Position Applying For Owner Operator Company Driver First Name Middle Initial Last Name Phone Number Email Social Security # DOB Street Address City State Zip License # Class State Issued Expiration Date Endorsements Has Your License Ever Been Suspended Or Revoked Number of Preventable Accidents in the past 3 years Number of Moving Violations In The Last 3 years Number Of Reckless Driving Violations In The Past 3 Years Have You Ever Been Convicted Of A Felony Have You Ever Had A DUI, DWI, or OUI Convictions Local Driving Experience Verifiable OTR Experience What Year Tractor Do You Have (Owner Operators Only) What Model Tractor (Owner Operators Only) What Types Of Trailers Have You Pulled Do You Give Gemini Traffic Sales Permission to Run You DAC Report Most Recent Or Current Employer Start Date Ending Date Position Street Address City State Zip Phone Number States Driven Type Of Trailers Reason For Leaving Previous Employer Start Date Ending Date Position Street Address City State Zip Phone Number States Driven Type Of Trailers Reason For Leaving
Gemini Traffic Sales Inc. • 41 Distribution Blvd. • Edison, NJ 08817 • 800 613-1287 • Fax 732 287-6159
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