update work history for Tester1 & Co
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New Updated Work History for Tester1 & Co
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PLEASE ANSWER ALL THE QUESTIONS ON THE APPLICATIONS - DO NOT SEND ANY MEDICAL INFORMATION WITH THIS APPLICATION.
Read and follow all instructions carefully.
VERY IMPORTANT!
The section entitled
"Employment Record"
must be completed correctly. You must list all employers, schools, military service and all periods of self-employment or unemployment for the most recent 10 full years. Dates, phone numbers and addresses must be correct with no period of time unaccounted for in the last 10 years.
Any offer of employment will be conditioned upon successfully completing: a DOT physical and company medical screening; drug screen; criminal background check and company road test.
Driver Qualification Application
Note:
Please answer or check all questions. If the answer to any question is "No" or "None," do not leave the item blank, indicate "No" or "None." This application will not be considered unless complete.
Date
*
MM slash DD slash YYYY
Today's Date
Applicant's name
*
First
Middle
Last
Email
*
Employment Record For The Past 10 Years
Begin with your current or most recent job and work backwards in order, listing your employers and any periods of unemployment for
at least 10 years
including all full and part-time employment. All time must be accounted for, including military service, school, self-employment, and periods of unemployment.
Number of previous jobs, including your current one
*
Please enter a number from
1
to
10
.
Current Or Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Second Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Third Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Fourth Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Fifth Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Sixth Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Seventh Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Eighth Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Ninth Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
Tenth Last Employer
From
*
MM slash DD slash YYYY
To
*
MM slash DD slash YYYY
Present Employer
Present
Company name
*
Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
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U.S. Virgin Islands
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West Virginia
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Phone number
*
Position held
*
What type of power unit?
*
Day Cab
Sleeper
Day Cab & Sleeper
N/A
What type of transmission?
*
Automatic
9 Speed
10 Speed
Super 10
13 Speed
15 Speed
18 Speed
N/A
What size of trailer did you pull?
*
24'
48'
53'
Other
Other trailer size
*
What type of trailer have you pulled?
*
Dry Van
Reefer
Flat Bed
Step Down
Low Boy
Curtain Side
Doubles
End Dump
Roll Off
Tanker
Belly Dump
Belt Trailer
Container
Car Hauler
Live Stock
Side Dump
Traveling Axel
Traveling Tail
Other
Other trailer type
*
Areas in which you drove
*
What type of deliveries have you done?
*
Local
Regional
Over The Road
LTL
Shuttle
N/A
How many stops did you do a day?
*
1 to 3
4 to 7
8 to 12
13 to 17
18 to 22
Shuttle
Who did you deliver to?
*
Warehouse/Distribution centers
Retail Outlets
End Users
N/A
How did you log your day?
*
Manual Log
Electronic Logging System
N/A
Reason for leaving
*
How were you paid?
*
Per Hour
Per Mileage
By Percentage of the Load
Other
Other how paid
*
Satellite communication
*
Yes
No
Were you subject to DOT regulations while working for this employer?
*
Yes
No
Were you required to perform safety sensitive functions (such as driving) subject to DOT drug and alcohol testing?
*
Yes
No
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