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Perkins Lead Sheet

Thank you for your interest in Perkins Specialized Transportation's
owner operator program.

Please fill out the form below and click on the Submit Lead Sheet button.  A representative from our fleet development department will contact you as soon as possible.  * - Denotes a required field.


(Hint: Use TAB to move from box to box. Using ENTER will immediately submit the form.)

Personal Information
*First Name:  

 *Middle Initial:

    
*Last Name:    
*Address:  
*City:  
*State:

 *Zip:
           
*Home Phone:

 

 Fax:    
Cell Phone:   E-Mail:
*SSN:   *Birthdate:
   mm/dd/yyyy
           
*CDL #:

*State:

 

*Class:

  
           



*Are you at least 23 years old? Yes No
*Moving violations in CMV or PMV last 3 years:  
*Preventable Accidents/Incidents in CMV last 3 years:  
*If you had any accidents or incidents, how many were DOT preventable?  
*Have you worked for Perkins before? Yes No   If yes, when?  
*Are you a US citizen? Yes No
*If not a U.S. Citizen can you legally live and work in the US? Yes No
*Have you ever refused or tested positive
for a drug and/or alcohol test? 		Yes No
*Have you been convicted of a DUI/DWI/OUI/OWI within the last 10 years? Yes No
*Do you have more have more than one DUI/DWI/OUI/OWI in a lifetime? Yes No
*Have you been convicted of careles or reckless driving in the past 5 years? Yes No
*Have you ever been convicted of a felony? Yes No
If yes, what/when?

*Do you have any misdemeanor convictions in the last 10 years? Yes No
If yes, what/when?

*Are you able to pass a DOT physical
and drug test?		 Yes No
*Do you require a DOT medical
waiver of any kind?		 Yes No
If yes, what?

*How much OTR driving experince do you have in:
Last 2 years

Last 3 years
Last 5 years
Employment History

*Most Recent Employer

Company Name:
Address:
City:
State:

 Zip:

  
Phone:  
Position Held:
Dates Employed - From:  
   mm/dd/yyyy

 To:

  
   mm/dd/yyyy
Reason for leaving:
Are you currently employed there?

Yes

 No
May we contact your current employer?

Yes

 No

*Next Most Recent Employer

Company Name:
Address:
City:
State:

 Zip:
Phone:  
Position Held:
Dates Employed - From:  
   mm/dd/yyyy

 To:

  
   mm/dd/yyyy
Reason for leaving:

*Next Most Recent Employer

Company Name:
Address:
City:
State:

 Zip:

  
Phone:  
Position Held:
Dates Employed - From:  
   mm/dd/yyyy

 To:

  
   mm/dd/yyyy
Reason for leaving:
     
*How did you find out about Perkins?

Web Site   ITJ   Trucking 2000
Referred by:
Other:

   

In compliance with applicable Federal and State laws, qualified applicants are considered for all positions without regard to race, color, religious preference, sex, national origin, marital status, or non job-related disability.

By pressing the Submit Application button below:

  • I certify that this application, which was completed by me, and all entries and information on it are true and complete to the best of my knowledge.

  • I understand that failure to pass the DOT Drug test required at time of orientation will result in immediate dismissal.  All costs incurred for lodging and/or return travel will be at my own expense.

  • I hereby authorize Perkins Specialized Transportation, Inc. to obtain all records of employment and/or application for employment, including assessments of my job performance, ability, and fitness to each and every company (or their authorized agents) which may request such information in connection with my application with said company.

  • I  authorize the release of all alcohol and controlled substance testing results (or refusals to test) pursuant to 382.413 of the Federal Motor Carriers Safety Regulations and release this company from any liability of any type as a result of providing the above mentioned information to the above mentioned person.