Application | Roadrunner Driver's Application

Step 1 of 5

What Position Are You Applying For?
Required fields have an *

*Applicant must be at least 23 years of age*
Do you have any prior experience working for or owning a driveaway company?*
First Name*
M.I.
Last Name*
Date of Birth*
MM slash DD slash YYYY
Phone*
Social Security Number*
Email*
Street Address*
Apart/Unit #
City*
State*
Zip Code*
Have you lived at this address for at least 3 years?*
How long at this residence?
Previous Address
PLEASE COMPLETE THIS SECTION
Street Address*
Apart/Unit #
City*
State*
Zip Code*
Add Another Address?
Previous Address
Street Address*
Apart/Unit #
City*
State*
Zip Code*

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Driver Experience and Qualifications
Driver License
State Issued*
License Number*
Type*
Expiration Date*
MM slash DD slash YYYY
Driving Experience
Do you have any vehicle experience you wish to provide?*
Vehicle 1
PLEASE COMPLETE THIS SECTION
Type of Vehicle (Straight Truck, Cargo Van, Tractor & Tanker, Flatbed, doubles, etc)
Local or Long Haul
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. # of Miles
Add Another Vehicle?
Vehicle 2
Type of Vehicle (Straight Truck, Cargo Van, Tractor & Tanker, Flatbed, doubles, etc)
Local or Long Haul
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. # of Miles
Add Another Vehicle?
Vehicle 3
Type of Vehicle (Straight Truck, Cargo Van, Tractor & Tanker, Flatbed, doubles, etc)
Local or Long Haul
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Approx. # of Miles
Accident Record
Accident record for the past three years or more. All fields below required. If none, please select No
Have you been involved in an accident in the past 3 years?*
Last Accident
PLEASE COMPLETE THIS SECTION
Date
MM slash DD slash YYYY
Nature of Accident (Head-on, rear-end, etc.)
Fatalities
Injuries
Fault/citations Issued
Have you been involved in another accident in the past 3 years?
Next Previous Accident
Date
MM slash DD slash YYYY
Nature of Accident (Head-on, rear-end, etc.)
Fatalities
Injuries
Fault/citations Issued
Have you been involved in another accident in the past 3 years?
Next Previous Accident
Date
MM slash DD slash YYYY
Nature of Accident (Head-on, rear-end, etc.)
Fatalities
Injuries
Fault/citations Issued
Traffic Convictions and Forfeitures
Traffic convictions and forfeitures for the past three years or more (other than parking violations). All fields below are required. If none, please select No.
Have you had any traffic convictions or forfeitures in the past three years?*
PLEASE COMPLETE THIS SECTION
Traffic Conviction or Forfeiture 1
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Have you had any other traffic convictions or forfeitures in the past three years?
Traffic Conviction or Forfeiture 2
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Have you had any other traffic convictions or forfeitures in the past three years?
Traffic Conviction or Forfeiture 3
Location
Date
MM slash DD slash YYYY
Charge
Penalty

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Previous Employment History

DOT requires that employment for the last 3 years and/or commercial driving experience (if operating a vehicle of 26,001lbs or more) for the past 10 years be shown. Please fill out or answer ALL questions. If not complete, we cannot process your application.
Do you have previous work experience that you wish to provide?*
You Cannot Proceed With Your Application Without Providing Previous Work Experience
The NEXT button will appear when you choose YES to this question.
PLEASE COMPLETE THIS SECTION
Most Recent Employment
Company*
Street Address*
City*
State*
Zip Code*
Phone
Fax Number
Position Held*
From Date*
MM slash DD slash YYYY
To Date*
MM slash DD slash YYYY
Salary
Reason for Leaving*
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?*
Was this job designated as a safety sensitive function subject to the drug and alcohol testing requirements of 49 CFR Part 40?*
Do you wish to add another employer?
Next Most Previous Employment
Company
Street Address
City
State
Zip Code
Phone
Fax Number
Position Held
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Salary
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?
Was this job designated as a safety sensitive function subject to the drug and alcohol testing requirements of 49 CFR Part 40?
Do you wish to add another employer?
Next Most Previous Employment
Company
Street Address
City
State
Zip Code
Phone
Fax Number
Position Held
From Date
MM slash DD slash YYYY
To Date
MM slash DD slash YYYY
Salary
Reason for Leaving
Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed?
Was this job designated as a safety sensitive function subject to the drug and alcohol testing requirements of 49 CFR Part 40?
(A) Have you ever been denied a license, permit or privilege to operate a motor vehicle?
(B) Has any license, permit or privilege ever been suspended or revoked?
(C) In the previous three years, have you tested positive, or refused to take a pre-employment drug and/or alcohol test administrated by a prospective employer regardless of if you were hired or not?
If the answer to A, B or C is yes, please give the details below.

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To Be Read and Signed By Applicant
"I hereby authorize and all former employers, motor vehicle reports, courts and any other who have information about me to provide such information to Roadrunner Driveaway and/or and of it's representatives, agents or vendors. I release all parties involved from any and all liability for any and all damage that may result in providing such information."

This certifies that I have read in its entirety and completed this application, and that all entries on it and information on it are true and complete to the best of my knowledge.
Applicant's Signature*
Date*
MM slash DD slash YYYY
Due Process Rights
As a driver application, you have the right to:
- Review information provided by previous employers (CFR 39123 (i)(2)).
- Have errors in the information corrected by the previous employer, and for that previous employer to re-send the corrected information to the prospective employer (CFR 39123(i)(3)).
- Have a rebuttal statement attached to the alleged erroneous information, if previous employer and the driver cannot agree on the accuracy of the information (CFR 39123 (i)(3)).
This certifies that I have read the Driver applicant Due Process Right
Applicant's Signature*
Date*
MM slash DD slash YYYY
Inquiry to Past Employers
"I hereby authorize the release of all records of employment including assessments of job performance, ability and fitness, character, work, habits, performance, traffic offense, credit, experience, and reason for termination. Additionally, I authorize the release of all records regarding positive alcohol test results with a concentration result of .02 or greater, any positive controlled substances test results, any alcohol or controlled substance test refusal and information on any required substance abuse processional evaluation, determination of need for assistance and information for employment and release all such persons or companies supplying information from any liability."
Applicant's Signature*
Date*
MM slash DD slash YYYY
Independent Contractor Fact Sheet
Please click and view THIS DOCUMENT and then sign below.

"I have reviewed the Independent Contractor Sheet and based upon the factors listed therein, I believe that I am an independent contractor."
Do you believe that you are an independent contractor?*
- NO
- YES
Applicant's Signature*
Date*
MM slash DD slash YYYY
Email
This field is for validation purposes and should be left unchanged.

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Step 1 of 5

Previous Address

Previous Address

Driver Experience and Qualifications

Driver License

Driving Experience

Vehicle 1

Vehicle 2

Vehicle 3

Accident Record

Last Accident

Next Previous Accident

Next Previous Accident

Traffic Convictions and Forfeitures

Traffic Conviction or Forfeiture 1

Traffic Conviction or Forfeiture 2

Traffic Conviction or Forfeiture 3

Previous Employment History

Most Recent Employment

Next Most Previous Employment

Next Most Previous Employment

To Be Read and Signed By Applicant

Due Process Rights

Inquiry to Past Employers

Independent Contractor Fact Sheet