First Name

Last Name

Street Address

City

State

Zip Code

Country

Email Address

Phone Number

Best Time to Contact Best Time to Contact Anytime Morning Afternoon Evening

Preferred Contact Method Preferred Contact Method Phone Email

Social Security Number

Date of Birth

Citizenship CitizenshipUnited StatesMexicoCanadaOther

Permanent Resident Card Permanent Resident CardYesNoDoes Not Apply

CDL or Non-CDL Driver CDL or Non-CDL DriverCDL DriverNon-CDL Driver

Do you own a van? Do you own a van?YesNo

Year

Make

Model

CDL Number

CDL State

CDL Expiration (mm/dd/yyy)

Previous CDL

Previous CDL State

Driving Experience (check all that apply) Driving Experience (check all that apply) Expedite Doubles / Triples Dump Tanker Household Goods Van Automobile Specialized Heavy haul / Oversized Livestock Flatbed Dry bulk Refridgerated Boat

What Type of Driver are You? What Type of Driver are You?Company DriverOwner OperatorRecent GraduateCurrent Truck Driving School

What is Your Working Preference? What is Your Working Preference?Over the RoadLocalRegional

Driving Experience Driving ExperienceNone1-3 Months4-6 Months7-9 Months10-12 Months13-18 Months19-24 Months2+ Years3+ Years

Number of Moving Violations in the Last 3 Years Number of Moving Violations in the Last 3 Years12345678910+

Number of Preventable Accidents in the Last 3 Years Number of Preventable Accidents in the Last 3 Years12345678910+

Has Your License Been Suspended or Revoked? Has Your License Been Suspended or Revoked?YesNo

If Yes, What Year?

Have You Ever Been Convicted of a Felony? Have You Ever Been Convicted of a Felony?YesNo

If Yes, What Year?

Have You Ever Receive a DUI/DWI? Have You Ever Receive a DUI/DWI?YesNo

If Yes, What Year?

Present or Last Employer

Employed From (MM/DD/YYY)

Employed To (MM/DD/YYY)

Employer Address

City

State

Business Phone

Trailer Pulled Trailer Pulled Expedite Doubles / Triples Dump Tanker Household Goods Van Automobile Specialized Heavy haul / Oversized Livestock Flatbed Dry bulk Refridgerated Boat

Length of Trailer Pulled Length of Trailer Pulled53 feet48 feetLess than 48 feet

How Many States Ran? How Many States Ran?12345678910+

Did You Keep Logs Did You Keep LogsYesNo

Comments on This Job

Hours of Service & Log Book Quiz (Please answer the following true/false questions) Hours of Service & Log Book Quiz (Please answer the following true/false questions)

If you operate a Commercial Motor Vehicle (CMV) more than 100 miles from your home terminal, you must maintain an up-to-date log book. If you operate a Commercial Motor Vehicle (CMV) more than 100 miles from your home terminal, you must maintain an up-to-date log book. True False

Your log must show a TIRE CHECK every two hours. Your log must show a TIRE CHECK every two hours. True False

Your log graph should be current up to your last change of duty status. Your log graph should be current up to your last change of duty status. True False

You should always mark your times according to the time zone of your home terminal. You should always mark your times according to the time zone of your home terminal. True False

As a general rule, you must show at least 1/4 hour ON DUTY time when you fuel your truck. As a general rule, you must show at least 1/4 hour ON DUTY time when you fuel your truck. True False

When performing a pre-trip inspection, you are only required to inspect the tractor. When performing a pre-trip inspection, you are only required to inspect the tractor. True False

After 14 hours total on-duty or 11 hours total driving, you must take a 10-hour break before you can drive again. After 14 hours total on-duty or 11 hours total driving, you must take a 10-hour break before you can drive again. True False

The only way to extend the 14-hour on-duty limit is to take a break of at least eight hours, followed by a break of at least two hours which does not extend the limit. The only way to extend the 14-hour on-duty limit is to take a break of at least eight hours, followed by a break of at least two hours which does not extend the limit. True False

Filling in the SHIPPING INFORMATION is optional. Filling in the SHIPPING INFORMATION is optional. True False

You must keep a copy of your last seven days' logs in your truck at all times during operation. You must keep a copy of your last seven days' logs in your truck at all times during operation. True False

Which of the following is NOT required on your log by DOT? Which of the following is NOT required on your log by DOT? Your signature Total miles for the day 8-day recap Vehicle numbers

If you run according to an 8-day log cycle, how many hours may you be on duty during that period? * If you run according to an 8-day log cycle, how many hours may you be on duty during that period? * 60 70 75 80

How many hours (consecutive) must you be off-duty in order to qualify for the restart provision? How many hours (consecutive) must you be off-duty in order to qualify for the restart provision? 10 12 34 36

Which of the following should be entered on the "SHIPPING INFO" line? Which of the following should be entered on the "SHIPPING INFO" line? Trip or Pro Number Shipper and Commodity Bill of Lading Number A, B or C

What is the maximum number of miles you may log in one day? What is the maximum number of miles you may log in one day? 600 650 700 Depends on Where You Run

Statement of Understanding Notice Regarding Background Reports 1. In connection with your application for employment with Barrett DirectLine, Inc (“Prospective Employer”), it may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name,address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: 2. I authorize Barrett DirectLine, Inc (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. 3. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. 4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain theinformation authorized above. I certify that I personally completed this application and that all of the information is true and correct. I authorize the Prospective Employer to obtain any and all information (including, but not limited to, work history, alcohol/controlled substance testing, training records, and criminal history) from previous and current employer(s), Medical Review Officer or their agent, DAC services, or other consumer reports, in accordance with State and Federal laws. I authorize my previous and current employer(s) to release any information requested by the above carriers and hold them harmless of all liability from release of said information. I have read and understand the above statements and acknowledge by affixing my digital signature below. I have read and understand the above. Statement of Understanding Notice Regarding Background Reports 1. In connection with your application for employment with Barrett DirectLine, Inc (“Prospective Employer”), it may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name,address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: 2. I authorize Barrett DirectLine, Inc (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. 3. I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. 4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain theinformation authorized above. I certify that I personally completed this application and that all of the information is true and correct. I authorize the Prospective Employer to obtain any and all information (including, but not limited to, work history, alcohol/controlled substance testing, training records, and criminal history) from previous and current employer(s), Medical Review Officer or their agent, DAC services, or other consumer reports, in accordance with State and Federal laws. I authorize my previous and current employer(s) to release any information requested by the above carriers and hold them harmless of all liability from release of said information. I have read and understand the above statements and acknowledge by affixing my digital signature below. I have read and understand the above. Yes No