Owner Operator Application:
Owner Operator Name:
Social Security Number:
Street:
City:
State:
Zip Code:
Phone Number:
Cell Number:
E-Mail:
Date of Birth:
Age:
How did you find out about CHTL?
Referred by:
Years of verifiable OTR experience:
CDL # / State:
Date Available:
Tractor: Year
Make
#Accidents (Last 3 years):
# Moving Violations (Last 3 years):
Years with Motor Vehicle License:
Hazmat Endorsement? Yes
No
License ever suspended? Yes
No
Any reckless driving charges? Yes
No
Have you tested positive or refused a drug screen and / or Alchohol test within the past 2 years?
Yes
No
Any DUI charges? Yes
No
Any felony convictions? Yes
No
PREVIOUS THREE EMPLOYEERS:
Employer 1:
Current or Previous Employer:
Job Description:
Street:
City:
State:
Zip Code:
From:
To:
FPC Phone:
Reason for leaving:
Employer 2:
Current or Previous Employer:
Job Description:
Street:
City:
State:
Zip Code:
From:
To:
FPC Phone:
Reason for leaving:
Employer 3:
Current or Previous Employer:
Job Description:
Street:
City:
State:
Zip Code:
From:
To:
FPC Phone:
Reason for leaving:
I certify that I personally completed this application and that all of the information is true and correct. I authorize CHTL to conduct a thorough background investigation in accordance with state and federal law and authorize my previous employers to release any information requested by CHTL and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR Part 382.405 and 382.413, I hereby authorize and require my previous and/or current employers specifically listed by me on this application to release the results (including any refusal to test) of all drug and alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment to CHTL by whatever means is most expedient.
© 2003 CHTL Trucking. All Rights Reserved.
