Driver Application

Dear New Owner Operator / Lease Driver:

Thank you for your interest in leasing on with Tri Star Freight System, Inc. To speed up the application process, please make sure the following items are done:

MUST supply accurate dates for 10 years work history. If you worked for a company twice put both dates

MUST supply working phone numbers for the past 3 years

MUST supply 1099 or pay stubs if the company is out of business

MUST fill out statement explaining gaps in work history

Before Safety will do anything with your application we will need copies of the following:

Current CDL

Medical Card–Short and Long Form

Registration

Annual Inspection

TWIC Card–Must have a TWIC card before we can process.

Contract / Lease are conditional until all work history is complete

Again thank you for your interest in Tri Star Freight System, Inc. We will process your information as quickly as we can. Should you have any questions, please contact the Safety Department at 1-800-229-1095 or fax to 713-631-1099, Attention Safety.

TRI STAR FREIGHT SYTEM, INC. 5407 MESA DRIVE, HOUSTON TX 77028

Applicants are considered without regard to race, creed, color, sex, religion, age or national origin.

DRIVERS INFORMATION SHEET

How did you hear about Tri Star?

Full Name

SS#:

Address

Date of Birth:

Cell Phone:

Place of Birth:

Name of Spouse:

In case of emergency, notify:

Phone

Address for Last 3 Years:

Address

Physical History:

Date of Last Physical:

Expires:

Doctor’s Name:

Phone Number:

Doctor’s Address:

Experience and Qualifications:

Valid Driver’s License

State:

License Number:

Type:

Expiration Date:

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

Yes

Has your license permit or privilege been suspended or revoked?

Yes

If yes, explain

Have you ever been convicted of driving under the influence of alcohol / drugs?

Yes

If yes, penalty

Have you ever been convicted of a crime?

Yes

If yes, explain

DRIVING HISTORY FOR THE PAST TEN YEARS

(Use separate sheet if necessary)

D.O.T. requires ten (10) years past experience. However Tri Star Freight System, Inc. reserves the right to inquire further during the qualification process.

Last company/individual you drove for:

Name

Address

Phone

From:

To:

Reason for leaving:

Type of Trailer Hauled:

2nd Last company/individual you drove for:

Name

Address

Phone

From:

To:

Reason for leaving:

Type of Trailer Hauled:

3rd Last company/individual you drove for:

Name

Address

Phone

Reason for leaving:

From:

To:

Type of Trailer Hauled:

4th Last company/individual you drove for:

Name

Address

Phone

Reason for leaving:

From:

To:

Type of Trailer Hauled:

5th Last company/individual you drove for:

Name

Address

Phone

From:

To:

Reason for leaving:

Type of Trailer Hauled:

Driver Statement

Driver:

Dates out of work

To:

Reason for out of work

Dates out of work

To:

Reason for out of work

Date

Driver Signature

TRI STAR FREIGHT SYTEMS, INC. 5407 MESA DRIVE, HOUSTON TX 77028

DRIVING EXPERIENCE

STRAIGHT TRUCK

TYPE OF EQUIPMENT

# OF YEARS

STATES YOU HAVE DRIVEN IN

TRACTOR TRAILER

TYPE OF EQUIPMENT

# OF YEARS

STATES YOU HAVE DRIVEN IN

BUS

TYPE OF EQUIPMENT

# OF YEARS

STATES YOU HAVE DRIVEN IN

OTHER

TYPE OF EQUIPMENT

# OF YEARS

STATES YOU HAVE DRIVEN IN

ACCIDENT RECORD LAST THREE YEARS

1. NATURE OF ACCIDENT

Date

# OF FATALITIES

# OF INJURIES

COMM. VEHICLE

PERSONAL VEHICLE

2. NATURE OF ACCIDENT

# OF FATALITIES

# OF INJURIES

COMM. VEHICLE

PERSONAL VEHICLE

3. NATURE OF ACCIDENT

Date

# OF FATALITIES

# OF INJURIES

COMM. VEHICLE

PERSONAL VEHICLE

4. NATURE OF ACCIDENT

Date

# OF FATALITIES

# OF INJURIES

COMM. VEHICLE

PERSONAL VEHICLE

TRAFFIC CONVICTIONS & FORFEITURES LAST 3 OTHER THAN PARKING

1. STATE

Date

CHARGE

PENALTY

COMM. VEHICLE AUTO

2. STATE

Date

CHARGE

PENALTY

COMM. VEHICLE AUTO

3. STATE

Date

CHARGE

PENALTY

COMM. VEHICLE AUTO

4. STATE

Date

CHARGE

PENALTY

COMM. VEHICLE AUTO

EDUCATION

Please indicate last grade attended:

Elementary

H.S.

College

Last School Attended Name:

Address

Other Training:

Are you now employed?

Yes

When will you be available?

Do you have full knowledge of federal safety regulations?

Yes

Have you served in the U.S. Armed Forces?

Yes

Branch:

Served from:

To:

Date Discharged:

Rank at Discharge

I attest under penalty of perjury, that I am (check one)

Select

1. A citizen or national of the United States

2. An alien lawfully admitted for permanent residence

3. An alien authorized by the immigration and naturalization service to work in the United States

1. Driver’s license number

1. Expiration Date

1. Social Security Number

2. Alien number

3. Alien number

3. Admission Number

3. Expiration Date

PREVIOUS PRE-EMPLOYMENT EMPLOYEE DRUG AND ALCOHOL STATEMENT

TRI STAR FREIGHT SYSTEM, INC. 5407 MESA DRIVE, HOUSTON TX 77028 PHN: 713-631-1095 FAX: 713-631-1099

Sec. 40.25(j) As the employer: You must also ask the employee whether he/she has tested positive, or refused to test, on any pre-employment drug and alcohol test administered by an employee to which the employee applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If the employee admits that he/she had a positive test you must not use the employee to perform safety sensitive functions for you until and unless the employee documents successful completion of the return of duty process. ( See Sec. 40.25 (b),(5) and (e))

Name

Social Security Number

The prospective employee is required by DOT Sec 40.25(j) to respond to the following question(s):

Have you tested positive, or refused to test, on any pre-employment drug or alcohol test and did not obtain safety sensitive transportation work covered by DOT Agency drug and alcohol testing rules during the past 2 years?

Yes

Have you ever tested positive on any drug or alcohol test?

Yes

If you answered yes, can you provide/obtain proof that you successfully completed the DOT return –to –duty requirements?

Yes

Prospective Employee Signature

Date

MUST BE READ AND SIGNED BY DRIVER

I agree and understand that any misrepresentations of information given shall be considered an act of falsification.

I agree and understand that Tri Star Freight System may investigate my background to ascertain that any and all information is factual.

This certifies that this information form was completed by me and that all entries on it and information in it are true and completed to the best of my memory.

I attest, under penalty of perjury, that I am eligible to drive in the United States. I am aware that federal law provides for imprisonment and/or fine for any false statements or use of false documents.

Date

Driver’s Signature