Owner Operator Prequalification

Thank you for taking time to learn more about Keystone Logistics and how we can keep your truck loaded and on the road. We would appreciate the opportunity to answer any questions you have via email, phone, or in person. Simply fill out the form below and we will be in touch shortly. 

 

Your Information (* indicates a required field)

Terminal/Agent:
Applicant:*
Address:*
City:*
State:*
Zip Code:*
Phone:*
Email:
Date of Birth:*
Social Security Number:
 
CDL License:*
CDL License Number:
Exp:
State:
 
Tickets:*
Last 36 Months:
(include dates)
 
Chargeable Accidents:*
Last 3 Years:
Major:
Minor:

DWI/DUI/Reckless Driving:*

No:    Yes:     Date:

Ever failed drug screen:*

No:    Yes:     Date:

License ever suspended:*

No:    Yes:     Date:

Ever terminated from job:*

No:    Yes:     Date:

Have you ever been convicted of a felony:*

No:    Yes:     Date:

If yes explain in the box below:

Do you give permission to check your employment under Part 391 & your past history on substance testing under 382.413 and allow Keystone Logistics, Inc. to purchase consumer reports (i.e. DAC, MVR, PSP but not limited to these listed)?*

No:    Yes:

(If answer is no, driver may not be hired)

VERIFICATION OF LAST 3 YEARS OF EMPLOYMENT:*
List employer company name, contact name, phone and dates worked.

Human Entry Test:*
This test prevents "bots" from automatically filling out the form and spamming our email.

Enter the following word in the field below exactly as shown, stop.

   

Site Map