Owner Operator Application

SLP Owner/Operator Application

Personal Information

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Social Security Number *

CDL/Drivers License Number *

State issued *

DATE OF BIRTH

MONTH *

Date *

Year *

Total Number of years experience as an Owner/Operator

Years as Owner Operator *

Months

HouseHold goods experience??? *

TradeShow Experience??? *

Former Employers (most recent first)

DATES

From-month *

Year *

To-month *

Year *

Company name *

Address *

City *

State *

Phone number *

Supervisor *

Reason for Leaving *

Next Employer

From-month

Year

To-Month

Year

Company

Address

City

State

Phone Number

Supervisor

Reason for Leaving

Next Employer

From-month

Year

To-Month

Year

Company

Address

City

State

Phone Number

Supervisor

Reason for Leaving

Do you have any Traffic Convictions? *

IF YES DESCRIBE BELOW

Name of Court

Location

Date

Charge

Penalty

Driving Accidents

Date

Vehicle Driven(Truck, Bus, Auto)

Nature of Accident

Injury or Fatality (yes/no)

Have you ever been convicted of, or forfeited bond or collateral upon, any of the following charges? Or, do you currently have any of the following charges pending against you?

A Felony? *

A felony, the commission of which involved the use of a motor vehicle? *

A crime involving the manufacturing, knowing transportation, knowing possession, sale, or habitual use of amphetamines, a narcotic drug, a formulaton of an amphetamine or a derivative of a narcotic drug? *

Operating motor vehicle under the influence of alcohol, an amphetamine or narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug? *

Leaving the scene of an accident which resulted in personal injury or death? *

A misdemeanor witha disposition (charge) date occurring in the last 12 months? *

A DOT violation(s) or refusal(s) to test and/or DOT alcohol violation(s) or refusal(s)? *

An alcohol test with a concentration result of .04, or greater, or have a verified positive controlled substances test? *

If yes to any of the above questions, explain in detail giving dates, city and state.

more details.....

Business and Personal References(please list at least 4 references)

Name *

Occupation *

Mailing address *

Phone Number *

Name *

Occupation *

Mailing address *

Phone Number *

Name *

Occupation *

Mailing address *

Phone Number *

Name *

Occupation *

Mailing address *

Phone Number *

Select Companies you want to recieve your application *

American Central Transport	Boyd Brothers Transportation	Comtrak Logistics	Covenant Transport	CRST Malone
FFE	Fikes Truck Line	Hurricane Express	John Christner Trucking	KLLM
Koch Trucking	Maverick Transportation	Mercer Transportation	Paschall Truck Lines	Prime Inc.
Tango Transport