Commercial Driver Application

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Personal

Motor Vehicle Record Disclosure

In connection with my ongoing employment or my application for employment, should I have or secure a position with Highway Trucking LLC, I understand that a motor vehicle record, which contains public information, will be requested. I authorize Highway Trucking LLC to obtain my motor vehicle record as needed for employment and safety compliance.

Personal Information

First Name *

Middle name

Last Name *

Address *

Apt

City *

State *

ZIP *

Date of Birth *

Phone *

Years Driving *

SSN *

State of Issuance *

Email *

Emergency Phone *

License Number *

To be read and signed by applicant

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of their furnishing such information. 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.

Employment Eligibility Verification

USCIS Form I-9

Citizenship Status

A citizen of the United StatesA noncitizen national of the United StatesA lawful permanent resident (Alien Registration Number/USCIS Number)An alien authorized to work

PSP Authorization

Important Disclosure Regarding Background Reports from the PSP Online Service

The below disclosure and authorization language is for mandatory use by all account holders

Authorization

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

Highway Trucking LLC

I authorize Highway Trucking LLC ("Prospective 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 authorizing 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 Employer to make a determination regarding my suitability as an employee.

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 challenge 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.

I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.

I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's consent.

The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of "employee" contained at 49 C.F.R. 383.5. LAST UPDATED 12/22/2015

Your name and signature date from below will be used automatically.

Independent Contract Driver and Policy Agreement

Please read each section and provide your initials.

1. Independent Contract Driver Status. I understand that I am an independent Contract Driver. This Agreement shall remain in full force and effective for a 1-year period beginning on the date first written, unless ended sooner under this agreement.

2. Equipment Responsibility. I understand that I am responsible for any of Highway Trucking Equipment in which I will be using and or assigned to me to provide transportation.

3. Contract Modifications. I understand that additions and deletions can be made at any time to this contract policy agreement by Highway Trucking, LLC. and I will be provided with a new copy to review and acknowledge.

4. Right to Refuse Jobs and Termination. I understand as a contract driver, I have a right to refuse any job offered and terminate contract at any time. If I decide to terminate contract while I have company equipment, I will return it promptly as required.

5. Tax Responsibility. I understand that I am responsible for filing my own taxes with the Internal Revenue Service and Resident State Revenue Department. Highway Trucking, LLC will provide me with a 1099 as required.

6. No Guarantee of Loads or Revenue. I understand that Highway Trucking, LLC. does not guarantee, nor am I obligated to haul a specific amount of loads or earn amount of revenue.

7. DOT and FMCSA Regulations. I agree to follow up and uphold all regulations set by the Department of Transportation and Federal Motor Carrier Safety Administration.

8. Zero Tolerance Policy. I understand that Highway Trucking, LLC. has a zero tolerance policy and does not permit anything that is deemed contraband or illegal by the laws of the United States of America.

9. Damage Deductible. I understand contractor is responsible for the first $1,000 deductible in case of damage to tractor and trailer.

10. Authorized Trip Routes. I understand taking the tractor and trailer anywhere other than authorized trip origin route and destination or my personal places of residence requires written authorization.

11. Truck Service Requirements. I understand that the truck must be serviced every 15,000-20,000 miles and receipts will be required.

12. Random Vehicle Inspection. I understand that Highway Trucking LLC. at any time can request a random viewing of the truck or trailer.

13. Equipment Return Requirements. I understand that the truck and trailer assigned to me must be returned in a timely manner and in clean and working operating condition at the request of Highway Trucking, LLC.

14. Abandonment and Recovery Expenses. I understand if I do not return the truck and trailer assigned to me by Highway Trucking, LLC. upon their request, this is considered abandonment and I will be liable for recovery expenses.

15. Two Weeks' Notice Requirement. I understand if I the Contractor do not give a 2 weeks' notice before quitting I agree to forfeit my remaining pay.

16. Damage Liability. I understand if any damages are caused to the Truck or Trailer by the Contractor, I will be held liable for repair costs and will be deducted from my pay.

17. Abandonment Defense Waiver. I understand that due to my abandoning truck and trailer I waive the right to use the trucking phrase "abandonment" as my defense if the units are stolen as a result of that abandonment.

18. Document Retention Responsibility. It is my responsibility to make and keep copies of the Vehicle Trip Report, Vehicle Expense Reports, Bill of Lading and all receipts of each trip until Highway Trucking, LLC. confirms they are received.

Final agreement: I understand and agree to the terms in this contract.

Electronic signature

Your electronic signature has the same legal effect as a handwritten signature
You have read and understand all terms and conditions of this application
You consent to the use of electronic signatures in lieu of paper-based signatures
You understand that your signature will be permanently associated with this document
You have the legal authority to sign this document on your own behalf

I have read and agree to the terms above. I consent to the use of electronic signatures and understand that my electronic signature will have the same legal effect as a handwritten signature.

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Date *

Commercial Driver Application

Motor Vehicle Record Disclosure

Personal Information