Driver Recruiting Information

First: *	Last: *	Middle:
Address: *	City: *	State: Ex. MN, ND, WI
Zip Code: *	Social Security Number:ex. xxx-xx-xxxx *	Telephone Number:* ex. (xxx)xxx-xxxx
Birth Date: mm/dd/yyyy	E-Mail:	Available Date:

License Number: *	Do you have a CDL? Yes No
State: *
Endorsements:

Owner Operator:	Years of Experience	Driver:
Type of Equipment: Flatbed:		Type of Equipment: Flatbed:
Type of Equipment Van:		Type of Equipment Van:
Over dimension:		Over dimension:

*Company* *One*	Name:	Phone:
	City:	State:
	Date Employed from: To:
	Reason for leaving Employer:

*Company* *Two*	Name:	Phone:
	City:	State:
	Date Employed from: To:
	Reason for leaving Employer:

*Company* *Three*	Name:	Phone:
	City:	State:
	Date Employed from: To
	Reason for leaving Employer:

*Company* *Four*	Name:	Phone:
	City:	State:
	Date Employed from: To:
	Reason for leaving Employer:

In connection with my application for employment (including contract for service) with you, I understand that an investigation is being done that will include information as to my character, work habits, performance, and experience, along with reasons for my being terminated of past employment. I also understand that you will be requesting information concerning my driving record and/or information from various federal, state, and other agencies which maintain records concerning traffic offenses, accidents, etc., as well as information: (1) previous driving record requests made by others such as state agencies; (2) state provided driving records; (3) claims including me in the files of insurance companies. I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY NOVCO INC. TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of the investigation. I hereby consent to your obtaining the above information from Novco Inc., and agree that such information which Novco Inc. has or obtains, and my employment history with you if I am hired, will be supplied by Novco Inc. to other companies.

To Applicant: READ THIS INFORMATION CAREFULLY BEFORE SUBMITTING THIS APPLICATION!

The Civil Rights act of 1964 and 1991 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits discrimination on the basis of age and disability. The laws of most States also prohibit some or all of the above types of discrimination as well as some additional types such as discrimination based upon ancestry, sexual preferences or marital status.

It is agreed and understood that any misrepresentations of information given above shall be considered an act of dishonesty. It is agreed and understood that the employer or his agents may investigate the applicant's background to ascertain any and all information of concern to the applicant's record, where same is of record or not and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information. The applicant agrees to furnish such additional information and complete such examinations as may be required to complete his/her employment file. It is agreed and understood that this application for employment in no way obligates the employer to employ the applicant. It is agreed and understood that if hired, the employee may be on a probationary period during which time he/she may be discharged without recourse. 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.