Independent Contractor Application

64825 County Road 31 Goshen, Indiana 46528

Phone: 574-642-2024 Facsimile: 574-642-2025
Website: QualityDriveAway.com





WHAT YOU CAN EXPECT FROM QUALITY DRIVE-AWAY, INC.


Driver appreciation company wide
Continued orientation and training

No forced dispatches
Sub-contractor means flexibility
Comdata paycard allows drivers instant
access to their money - day or night

Outstanding return freight percentages

due to strategic partnerships nationwide

Safe driving
rewards programs

Fuel and lodging discounts through our

affiliations with select companies

A Percentage Of Your Pay In Advance

You will receive a percentage of your trip pay at the time of dispatch to help offset your expenses. The
balance will be paid after all of the paperwork is completed and returned to Quality Drive-Away, Inc.
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Quality Drive-Away, Inc. has prospered because of the professionalism of our drivers. If you are a
true professional driver, we would like you to join the Quality team.

Questions? Please contact a recruiter toll free now!

1-866-764-1601

Page 1 of 7

* Rates are subject to change without notice and may vary from terminal to terminal location

SUB-CONTRACTOR REQUIREMENTS
____ Must be at least 23 years of age
____ Must be able to legally work in the U.S.
____ Provide copy of social security card
____ Provide copy of CDL or chauffeur driver license
____ Must be able to pass company drug screen
____ No alcohol or drug convictions in a vehicle
____ Camera (digital or other)

____ Must be able to pass a D.O.T. physical & provide long form/card
____ No more than 6 points on a driver license, to include no more

than 2 moving violations or 2 accidents in the past three years

(regardless of fault)
____ Minimum of 6 months commercial experience
____ No felonies during the past ten years
____ Working Cell phone

PAY
Quality Drive-Away, Inc. will pay you per loaded mile for the delivery of the unit. We will also reimburse you for authorized tolls, permits
and washes. You are responsible for fuel, meals, and sleeping arrangements. As a Sub-Contractor you set your schedule and will
receive a 1099 showing income earned. We suggest finding a good trucking accountant to help you with deductions and tax filing.

BOND REQUIREMENTS
Every Sub-Contractor is responsible for a $1,000 deductible on damages. This is taken out of your gross pay until $1,000 is met and
placed in a bond account.

EQUIPMENT REQUIREMENTS MOTORIZED DIVISION

____ Set of 3 triangles Every driver must carry with them per FMCSA requirements.
If using tow vehicle:
____ Proof of Insurance Declaration page
____ Tow package & auxiliary lights installed on vehicle

____ Vehicles registration

____ Weight ticket showing vehicle under 3,200 lbs.
____ Gauged fire extinguisher must be securely mounted

* DRIVERS MUST MEET 68%&2175$&725 REQUIREMENTS ABOVE.

ATTENTION
Although we dont require our sub-contractors to have a tow vehicle to use for their return trip,
it is highly recommended. Before entering into this type of business it is also recommended that
you research public transportation schedules and prices so that you can be more profitable.

Page 2 of 7


'R\RXKDYHDYHKLFOHZKLFKPD\EHWRZHG": Yr.________ Make____________ Model____________

APPLICATION FOR SUB-CONTRACTOR

REFERENCE #

EMAIL ADDRESS - PRINT CLEARLY

12/8/15
DATE_____________________

agaston75@gmail.com

COMPANY: 48$/,7<'5,9($:$<, INC.

ADDRESS: 64825 COUNTY RD. 31 GOSHEN, INDIANA 46528
The Company does not discriminate on the basis of race, color, religion, creed, national origin, sex or ancestry, or on
the basis of age. No question on this application is intended to secure information to be used for such discrimination.
This application will be given every consideration, but its receipt does not imply that the applicant will be accepted.
NAME Anthony Gaston

DATE OF BIRTH 02/12/75

ADDRESS 1950 Philadelphia Dr

SS# 270-74-1374

CITY Dayton

LENGTH OF RESIDENCE 1 year

HOME PHONE

STATE ohio
(937) 514-9607

(If length of residence is less than 3 years, list all previous addresses for past 3 years on separate sheet.)
In case of emergency, notify
Name
Address
Phone

ZIP 45406

CELL
Cell

HISTORY OF EMPLOYMENT

All applicants who operate in interstate commerce must provide the following information on all current and previous
employers for the past 10 years. Any gaps greater than 30 days must have documentation showing proof. If retired or
unemployed you must show or have a professional letter of recommendation on letterhead. If self-employed you must
provide a copy of your 1099 or profit/loss statement from your tax form.
Name:

EMPLOYER

Date: (Include, month & year)

Remember Me Flowers

From: 07/13

Address: 3115 Salem Ave

City:
Contact:

Dayton
Bonita Saunders

Position: Driver
State:

ohio

Phone:

Zip Code:

45406

937-304-5317

Were you subject to the FMCSRs while employed?: _____ Yes

Reason for leaving:

Closed due to fire

_____
No

Was your job designated as a safety-sensitive function subject to the drug and alcohol testing
No
requirements 49CFR Part 40? _____ Yes _____

Wage:

EMPLOYER
Name: DNA

Contact:

10.00

Date: (Include, month & year)

From:

Computers

Address:
City:

To: 11/15

3/11

To: 7/13

Position: Technician

Kettering
Gayle Jenkins

State:

ohio

Phone:

Zip Code:

937-304-0033

Were you subject to the FMCSRs while employed?: _____ Yes

_____
No

Was your job designated as a safety-sensitive function subject to the drug and alcohol testing
No
requirements 49CFR Part 40? _____ Yes _____

Reason for leaving:

Owners were having court

issues.

