Owner Operator Application | Diligent Delivery Systems

Diligent Location You're Requesting

Basic Information

Name ⁄ DBA*

SSN# ⁄ EIN#*

DL#*

Date of Birth*

Business Address*

City*

State*

Zip Code*

Daytime Phone*

Evening Phone

Email*

First date you can provide contract services:

Are you currently a commercial driver?

Can you provide us a MVR?

Have you previously contracted with Diligent?

If yes, when?

What type of vehicle will you use when delivering for Diligent?

Year:

Make:

Model

Previous Contracted Services or Work Related History

List below previous contracted services or work related history, listing the most current one first.

Dates	Client's Name & Address	Type of Job	If No Longer a Client, Reason Why
From: To:
From: To:
From: To:
From: To:

Special Questions

Have you ever been convicted of a felony?
Answering yes does not exclude you from consideration.

If yes, please explain:

Are you a citizen of the United States?

Resident alien?

General Background

For your security and the security of the business for which you may provide contract services, may we obtain and provide to you a copy of a background check?

List below three persons not related to you who you have known at least three years.

Name	Address	Phone Number	Years Known

Driving Information

How long have you driven as an Independent Contractor?

How many accidents/collisions have you been involved in within the last three years?

Major moving violations in the last three years: (Please check all that apply.)

Hit & Run; leaving the scene of an accident DWI, DUI; driving while intoxicated Reckless, negligent or careless driving License suspension or revocation Speeding less than 15 MPH over posted limit Speeding at least 15 MPH over posted limit Have you had 3 or more moving violations in a year Any felony, homicide or manslaughter involving the use of a motor vehicle. None of these moving violations in the last three years

Where did you learn of this opportunity?

Newspaper Cable TV Friend

If heard from a friend, who?

Resources

Careers

Diligent Owner Operator Application