requires that driver applicants state their date of birth (391.21 (b)(2).
*Social Security Number: --
*Are you a citizen of the United States? Yes No
*If no, do you possess a valid work permit? Yes No
2. EXPERIENCE & QUALIFICATIONS
*Driver's License Numbers:
State: Type: Exp. Date:
State: Type: Exp. Date:
State: Type: Exp. Date:
*Have you ever been convicted of a felony?: Yes No
If yes, please explain:
*Have you ever been convicted of DUI/DWI or reckless driving?: Yes No
If yes, please explain:
*Have you tested positive or refused a drug screen in the past 2 years?: Yes No
If yes, please explain:
*Have you ever had any license, permit or privilege suspended or revoked?: Yes No
If yes, please explain:
3. DRIVING EXPERIENCE
TYPE
TRAILER
LENGTH
DATES:
FROM
DATES:
TO
APPROXIMATE #
OF TOTAL MILES
STATES
OPERATED
Tractor with
Flatbed
Tractor with
Van
Tractor with
Reefer
Tractor with
Tank
Straight
Truck
Other
(specify)
Other
(specify)
4. MOTOR VEHICLE ACCIDENT RECORD FOR PAST 3 YEARS (Preceding date of application)
DESCRIPTION OF
ACCIDENT
DATE
LOCATION
INJURIES OR FATALITIES
TYPE OF VEHICLE
5. TRAFFIC VIOLATIONS IN PAST 3 YEARS (Other than parking violations)
DATE
VIOLATION
LOCATION
PENALTY
*Have you ever been denied a license, permit or privlege to operate a motor vehicle? Yes No
If yes, please explain:
*Has any license, permit or privever been suspended or revoked? Yes No
If yes, please explain:
6. PREVIOUS EMPLOYERS
The U.S. Department of Transportation requires commercial driving experience to be listed for past 10 years.
*Previous Employer Name:
*Supervisor:
*Address:
*Phone Number:
*Dates of Employment:
From: To:
*Reason for Leaving:
Employer 2
Previous Employer Name:
Supervisor:
Address:
Phone Number:
Dates of Employment:
From: To:
Reason for Leaving:
Employer 3
Previous Employer Name:
Supervisor:
Address:
Phone Number:
Dates of Employment:
From: To:
Reason for Leaving:
Employer 4
Previous Employer Name:
Supervisor:
Address:
Phone Number:
Dates of Employment:
From: To:
Reason for Leaving:
7. PHYSICAL HISTORY
*Date of Last USDOT Physical Examination:
*Doctors Name:
Phone Number:
Address:
8. EDUCATION
Highest grade completed:
1. 2. 3. 4. 5. 6. 7. 8.
High School:
9th. 10th. 11th. 12th.
College:
1 year 2 years 3 years. 4 years
Last School Attended:
Driving School:
9. TO BE READ AND AUTHORIZED BY APPLICANT
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. I understand that any false, misleading, or misrepresentation of information given shall be considered an act of dishonesty and grounds for refusing a contract hire opportunity or terminating lease agreement.
I agree and understand that the company may investigate my background, including my past employment, education, and driving record. I further agree to indemnify Summit Express, Inc. against any liability that may result from making such an investigation.
I understand that if offered a contract hire opportunity, I will be required to take a physical examination if applicable, and a pre-employment drug screen and authorize the company chosen physician to release any information which may be necessary to determine my ability to perform the duties of the job.