Wage:

10.00

EMPLOYER
Name: Mendelsons Electronics

From:

Address:

Position: Technician

City:
Contact:

dayton

State:

Date: (Include, month & year)

ohio

Zip Code:

Phone:

Were you subject to the FMCSRs while employed?: _____ Yes

To: 7/10

Reason for leaving:

Other opportunities.

No
_____

Was your job designated as a safety-sensitive function subject to the drug and alcohol testing
requirements 49CFR Part 40? _____ Yes _____
No
Page 3 of 7

2/09

Wage:

(Please use additional sheet if necessary)''

9.00

HISTORY OF EMPLOYMENT (CONTINUED)

All applicants who operate in interstate commerce must provide the following information on all current and previous
employers for the past 10 years. Any gaps greater than 30 days must have documentation showing proof. If retired or
unemployed you must show or have a professional letter of recommendation on letterhead. If self-employed you must provide
a copy of your 1099 or profit/loss statement from your tax form

EMPLOYER

Date ( Month and Year)

Name: Belcan Technical Services Aksteel

From:

Address:

Position: Electronic Maintenance Technician

City:

State:

Contact:

Phone:

Zip:

To: 11/08

Reason for leaving:

contract

Where you subject to the FMCSRs while employed?

Yes

No

Was your job designated as a safety-sensitive function subject to the drug and alcohol testing
requirements 49CFR Part 40?
Yes
No

EMPLOYER
Name: CBS Personnel Services

5/08

Wage:

32.00

Date ( Month and Year)

From:

Kodak

Address:

10/07

To: 12/07

Position: Alignment Tech

City:

State:

Contact:

Phone:

Zip:

Reason for leaving:

contract

Where you subject to the FMCSRs while employed?

Yes

No

Was your job designated as a safety-sensitive function subject to the drug and alcohol testing
requirements 49CFR Part 40?
Yes
No

EMPLOYER

Wage:

14.00

Date ( Month and Year)

Name: Belcan Technical Services Ak Steel

From:

Address:

Position: Electronic Maintenance Technician

City:

State:

Contact:

Phone:

Zip:

03/07

To: 10/07

Reason for leaving:

contract

Where you subject to the FMCSRs while employed?

Yes

No

Was your job designated as a safety-sensitive function subject to the drug and alcohol testing
requirements 49CFR Part 40?
Yes
No

EMPLOYER

Wage:

32.00

Date ( Month and Year)

Name: Pro Coach Leasing

From:

Address:

Position: Bus Driver

City:
Contact:

clayton
Mike Gibson

State:

ohio

Zip:

Tour Ended Conract

Yes

No

Was your job designated as a safety-sensitive function subject to the drug and alcohol testing
requirements 49CFR Part 40?
Yes
No

Page 4 of 7

To: 03/08

Reason for leaving:

Phone:

Where you subject to the FMCSRs while employed?

01/07

Wage:

1000 wk

EXPERIENCE
TYPE OF EQUIPMENT

NUMBER OF YEARS

APPROX. MILES

10000

10000

Straight Truck
Tractor-Trailer
Bus
Pick Up Truck RV Trailer Horse Trailer
Motor Home

Ohio,Atlanta,Indiana,Kentucky
List the states you have driven regularly ____________________________________________________

TRAFFIC VIOLATION CONVICTIONS

YES

NO

DOT Regulations require commercial motor operators to report convictions of state violations to their state licensure and to their employers.
List all traffic violation convictions, other than parking, within the past three years.
DATE

VIOLATION

TOWN & STATE

01/13

roundabout

TYPE OF VIOLATION AND NOTES

ohio

wrong way on roundabout

1/13

seabelt

ohio

seatbelt

ACCIDENTS

List all motor vehicle accidents, chargeable or non-chargeable, in which you were involved within the past three years.
DATE

CHARGE

TOWN & STATE

TYPE OF ACCIDENT

PERSONAL INJURIES

FATALITIES

AUTO AND/OR CHAUFFEURS LICENSES

DOT Regulations specify that it shall be illegal for a commercial motor vehicle operator to have more than one drivers license.
Exception until Dec. 31, 1989, if state law requires. (You must list ALL LICENSES held by you within the past 3 years).

