Driver Application

Please fill the following documents

Items marked This form are completed on the application below. Items marked Fill online open a secure online form. Questions: bwtansport@bwtllc.net.

1. Application for independent contractor driver status.This form ↓
2. Independent contractor agreement.Signed with the office at hire.At hire
3. Motor vehicle report and background check disclosure and release.This form ↓
4. Consent to drug and alcohol testing.All CDL drivers must register with the FMCSA Clearinghouse — clearinghouse.fmcsa.dot.gov. Disregard if already registered; let us know if you need help.This form ↓
5. Request for information from previous employer.This form ↓
6. Deduction agreement.This form ↓
7. Medical examination and driving record requirements.This form ↓
8. W-9Fill online
9. W-4Fill online
10. Employment eligibility verification (Form I-9).Download
11. Company speed policy.Acknowledged on the form below ↓ReadDownload
12. Comprehensive safety and compliance policy.Acknowledged on the form below ↓ReadDownload
13. Driver evaluation.Completed by the office during your road test.Office
14. TSA/STA form.Office
15. Drug test form.Office

Application for Independent Contractor Driver Status

All information is kept confidential. Fields marked * are required.

Full Legal Name (Last, First, M.I.) *

First

Last

Social Security Number *

Date of Birth *

Home address: Street address *

Apt / Unit

City *

State *

ZIP code *

Have you lived at this address for the last 5 years? (If No, list your previous addresses below) *

• Yes
• No

Previous address I: street address

Apt / Unit

City

State

ZIP code

Previous address II: Street address

Apt / Unit

City

State

ZIP code

Previous address III: Street address

Apt / Unit

City

State

ZIP code

Phone Number *

Email Address *

Do you have a valid driver’s license? (If NO, stop and contact the office manager) *

• Yes
• No

Driver’s License Number *

State of Issue *

License Expiration Date *

Commercial Driver’s License (CDL) Class *--- Select Choice ---Class AClass BClass CNo CDL

Has your driver’s license ever been suspended or revoked? *

• Yes
• No

Have you ever been convicted or pled guilty or no contest to a D.U.I. or D.W.I. charge? *

• Yes
• No

If yes, please explain (D.U.I./D.W.I.)

Have you had any accidents during the last three (3) years? *

• Yes
• No

If yes, how many accidents?

Have you had any moving violations during the past three (3) years? *

• Yes
• No

If yes, how many moving violations?

If hired, on what date can you start working? *

Can you work weekends? *

• Yes
• No

High School: name of school

City / State

Years completed

Graduated?

• Yes
• No

Degree / Major

College: name of school

City / State

Years completed

Graduated?

• Yes
• No

Degree / Major

Technical School: name of school

leaving phone name

City / State

Years completed

Graduated?

• Yes
• No

Degree / Major

Other education, training or certifications (optional)

Employer #1: employer name *

Address

City

State

ZIP code

Position held *

From (month/year) *

To (month/year)

Supervisor name

Supervisor phone

Reason for leaving

Employer #2: employer name

Address

City

State

ZIP code

Position held

From (month/year)

To (month/year)

Supervisor name

Supervisor phone

Reason for leaving

Employer #3: employer name

Address

City

State

ZIP code

Position held

From (month/year)

To (month/year)

Supervisor name

Supervisor phone

Reason for leaving

Are you at least 21 years of age? (If NO, contact the office manager) *

• Yes
• No

Have you ever been convicted of a Felony? *

• Yes
• No

If yes, please explain (Felony)

Have you been convicted of a misdemeanor in the last two (2) years? *

• Yes
• No

If yes, please explain (misdemeanor)

Are you presently charged with committing a criminal offense? *

• Yes
• No

If yes, please explain (current charge)

Have you used illegal drugs in the last five (5) years? *

• Yes
• No

If yes, please explain (drug use)

Reference #1: full name (not a relative) *

Relationship to you

Phone number *

Address

Reference #2: full name (not a relative) *

Relationship to you

Phone number *

Address

Reference #3: full name (not a relative) *

Relationship to you

Phone number *

Address

Application Acknowledgment *

• I acknowledge that the information contained in this application is true and complete to the best of my knowledge, and I understand that any false information on this application may be grounds for termination.

Motor Vehicle Report and Background Check Disclosure and Release *

• In connection with my application to provide services as an Independent Contractor for BWT LLC, I understand that consumer reports that may contain public record information may be obtained from various sources at BWT LLC's discretion, including but not limited to prior employers, driving record, worker's compensation claims, credit, bankruptcy proceedings, and criminal records from Federal, State, and other agencies, to determine my eligibility to provide services as an independent contractor to BWT LLC. I authorize, without reservation, any party contacted on behalf of BWT LLC to furnish this information, and I hereby authorize procurement of consumer report(s). This authorization shall remain on file as ongoing authorization to procure consumer reports at any time during my contract period.

Consent to Drug and Alcohol Testing *

• I understand and agree that as a condition for my application being considered, I am required to undergo a test for drugs and/or alcohol. I voluntarily and freely give my consent to such test, having been fully informed of the test procedure and what I am being tested for, and that a copy of the results be placed in my record if I am ultimately contracted. I understand that a positive test result for controlled substances means I am not qualified to operate a commercial vehicle for BWT LLC and my contract will be terminated immediately, and that the cost of the drug test will be deducted from my final paycheck.

Independent Contractor Status Acknowledgment *

• I acknowledge that if contracted, I will not be an employee of BWT LLC or any of its affiliates, but an Independent Contractor. BWT LLC will not withhold my Federal or State income taxes or pay Social Security, Medicare, Workers' Compensation, State Disability, or Unemployment Insurance on my behalf, and I am not eligible to participate in any employee benefit programs. I understand these obligations are my own, and that a separate Independent Contractor Agreement will be executed upon hire covering the term, duties, and other conditions of the contractor relationship.

Request for Information From Previous Employer *

• I hereby authorize BWT LLC to request and release information from and to my previous employers for the purposes of investigation as required by Sections 391.23, 391.89 and 382.413 of the Federal Motor Carrier Safety Regulations, and I release all parties from any and all liability that may result from furnishing such information.

Deduction Agreement *

• I authorize BWT LLC to deduct from my pay: any and all cash advances received by me; repayment of all fines, penalties or damages paid by BWT LLC and incurred or suffered as a result of my negligence or wrongful action; damage to company vehicle (cost to repair); late deliveries which are late due to no fault of BWT LLC; lost or damaged cartons (cost to BWT LLC); damaged or lost pallets (cost to repair or replace); and other driver error (cost to correct such errors). I understand such charges shall be deducted from my weekly paycheck, and I acknowledge receipt and understanding of this Deduction Agreement.

Medical Examination and Driving Record Requirements *

• I understand that, in order to comply with DOT regulations, I am required to pass a medical examination conducted by a licensed health care professional, and to provide BWT LLC with a copy of the Medical Examiner's Certificate within 14 days. I understand it is my responsibility to inform BWT LLC of any changes in my driving record, including but not limited to moving violations, citations, cancellations, and/or suspensions.

Company Speed Policy and Comprehensive Safety and Compliance Policy *

• I acknowledge that I have received, read, and understand BWT LLC's Company Speed Policy and Comprehensive Safety and Compliance Policy, including the Safe Driving Policy and Disciplinary Measures sections, and I agree to comply with them.

Applicant Printed Full Name (serves as your electronic signature for all acknowledgments above) *

Date *

Electronic Signature Consent *

• By typing my name above and submitting this form, I am electronically signing this application and all of the acknowledgments contained within it, with the same legal effect as a handwritten signature.

Submit