Driver Application

The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and Howard Sheppard, Inc. In compliance 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, veteran status, non-job disability, or any other protected group status.

To be Read and Signed by Applicant

I authorize Howard Sheppard, Inc 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(generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, health care providers 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.

I understand that information I provide regarding current and/or previous employers may be used, and that previous employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to:

• Review information provided by previous employers;
• Have errors in the information corrected by previous employers and for those previous employers to provide corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information from a previous employer(s) and I cannot agree on the accuracy of the information.

The U.S. Department of Transportation requires that driver applications provide their date of birth.

* The age Discrimination of Employment Act of 1967 Prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.

Position Applying For:

Phone Number(s)

Current & Previous Addresses: (list 3 years)

Driver's License (list each driver's license held in the past 3 years)

Driving Experiences

Accident Record for the past 3 years

Traffic Convictions and Forfeitures

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

B. Has any license, permit or privilege ever been suspended or revoked?

C. Have you ever been convicted of a crime?

D. Have your ever tested positive or refused a DOT drug or alcohol pre-employment test within the past 2 years for an employer who did not hire you?

Employment History

We must have a complete record of all previous employment for the past 10 years. For all listings where you were an independent contractor or drove for an independent contractor you must put the name and contact information for the motor carrier to which the truck was leased. We have 30 days after you have accepted your first dispatch to verify past employment. Having the correct carrier name, phone number, address and contact person will make it easier to complete the verification.

Personal References

List three persons for references, other than family members, who have knowledge of you.

To Be Read and Signed by Applicant

It is agreed and understood that any misrepresentation given on this application for qualification shall be considered an act of dishonesty and may result in immediate termination.

I give the motor carrier and its agents or representation the right to investigate all references and to secure additional information about my employment background. I hereby release from all liability for damages the motor carrier and its agents or representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

I agree to furnish such additional information and complete such examinations as may be required to complete my driver qualification file. It is agreed and understood that this application for employment in no way obligates the motor carrier to hire me. It is agreed and understood that if qualified to operate under the motor carrier's name, I will have a probation period of not less than 90 days, during which I may be terminated 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.

NOTE: The Company has adopted a program for the orientation of potential new employees, which is designed to facilitate a smooth integration into the workforce. Being invited to orientation does not constitute employment status; only upon meeting all the qualifications set forth by the DOT and Howard Sheppard, Inc. will an offer of employment be made.

*** YOUR APPLICATION MUST BE TURNED IN WITH A CURRENT 7-YEAR MVR *** ALONG WITH COPY OF YOUR CDL AND SOCIAL SECURITY CARD

YOUR PRIVACY: Howard Sheppard maintains a high level of confidentiality. We do not share information with any other organization and will treat clients' personal information with care.