Pro-Lease Trucking
Carrier Contracting With:
Applicant Name
Your email
Recruiter Name
Social Security Number
EIN Number
Telephone:
Birthdate:
Marital Status MarriedSingleOther
Spouse Birthdate:
Spouses Name
Current Address
City
State
Zip
Time at Current Address
Previous Address
Time at Previous Address
Are you in active bankruptcy? NoYes
Do you owe a child support balance over $5000? NoYes
Have you had a repossession in the past three years? NoYes
Have you ever had a tractor abandonment? NoYes
Drivers License Number
License State
Expiration Date
Are you a first-time owner operator? YesNo
If No: time as owner operator:
Business name or DBA
Current Employer:
Phone
Length of Employment
Haul Type VanReeferFlatbed
Previous Employer:
Applicant Signature:
Applicant Signature Date:
