DRIVER APPLICATION FOR CONTRACT

Company

Address

City State Zip

(answer all questions- please print)

In accordance with Federal and State equal employment opportunity laws, qualified applicants

are considered for all positions without regard to race, color, religion, sex, national origin, age,

marital status, or non-job related disability.

Position(s) Applied for

Last Name First Name MI

Social Security Number

List your addresses of residency for the past 3 years.Current Address

Street City State Zip

Phone How Long?

Previous Address

Street City State Zip

Phone How Long?

Street City State Zip

Phone How Long?

Street City State Zip

Phone How Long?

Do you have the legal right to work in the United States?

Date of Birth: Can you provide proof of age? YES NO

Have you worked for this company before? YES NO Where?

Dates: From: To: Salary: Position:

Reason for leaving

Are you now employed? If not, how long since leaving last employment?

Who referred you? Rate of pay expected

Is there any reason you might be unable to perform the functions of the job for which you have applied?

If Yes, explain if you wish.

Taxi Freight LLC101 Colony Park Drive Suite 300 Cumming GA 30040

Please complete and fax application to 1-866-591-8483Phone: 770-871-5015

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employersduring the preceding 10 years. List complete mailing address, street number, city, state and zip code. Backgroundcheck will be performed for the previous 3 years.

(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

EMPLOYER DATENAME

FROM MO YR

TO MO YR

ADDRESS POSITION HELD

CITY STATE ZIP SALARY/WAGE

CONTACT PERSON PHONE NUMBER REASON FOR LEAVING

Subject to FMCSR's while employed? YES NO Was this job designated as safety-sensitive in any DOT regulated mode subject to alcohol & controlled substances testing?

YES NO

EMPLOYER DATENAME

FROM MO YR

TO MO YR

ADDRESS POSITION HELD

CITY STATE ZIP SALARY/WAGE

CONTACT PERSON PHONE NUMBER REASON FOR LEAVING

Subject to FMCSR's while employed? YES NO Was this job designated as safety-sensitive in any DOT regulated mode subject to alcohol & controlled substances testing?

YES NO

EMPLOYER DATENAME

FROM MO YR

TO MO YR

ADDRESS POSITION HELD

CITY STATE ZIP SALARY/WAGE

CONTACT PERSON PHONE NUMBER REASON FOR LEAVING

Subject to FMCSR's while employed? YES NO Was this job designated as safety-sensitive in any DOT regulated mode subject to alcohol & controlled substances testing?

YES NO

EMPLOYER DATENAME

FROM MO YR

TO MO YR

ADDRESS POSITION HELD

CITY STATE ZIP SALARY/WAGE

CONTACT PERSON PHONE NUMBER REASON FOR LEAVING

Subject to FMCSR's while employed? YES NO Was this job designated as safety-sensitive in any DOT regulated mode subject to alcohol & controlled substances testing?

YES NO

ACCIDENT HISTORY

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE

DATES NATURE OF ACCIDENT (head-On, Rear-End, etc.) INJURIES

LAST ACCIDENT NEXT PREVIOUS NEXT PREVIOUS

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

LOCATION DATE CHARGE

ATTACH SHEET IF MORE SPACE IS NEEDED

EDUCATION CIRCLE HIGHEST GRADE COMPLETED: 1 2 3 4 5 6 7 8 HIGH SCHOOL: 1 2 3 4 COLLEGE: 1 2 3 4

LAST SCHOOL ATTENDED: NAME:

EXPERIENCE AND QUALIFICATIONS STATE LICENSE NO. TYPE EXPIRATION DATE

DRIVER LICENSES

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No B. Has any license, permit or privilege been suspended or revoked? Yes No

IF THE ANSWER TO EITHER A OR B IS YES, ATTACH STATEMENT GIVING DETAILS

DRIVING EXPERIENCE IF NONE, WRITE NONECLASS OF EQUIPMENT TYPE OF EQUIPMENT DATES APPROX. # MILES (VAN, TANK, FLAT, ETC.) FROM TOTAL

STRAIGHT TRUCK

TRACTOR/ SEMI-TRAILER

TRACTOR/ TWO TRAILERS

MOTORCOACH/SCHOOL BUS

OTHER

LIST ALL STATES WHERE YOU HELD A CDL LICENSE OR CDL PERMIT IN THE PAST THREE YEARS:

SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER

WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?

EXPERIENCE AND QUALIFICATIONS - OTHER SHOW ANY TRUCKING, TRANSPORTATION OR OTHER DRIVING EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY

LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION

LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN ALREADY SHOWN)

TO BE READ AND SIGNED BY APPLICANT This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal,employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. This includes contacting previous employers for the purpose of investigating my safety performancehistory as required in 391.23. I realize I have the following rights: The right to review information provided by myprevious employers. The right to have errors in the information corrected by the previous emplyers. The right to have a rebuttal statement attached to the alleged eroneous information if the previous employer and I cannotagree on the accuracy of the information. (Generally, inquiries regarding medical history will be made only if andafter a conditional offer of employment has been extended.) I hereby release employers, schools, health careproviders and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

Date Applicant's Signature

PROCESS RECORD APPLICANT HIRED REJECTED DATE EMPLOYED POINT EMPLOYED DEPARTMENT CLASSIFICATION (IF REJECTED, SUMMARY REPORT OF REASONS SHOULD BE PLACED IN FILE)

THIS SECTION TO BE FILLED IN BY RESPONSIBLE OFFICER OR COMPANY REPRESENTATIVE

SUPERIOR GOOD FAIR BELOW AVERAGE WRITTEN RECORD ON FILE1. APPLICATION 2. INTERVIEW 3. PAST EMPLOYMENT 4. WRITTEN EXAM 5. ROAD TEST 6. CRIMINAL AND 7. TRAFFIC CONVICTIONS

SIGNATURE OF INTERVIEWING OFFICER

TRANSFERS FROM: TO: FROM: TO: DATE: DATE: REASON FOR TRANSFER: REASON FOR TRANSFER:

FROM: TO: FROM: TO: DATE: DATE: REASON FOR TRANSFER: REASON FOR TRANSFER:

TERMINATION DATE TERMINATED: DEPARTMENT RELEASED FROM:

DISMISSED: VOLUNTARILY QUIT OTHER:

TERMINATION REPORT PLACED IN FILE SUPERVISOR:

PROGRAM PARTICIPANT AGREEMENT

ALL NEW HIRES OR TRANSFERS TO A CDL POSITION MUST HAVE A PRE-

EMPLOYMENT DRUG SCREEN. PLEASE USE THE CHAIN OF CUSTODY FORM PROVIDED BY THE TRANSPORTATION ADVISOR TO PERFORM THIS

TEST. I am aware of the company’s drug and alcohol policy. I agree to read and abide by the company’s policy of having a drug and alcohol free workplace. My signature acknowledges receipt of a formal information packet outlining both company and driver responsibilities under 49 CFR part 382 and part 40. Company Name: ___________________ __________________ Print Name Social Security #

__________________________________________________ Driver’s Signature Date Date of pre-employment drug screen: ____________________________

THIS DRIVER WILL NOT BE ACTIVATED IN RANDOM POOL WITHOUT A PRE-EMPLOYMENT DRUG SCREEN RESULT ALONG WITH THIS FORM.

UPON SIGNING PLEASE FAX BACK TO THE TRANSPORTATION ADVISOR

Phone: 800-608-8890 Fax: 413-284-0022 vicky@transadvisor.com

DF - 6

DRIVER STATEMENT OF ON-DUTY HOURS (For Newly Hired Drivers)

INSTRUCTION: Motor carriers when using a driver for the first time shall obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395.8(j)(2) Federal Motor Carrier Safety Regulations. NOTE: Hours for any compensated work during the preceding 7 days, including work for a non-motor carrier entity, must be recorded on this form. Driver Name (Print) _________________________________________________________________________________ Social Security Number _____________________________________________________________________________ Driver’s License: State _____ Number _________________ Class _____ Endorsement(s) ______ Restriction(s) _______ Type of License __________________________________ Issuing State ______________________________________

DAY 1 (yesterday)

2 3 4 5 6 7

DATE

HOURS WORKED

TOTAL HOURS

I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at A.M. ___________________ P.M. On _________________________________ Time Day Month Year _____________________________________________ ______________ Driver’s Signature Date

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

DRIVER CERTIFICATION FOR OTHER COMPENSATED WORK

INSTRUCTIONS: When employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2 paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations includes time performing any other work in the capacity of, or in the employ or service of, a common, contract or private motor carrier, also performing any compensated work for any nonmotor carrier entity. (check one) Are you currently working for another employer? □ Yes □ No At this time do you intend to work for another employer while still employed by □ Yes □ No this company? I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity. ____________________________________________ ________________ Driver’s Signature Date

Witness: ____________________________________________ ________________ Company Representative Date

Phone:

Fax:

Job Title:

Termination Date: _______________ Resigned: Yes No Discharged: Yes No

If Discharged, why?________________________________________________________________________________

Equipment:

Accidents:

Violated other D.O.T. drug/alcohol regulations?

