Owner Operator Application | www.dieljerue.com

To apply to become a Diel-Jerue Logistics Owner Operator, please complete the application below. We will contact you to complete the process.

Personal Information

First Name: *

Middle Initial:

Last Name: *

Home Address

Street: *

City: *

State: *

ZIP Code: *

Email Address: *

Home Phone (999-999-9999): *

Cell Phone:

Date of Birth: *

Your Driving Record

CDL Number: *

CDL State: *

CDL Expiration Date: *

CDL Issue Date: *

Has your CDL ever been revoked?: *

Yes

If yes, explain:

Have you ever been convicted of a felony?: *

Yes

If yes, explain:

Number of tickets in last three years: *

Explanation of tickets received:

Number of accidents in last three years: *

Explanation of accidents:

Endorsements:

HAZ-MAT

Doubles/Triples

Tanks

Years of driving experience: *

Number of licenses held in last three years: *

Type of driving assignment desired:

Authorization: *

Check this box to authorize Diel-Jerue to run an MVR (Motor Vehicle Record) and PSP (Pre-employment Screening Program). There is no cost to you for these reports.