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RexDon
Power-Only Transport

Driver Application

Personal Info

Name*
Date of Birth*

Contact Info

Address*
Emergency Contact*

Driver's License

Date of Issue*
Date of Expiration*

Equipment

Truck Experience

Straight Truck

From Date
To Date
Approximate Number of Miles

Tractor and Semi-Trailer

From Date
To Date
Approximate Number of Miles

Tractor and Two Semi-Trailers

From Date
To Date
Approximate Number of Miles

Other Trucks and Trailers

From Date
To Date
Approximate Number of Miles

Additional Trucking Experience

States you've operated in within last 5 years*

Physical Condition

Education

Previous Employer

All driver applicants to drive in interstate or foreign commerce must provide the following information covering at least the last seven years. List employers in reverse order starting with present or most recent employer or company leased to as an owner-operator.

Employer 1

From Date
To Date
Address
Contact Person

Employer 2

From Date
To Date
Address
Contact Person

Employer 3

From Date
To Date
Address
Contact Person

Employer 4

From Date
To Date
Address
Contact Person

Employer 5

From Date
To Date
Address
Contact Person

Employer 6

From Date
To Date
Address
Contact Person

Employer 7

From Date
To Date
Address
Contact Person

Accident Record

List any accidents for past seven years in reverse order starting with most recent.

Accident 1

Date

Accident 2

Date

Accident 3

Date

Accident 4

Date

Accident 5

Date

Accident 6

Date

Accident 7

Date

Traffic Convictions/Forfeitures

List any traffic convictions or forfeitures for past seven years in reverse order starting with most recent.

Incident 1

Date
Location

Incident 2

Date
Location

Incident 3

Date
Location

Incident 4

Date
Location

Incident 5

Date
Location

Incident 6

Date
Location

Incident 7

Date
Location

Previous Pre-Employer Employee Alcohol and Drug Test Statement:

The prospective Lessee is required by Sec. 40.25(j) to respond to the following questions.

Miscellaneous

Captcha image

By submitting this application, I agree to the following conditions:

If chosen to lease on with REXDON INC. as an owner operator to operate as an independent contractor, I agree to establish myself as an independent contractor by putting my name and address on my tractor in addition to REXDON placards.

I recognize and agree I am responsible for periodic inspections of my vehicle as per company requirements and federal law. I am responsible for the upkeep and maintenance of my vehicle, including tires. I am responsible for fuel, cost of physical damage insurance on my tractor if any, the filing and payment of all highway taxes, the cost of state license plates, and all other truck expense.

Furthermore, as an independent contractor I am responsible to file and pay my own payroll taxes of any nature and the cost of workman’s compensation insurance as required now or in the future. I agree to abide by all the terms and conditions of REXDON equipment lease and addendum to same.

I certify 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. I authorize REXDON to make such investigations and inquiries of my personal Employer, medical history and other related matters prior to their decision to use my services, or later at their discretion. I understand any false or misleading information supplied by me may result in cancellation of any lease agreements entered into with REXDON.

Prior to driving in REXDON’s service as an owner operator or as a driver for an owner operator, I agree I must pass a required DOT physical and drug and alcohol test and furnish a copy of same to REXDON Safety Department. My express permission is hereby given for REXDON to require me to submit successfully to their tests and exams, and to their judgement as to whether or not I am qualified and needed to drive a truck in their service.

I recognize and agree I will not be an employee of REXDON and they are not my employer by my signing a lease with them or driving for an owner operator who is leased to REXDON.


Under penalty of perjury, I affirm that the information provided is correct to my knowledge and hereby offer my legally-binding digital signature.*
*required
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