_________________________________________________________

Applicant's Printed Name

Applicant's Signature Date

Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information, must

submit a written request to the Safety Compliance Manager of Taxi Freight LLC, which may be done at any time, including when applying, or as late as thirty (30) days after being employed or

being notified of denial of employment. Taxi Freight LLC will provide this information to the applicant within five (5) business days after receiving the written request. If, however, Taxi Freight LLC

has not yet received the requested information from the previous employer(s), then it will provide the information to the applicant within five (5) business days after it receives the requested safety

performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of Taxi Freight LLC making them available, Taxi Freight LLC will

consider the driver to have waived the request to review the records.

Yes _____ No _____

Yes _____ No _____

Person Providing Information

Applicant's Due Process Rights: 1) The right to review information provided by previous employers; 2) The right to have errors in the information corrected by the previous employer and for that

previous employer to re-send the corrected information to Taxi Freight LLC; and 3) The right to have a rebuttal statement attached to the alleged errneous information, if the previous employer and

the driver cannot agree on the accuracy of the information.

It is expressly acknowledged, understood and agreed that the information provided by the applicant regarding the applicant's employment during the previous three (3) years in accordance with Section

391.21(b)(10) of the Federal Motor Carrier Safety Regulations ("FMCSR") may be used, and the applicant's prior employers may be contacted, for the purpose of investigating the applicant's safety

performance history information as required by paragraphs (d) and (e) of Section 391.23 of the FMCSR. The applicant has certain due process rights under the FMCSR regarding the information

received as a result of these investigations, as described below.

Name of Applicant: _______________________________________

# Preventable: ______________

Commodities Hauled: _____________________________________________________________________________

1.) I hereby authorize the above-mentioned employer/school to release all information as to my character, work habits, performance, experience, fitness, together with reasons for termination

concerning my employment to Taxi Freight LLC (or their authorized agents) which may request such information in connection with my application for employment with Taxi Freight LLC 2.) In

conformity with 49 CFR part 40, I hereby authorize the above-mentioned employer/school and their agents to furnish Taxi Freight LLC the above-requested information concerning D.O.T. drug and

alcohol tests including pre-employment tests during the previous 3 years; the dates when I tested positive; the dates when I tested .04 or greater; the dates when I refused (including a verified

adulterated or substituted result) to be tested for drugs and alcohol; and any other violations of 49 CFR part 40 and any information the above-mentioned employer/school and/or their authorized

agents have received regarding violations of 49 CFR part 40 from my previous employers covered by D.O.T.

3.) I hereby release the above-mentioned employer/school and their authorized agents from any and all liability of any type as a result of providing the above-requested information to Taxi Freight LLC

Refrigerated _____ Flatbeds _____ Vans _____ Tanker _____ Other _____

Have you received information from a previous employer that this individual has violated D.O.T.

drug/alcohol regulations?

Ever refused a required test for drugs or alcohol in the last 3 years?

Description: ______________________________________________

# Non-Preventable: __________ Description: ______________________________________________

Drug/Alcohol information below requested in accordance with DOT 49 CFR Part 40. (Tests done in last 36 months.)

________________________________________________________________________________________________

By signing below, I certify that I have read and fully understand Parts 1, 2, and 3 of this release and that I executed this release voluntarily, with the knowledge that any and all information

released could affect my being employed with Taxi Freight LLC

Yes _____ No _____

Yes _____ No _____

Had a breath alcohol test result with a concentration of .04 or greater in the last 3 years? Yes _____ No _____

Sent to: ____________________________________________

If Yes, please give type of test, date of test, and SAP information (if applicable): ______________________________

______________________________________Title

PAST EMPLOYMENT VERIFICATION

Tested positive for controlled substance in last 3 years?

Poor _____ Fair _____ Good _____ Excellent _____

Social Security #: ______________________

Taxi Freight LLC101 Colony Park Drive, Cumming GA 30040

Fax Number: __________________________Previous Employer

Requested by: 1-770-871-50151-866-591-8483

Witness

Areas of Operation: _______________________________________________________________________________

Hire Date: _________________

Type of Tractor/Truck: ______________________________________ Trailer Length: _______________

Eligible for Rehire? Yes _____ No _____ Upon Review _____ If No, please explain: ______________________

Accident information below requested in accordance with FMCSR Part 391.23. (Accidents within last 36 months.)

Overall Performance: