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Contractor Application
Position Applying For:		ContractorDriverContractor's Driver
Contractor Information
Company Name:
PhysicalAddress:
City:	State:		Zip:
Contact Name:			Telephone:
Email:			Fax:
Federal Tax ID #:			Website:
Invoice Remit to:
Payee Name:
Address:
City:	State:		Zip:

Contractor's Driver Information
First:	Middle:		Last:
Physical Address:
City:	State:		Zip:
If less than three years at current address, please list previous addresses for past 3 years.
			(From/To)
			(From/To)
			(From/To)
Have you worked for IWES before?		YesNo
If so, give dates (From/To):
Reason for leaving:

Home Phone:	Cell:		Fax:
Social Security Number:	Date of Birth:
Email Address:

Military Experience
Have you ever served in the armed forces?	YesNo	If so which branch?
Describe any military training received relevant to the position for which you are applying.

Are you currently serving in Military Reserves or the National Guard?			YesNo

Education History
Highest grade completed:		Last School Attended:

Driver's License Information
Current CDL #:		State:
Expiration Date:		Date of last DOT Physical Examination:
Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the loss of a foot, leg, hand, or arm?
	YesNo

Driver's License held in last three years must be shown:
State	License Number	Type	Expiration Date





Do you have a T.W.I.C. Card?	YesNo	Expiration Date:
Do you have a Passport?	YesNo

History
In the past five years have you tested positive or refused to take a drug screen or alcohol test?		YesNo
	A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?		YesNo
	B. Has any license, permit, or privilege ever been suspended or revoked?		YesNo
	C. Is there any reason why you might not be able to perform the functions of the job for which you have applied?		YesNo


If answers to A, B, or C is "Yes", please give details.

Accident History Accident Review for the past 3 years
Date	Nature of Accident	# Fatalities	# Injuries	# Vehicles Towed	Citation Issued

Motor Vehicle Driving Record (MVR) Traffic Convictions and Forfeitures for the past 3 years (excluding parking tickets)
Date	Location	Charge	Penalty

Experience
Class of Equipment	Type of Equipment	Dates (From-To)	Approximate Total Miles
Straight Truck
Tractor/Trailer
Twin
O/D (H. Haul)
O/D (H. Haul)
O/D (H. Haul)
Other
List ALL States operated in during the last Five years:

List ANY special courses or training that will help you as a driver:

List ANY Safe Driving Awards and who the awards were presented by:

Employment Record
Note: List all periods of employment for the past 10 years, including gaps, starting with the most recent employer. All dates must be accounted for!
Employer:
City/State:	Dates of Employment:
Position held:	Type of Trailer:
Reason for Leaving:

Supervisor:	Telephone:
Were you subject to the FMCSR's while employed there?		YesNo
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to dug and alcohol testing requirements of 49 CFR Part 40?		YesNo

Employer:
City/State:	Dates of Employment:
Position held:	Type of Trailer:
Reason for Leaving:

Supervisor:	Telephone:
Were you subject to the FMCSR's while employed there?		YesNo
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to dug and alcohol testing requirements of 49 CFR Part 40?		YesNo

Employer:
City/State:	Dates of Employment:
Position held:	Type of Trailer:
Reason for Leaving:

Supervisor:	Telephone:
Were you subject to the FMCSR's while employed there?		YesNo
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to dug and alcohol testing requirements of 49 CFR Part 40?		YesNo

Employer:
City/State:	Dates of Employment:
Position held:	Type of Trailer:
Reason for Leaving:

Supervisor:	Telephone:
Were you subject to the FMCSR's while employed there?		YesNo
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to dug and alcohol testing requirements of 49 CFR Part 40?		YesNo

Employer:
City/State:	Dates of Employment:
Position held:	Type of Trailer:
Reason for Leaving:

Supervisor:	Telephone:
Were you subject to the FMCSR's while employed there?		YesNo
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to dug and alcohol testing requirements of 49 CFR Part 40?		YesNo

Employer:
City/State:	Dates of Employment:
Position held:	Type of Trailer:
Reason for Leaving:

Supervisor:	Telephone:
Were you subject to the FMCSR's while employed there?		YesNo
Was your job designated as a safety-sensitive function in any DOT regulated mode subject to dug and alcohol testing requirements of 49 CFR Part 40?		YesNo

Personal References
Name:	Address:	Phone:
Name:	Address:	Phone:
Name:	Address:	Phone:

Emergency Contacts
Name:	Address
City:	State:	Zip:
Phone:	Relationship:

Name:	Address:
City:	State:	Zip:
Phone:	Relationship:

Equipment Information
Tractor
Owners:
Make:	Year/Model:	Color:
Mileage:	Vin #:
License #:	State:	Expiration:
Lien holder:	Phone:
Trailer
Owner:
Make:	Year/Model:	Color:
Type:	# Axles:	Width:
Commodities Hauled:
Trailer
Owner:
Make:	Year/Model:	Color:
Type:	# Axles:	Width:
Commodities Hauled:
Driver Qualification Requirements Must be at least 25 years of age Must have a minimum of 3 years verifiable experience within the last 5 years, in over-dimensional trucking Must have a current Class A CDL Must have verifiable and acceptable work history for the past 10 years No more than 2 moving violations in the past three years Furnish a Long Form Physical taken in the last 6 months No CDL suspensions or revocations No drug and/or alcohol related incidents in past 10 years No felonies in the past 10 years Must have a cellular phone, laptop, and valid email No more than 2 accidents in the past 7 years IMPORTANT NOTICE regarding background reports from the PSP Online Service 1. In connection with your application for employment with Integrated Wind Energy Services, LLC ("Prospective Employer"), it may obtain one or more reports regarding your driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). 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. 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 Prespective 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 Emplyer to make a determination regarding my availability 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 wehre 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 FMCSA 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 electronically sign this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and it's employees, authorized agents, and/or affiliate to obtain the information authorized above. Date: Full Name: Initial here to authorize electronic signature: Waiver: I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or its agents may investigate the applicant's background to ascertain any and all information of concern to the applicant's record, whether the same is of record, or not, and applicant releases employers and other such persons named herein from all liability for any damages that result from furnishing such information. I understand, that as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job. I understand that I have the following rights concerning the investigation information that is being provided by a past employer: (1) the right to review released information, (2) the right to have errors in the information corrected, (3) the right to have a rebuttal statement attached to the alleged erroneous information if I and the previous employer cannot agree to the accuracy of the information provided. I hereby authorize this company, as required by the Federal Motor Carrier Safety Administration (FMCSA) regulations, Section 391.23, to investigative and compile a complete history of my former work history, including any information concerning my ability, personal character, credit history, and arrest record. It is also agreed and understood that under the Fair Credit Reporting Act, Public law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, personal reputation and mode of living. I authorize release of information for purpose of investigation of drug and alcohol results as required by sections 382.405(f) and 382.413 of the FMCSA regulations. I hereby Authorize any local, county, state, or federal law enforcement agency to furnish any and all information regarding any arrests or convictions listed under my name which might be on file. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentations or omissions of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of this employer. Pre-Qualification Urinalysis Consent Form I understand that, as a part of pre-qualification condition, I am required by section 382.301 of Title 49, Federal Motor Carrier Safety Regulations, to submit to a controlled substance test. I agree to provide a urine sample at a location and time designated by the company to be tested for controlled substances. I understand if I test positive for controlled substances, I am not medically qualified to operate a commercial motor vehicle. The results of the controlled substance test will be maintained by the company designated review office who will notify the company of the results. I authorize the company to release the test results to the examining medical physician to assist in determining if I am medically qualified to operate a commercial motor vehicle. The results will not be released to any additional party without my consent. Unauthorized Passenger Agreement POLICY: Contractors are not permitted to allow an individual to travel in his/her commercial vehicle. If the fields above were not sufficient to fill all necessary information, then please attach a file containing the extra information.