Davis Delivery Service, Inc.

Owner-Operator Contractor Application

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Before you begin

THIS IS NOT AN APPLICATION FOR EMPLOYMENT. This form is used to qualify an independent owner-operator to provide transportation services to Davis Delivery Service, Inc. under a separate written contract.

Davis Delivery Service, Inc. does not withhold federal, state, or local taxes from contractor settlements and will issue IRS Form 1099 to the contractor and to the appropriate government agencies. Contractors supply their own equipment, insurance, and operating expenses, control the manner and means by which they perform their services, and are free to provide services to other customers and carriers.

If you will operate under Davis Delivery Service's USDOT operating authority, a written equipment lease meeting the requirements of 49 CFR Part 376 must be executed before dispatch.

Section 1

Contractor business information

Business structure:
Do you intend to continue providing services to other customers during this engagement?

Section 2

Operating authority

How do you intend to operate?
Current FMCSA safety rating:
Has your operating authority ever been revoked, suspended, or placed out of service?

Section 3

Service requirements

Freight moved under this contract is handled by hand. Services require the driver to:

  • Lift, carry, and lower freight weighing up to 50 lbs without assistance, repeatedly throughout the shift
  • Hand-unstack and restack floor-loaded freight inside a trailer or box truck
  • Push and pull loaded pallet jacks
  • Climb into and out of the truck, trailer, and cab many times per day
  • Stand, walk, bend, squat, kneel, and reach overhead for most of the shift
  • Operate a liftgate and secure loads with straps and load bars
  • Carry freight over thresholds, steps, and uneven ground on residential and job-site deliveries
  • Work in non-climate-controlled conditions, including heat, cold, and rain
Can you, and any driver you provide, meet these service requirements?

Section 4

Driver qualification

Federal law requires Davis Delivery Service to maintain a driver qualification file for every driver who operates a commercial motor vehicle under its operating authority, including leased owner-operators. The information in Sections 4 through 8 is required by 49 CFR Part 391 and is collected only for that purpose. It does not create an employment relationship and is not used to direct how you perform your services.

For your security, we don't ask for your Social Security number or date of birth online. We'll collect them from you in person if we move forward with your application.

Federal rule 49 CFR 391.21(b)(3) requires every address where you have lived during the past three (3) years.

Section 5

Driver's license and driving experience

Do you hold a current DOT medical examiner's certificate?
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Has any license, permit, or privilege ever been suspended or revoked?

Equipment experience — complete every line you have operated

26 ft box / straight truck
Straight truck with liftgate
Tractor-trailer (48–53 ft)
Tractor with 2 trailers
Yard tractor / spotter
Other (list)

Final-mile and freight-handling experience

Check everything you have done:Check all that apply.

Section 6

Accident record — past 3 years

Check here if you have had no accidents in the past three years:

Accident 1

Section 7

Traffic convictions and forfeitures — past 3 years

List all violations of motor vehicle laws or ordinances of which you were convicted or forfeited bond or collateral during the past three years, other than parking violations. If you need more room, use the box at the end of this step.

Check here if you have had no such convictions in the past three years:

Conviction or forfeiture 1

Section 8

Driving history

List every carrier or company you have driven a commercial motor vehicle for, most recent first, covering the past ten (10) years. Also list any non-driving work during the past three (3) years. Federal rule 49 CFR 391.21(b)(10) and (b)(11) requires three years of all employment plus seven additional years of CMV driving, and for both tiers it requires each employer’s name and address, the dates, and the reason the work ended. If you need more room, use the box at the end of this step.

Carrier or employer 1 — most recent

In this role you were:
Subject to the Federal Motor Carrier Safety Regulations?
Subject to DOT drug and alcohol testing under 49 CFR Part 40?
May we contact this carrier?

Section 9

Equipment

Equipment type:Check all that apply.
Equipment on the vehicle:Check all that apply.

Section 10

Insurance

Attach a certificate of insurance listing Davis Delivery Service, Inc., 943 Gainesville Hwy, Buford, GA 30518, as certificate holder.

Occupational accident / workers' compensation:Check all that apply.

Section 11

Drug and alcohol testing program

Are you currently enrolled in a DOT drug and alcohol testing consortium or third-party administrator program?

Before you may operate under Davis Delivery Service's authority, a pre-employment FMCSA Drug and Alcohol Clearinghouse full query must be completed. You must register with the Clearinghouse at clearinghouse.fmcsa.dot.gov and give electronic consent there — that consent cannot be given on this form.

Section 12

Documents to submit with this application

What you can provideYou can’t upload files here. Check what you have ready and we’ll collect copies when we follow up.

Section 13

Certification and authorization

Copy of your driver’s license or photo ID optionalA phone photo is fine — front and back if you have both. You can skip this and bring it by the office instead.
    Copy of your DOT medical examiner’s certificate (medical card) optionalA phone photo of the card is fine — we check the expiration date. You can skip this and bring it by the office instead.
      1. I certify that the information in this application is true and complete to the best of my knowledge. I understand that false or misleading information is grounds for rejection of this application or for termination of any contract that results from it.
      2. I authorize Davis Delivery Service, Inc. to contact the companies listed in this application and to request safety performance history information from my previous DOT-regulated employers and carriers as provided in 49 CFR 391.23, including accident information and drug and alcohol testing records for the preceding three years. I understand that I have the right to review that information, to have errors corrected, and to have my rebuttal attached to the file, as provided in 49 CFR 391.23(i) and (j).
      3. I authorize Davis Delivery Service, Inc. to obtain my motor vehicle record and Pre-Employment Screening Program (PSP) report.
      4. I understand that operating a commercial motor vehicle under Davis Delivery Service's authority requires a current DOT medical examiner's certificate and participation in a DOT drug and alcohol testing program, and I agree to meet those federal requirements.
      5. I understand and agree that no employment relationship is created by this application or by any contract that may result from it; that I am responsible for my own taxes, insurance, equipment, maintenance, fuel, and operating expenses; that I control the manner and means by which I perform contracted services, subject only to federal and state transportation regulations and the delivery requirements of the customer; that I am free to provide services to other customers and carriers; that I am not entitled to employee benefits, workers' compensation coverage, or unemployment compensation from Davis Delivery Service, Inc.; and that any engagement will be governed by a separate written agreement and, where applicable, a written equipment lease meeting 49 CFR Part 376.

      If a consumer report (background check, motor vehicle record, or PSP report) is obtained through a consumer reporting agency, you will receive a separate written disclosure and authorization form, as required by the Fair Credit Reporting Act.

      Davis Delivery Service, Inc. selects contractors without regard to race, color, religion, sex, national origin, age, disability, genetic information, or veteran status.

      Federal rule 49 CFR 391.21(d) requires us to tell you this before you complete this application: the information you give about your previous employers may be used, and those employers will be contacted, to investigate your safety performance history as required by 49 CFR 391.23(d) and (e). You have due process rights concerning the information those employers provide, as described in 49 CFR 391.23(i) — you may review it, ask that errors be corrected, and have your own rebuttal attached to the file.

      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.

      Application received

      Thank you. Your application has been sent to our team. If your background fits what we're hiring for, someone will contact you at the phone number or email you gave us.

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