Owner Operator

RAVEN TRANSPORT HOLDING
6800 Broadway Avenue
Jacksonville, FL 32254
(877) 777-5058 (Toll-Free)
OWNER-OPERATOR PROCESSING INFORMATION
Required fields are indicated by an asterisk *

* Date:

How did you hear of Raven Transport?

PERSONAL DATA

* E-Mail Address
* Date of Birth
*First Name
 *Driver's License No.
* Middle Name
 * State of License
* Last Name
 * License Expiration Date
* Social Security No.
  

List your addresses of residency for the past 3 years.
* Current Address
*Street   
*City          *State    *Zip Code
*Phone
How long?

Previous  Addresses
Street   
City          State    Zip Code
How long?

Street   
City          State    Zip Code
How long?

VEHICLE INFORMATION: (Complete all information concerning your tractor)
Year   
Make  
Model 
Vehicle Identification Number
License Plate No. And Base State 
Lien Holder 
Cost of vehicle(new)  
Empty weight  
Gross weight   

Will you need to purchase insurance through Raven Transport?
Yes   No

If ''No'', complete the following:
Name of Carrier and Policy No. for:
Non-Trucking Use Liability and Physical Damage
Occupational accident

EMPLOYMENT HISTORY
All driver applicants who drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, zip code, phone number and fax. number. Applicants who drive a commercial motor vehicle in interstate or intrastate also shall provide an additional 7 years of employment history for those employers for which the applicant drove a commercial motor vehicle.

PRESENT EMPLOYER

DATE

*Name     
*Address  
*City             *State    *Zip 
*Phone          Fax  
Reason for Leaving  

*to        
*from    
salary  
position

 

 

PAST EMPLOYER

DATE

Name     
Address  
City             State    Zip
Phone          Fax  
Reason for Leaving  

to        
from    
salary  
position

 

 

PAST EMPLOYER

DATE

Name     
Address  
City             State    Zip
Phone          Fax  
Reason for Leaving  

to        
from    
salary  
position

 

 

PAST EMPLOYER

DATE

Name     
Address  
City             State    Zip
Phone          Fax  
Reason for Leaving  

to        
from    
salary  
position


  Required fields are indicated by an asterisk *

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