2/12/16
ohio
A
rm3434008
License No. __________________________________
State _________________
Type or Class ____________________
Expiration Date ____________________
License No. __________________________________ State _________________ Type or Class ____________________ Expiration Date ____________________

LICENSE REVOCATION, SUSPENSION, CANCELLATION

DOT Regulations require commercial motor vehicle operators to notify their employers if their driver license has been suspended, revoked, or
cancelled, or if they are disqualified.
Yes
Has your privilege to operate a motor vehicle ever been suspended, revoked, withdrawn or denied?
l
l No

Suspended due to not having insurance. I didnt have insurance because i was out of work.
If YES, explain in detail______________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
Have you ever tested positive for alcohol or drugs?

l Yes

No
l

If YES, give a date and a brief explanation_______________________________________________________________________________

________________________________________________________________________________________________________________
Have you ever been convicted of a misdemeanor or felony?

l Yes

No
l

If yes, give a date(s) and brief description_____________

________________________________________________________________________________________________________________
________________________________________________________________________________________________________________

yes
Do you have the legal right to work in the United States? ___________________________________________________________________
no
Have you worked for this Company before? __________________
When? From _____________________ to ________________________
Position Held ____________________________________ Reason for leaving__________________________________________________




Page 5 of 7

MOTOR VEHICLE DRIVER'S

CERTIFICATION OF VIOLATIONS
MOTOR CARRIER INSTRUCTIONS: Each motor carrier shall, at least once every 12 months, require each driver it employs to prepare
and furnish it with a list of all violations or motor vehicle traffic laws and ordinances (other than violations involving only parking) of
which the driver has been convicted, or on account of which he/she has forfeited bond or collateral during the preceding 12
months. (Section 391.27)
DRIVER INSTRUCTIONS: Each driver shall furnish the list required in the above motor carrier instructions. If the driver has not been
convicted of, forfeited bond or collateral on account of any violation which must be listed he/she shall so certify.
Drivers who have provided information required by Section 383.31 need not repeat that information in the annual list of violations.
I certify that the following is a true and complete list of traffic violations required to be listed, other than parking violations, for
which I have been convicted or forfeited bond or collateral during the past 12 months.

Date:

Offense:

Location:

Vehicle Type Operated:

If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation
required to be listed during the past 12 months. YOU MUST SIGN YOUR NAME WHERE SHOWN

10/1/16

rm344008

Certification Date

Driver's License Number

Type of License:

Anthony Gaston
Printed Applicant's Name

CDL

ohio

Chauffeur

State

Other

Quality Drive-Away, Inc.

Motor Carrier's Name

Anthony Gaston

Anthony Gaston (Dec 8, 2015)

Applicant's Signature

Motor Carrier's Employee Signature

Motor Carrier's Employee Title

Page 6 of 7

2/12/16
Expiration Date

APPLICANT READ COMPLETELY AND SIGN

In connection with my application for Sub-Contractor driver (including contract for services) with Quality Drive-Away, Inc., I
understand that consumer reports which may contain public record information may be requested from Quality Drive-Away, Inc.
These reports may include the following types of information: Names and dates of previous employers, reason for termination of
employment, work experience, accidents, safety performances, etc. I further understand that such reports may contain public
record information concerning my driving record, workers compensation history, credit, bankruptcy proceedings, criminal
records, as well as dates, violations and accidents included in MCMIS, etc. from federal, state and other agencies which maintain
such records. I AUTHORIZE, WITH-OUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY Quality Drive-Away, Inc. TO
FURNISH THE ABOVE MENTIONED INFORMATION TO THE EXTENT AUTHORIZED BY STATE AND FEDERAL LAW.
I have the right to make request to Quality Drive-Away, Inc., upon proper identification,to request the nature and substance of
all information in the files on me at the time of my request, to have incorrect information corrected and to have a rebuttal
statement included if necessary. In conformity with 49 C.F.R. Part 40, I hereby authorize motor carriers (company/school) listed
on my application to furnish Quality Drive-Away, Inc. the following information concerning drug and alcohol tests: DOT drug and
alcohol testing violations including pre-employment tests during the past three years (I) the dates on which I tested positive for
drugs and the drugs involved; (II) the dates on which I tested .04 or greater for alcohol and the test result levels; (III) the dates on
which I refused to be tested for drugs and/or alcohol; (IV) any failure to undertake or complete a rehabilitation program
prescribed by a Substance Abuse Professional; (V) other violations of D.O.T. drug and alcohol testing regulations; and (VI) any
information the carriers have received regarding violations of drug/alcohol testing regulations from my previous employers
observed by D.O.T.
I fully understand that the information I authorize Quality Drive-Away, Inc. to receive, involves tests which were required by the
Department of Transportation (DOT). If any carrier (company/school) listed on my application furnishes Quality Drive-Away, Inc.
with information concerning items (I) through (V) above, I also authorize that carrier (company/school) to release and furnish the
dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the names
and phone numbers of any substance abuse professional who evaluated me during the past three years.

Anthony Gaston

Anthony Gaston (Dec 8, 2015)

Applicant Signature

Dec 8, 2015
Signature Date

APPLICANT READ COMPLETELY AND SIGN

In compliance with Federal and State equal 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 group protected status.
I certify that the information presented on 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.

Signature:

Anthony Gaston

Anthony Gaston (Dec 8, 2015)

Email: agaston75@gmail.com
Applicant Signature

Dec 8, 2015
Signature Date

Notes [For internal use only]

Notes [For internal use only]