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|8 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

|9 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

|10 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

|11 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

Page 5 of 10

INVESTIGATIVE CONSUMER REPORT DISCLOSURE

DRIVER RELEASE OF INFORMATION

In connection with my application for employment (including contract for services) with you, I understand that a consumer report, which may contain public record information, is being requested from USIS services, Tulsa, Oklahoma. This report may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, academic history, professional credentials, drug and alcohol results, information relating to your character, general reputation, personal characteristics, mode of living, educational background, etc. I further understand that such report may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies which maintain such records as well as information from USIS concerning (1) previous driving record requests made by others from such state agencies; (2) state provided driving record; (3) claims involving me in the files of insurance companies.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY USIS TO FURNISH THE ABOVE-MENTIONED INFORMATION.

I have the right to make a request to USIS, within a reasonable period of time (not to exceed 30 days), upon proper identification, to request the nature and substance of all information in its files on me at the time of my request; the sources of information; the recipients of any reports on me, which USIS has previously furnished within the three-year period preceding my request, I hereby consent to your obtaining the above information from USIS, and I agree that such information, which USIS has or obtains, and my employment history with you if I am hired, will be supplied by USIS to other companies, which subscribe to USIS Services, I understand that I can contact USIS by mail at PO Box 33181, Tulsa, OK, 74153, or by phone at (800) 381-0645.

-----------------------

A conviction may not necessarily bar drivers from being qualified. Occurrences are taken on a case by case basis.

Page I Of- 10

Have you EVER been convicted of a crime: felony or misdemeanor? ( YES ( NO If YES, Describe in full; (Year, Charge, Penalty, etc)

Last school attended: ___________________________________ __________________________________________________

Name Address

College: 1 2 3 4

EDUCATION

Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12

Circle highest grade completed: 1 2 3 4 5 6 7 8 9 10 11 12 College: 1 2 3 4

If YES, please explain

Position Applying for: Owner Operator Company Driver Lease Driver (driver for an Owner Operator or Contractor) (If you checked Owner operator or Lease driver, you are not a company employee and not eligible for company employee benefits.)

Who referred you? Rate of pay expected? ________________________

Have you worked for this company before? ( Yes ( No / Dates: Start _______ End_________ Where? ___________________

MONTH/YEAR MONTH/YEAR

If YES, Reason for leaving ___________________________________________________________

Names of any relatives employed or contracted by this company? _______________________________________________________

Are you currently employed or contracted? ( Yes ( No -- If not, how long since leaving last employment? Is there any reason you are unable to perform the functions of the job for which you have applied? ( YES ( NO

Chesnut Cargo, Inc.

86 Gamble Road

Franklin, GA 30217

(706)882-3270 - ph (706)882- 4012 - fax

[pic]

STREET City STATE ZJP code

How long did you live at this address? _____________________

STREET City STATE ZIP CODE

How long did you live at this address? ___________________

CITY

How long did you live at this address? __________

Note: Please print or type all

Qualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, marital status or disability.

Driver Application Date: _______________________

Social Security Number: _____________________________________ APPLICATION MUST BE RENEWED AFTER 30 DAYS.

Name: __________________________________________________________ Phone: ____________________________________________________

FIRST MIDDLE LAST Cell Number: _____________________________

Home Address: ________________________________________________________________________________________________

How long have you lived at this address: __________________

If the above residence for less than three years, list below all residences for the past three years. Attach a separate sheet if necessary.

YOU MUST LIST A STREET ADDRESS IN ADDITION TO ANY P.O. BOX ADDRESS

COMPLIANCE CERTIFICATE

In compliance with the Federal Motor Carrier Safety Regulations and the stated policy of the motor carrier and in consideration of my continued qualification as a driver for the motor carrier, I understand and will comply with the following provisions as required by the Federal Motor Carrier Safety Regulations:

1) I do not hold any driver licenses other than the one from my state of domicile.

1) I will notify the motor carrier before the next dispatch of any conviction of a moving violation.

2) I will notify the motor carrier immediately if my operator's license is suspended, revoked or canceled or if I am disqualified as a driver.

DRIVER'S LICENSE INFORMATION

List ALL licenses and permits held in the last 3 years. Including present license.

DRIVING EXPERIENCE AND QUALIFICATION Print Name:

Date of Birth (month/day/year) Social Security # ______-___ - ____

The Federal Motor Carrier Safety Regulations require that driver applicants state their date of birth per §391.21(b)(2)

|DRIVER'S |STATE |LICENSE # |TYPE |EXPIRATION DATE |

|LICENSE | | | | |

| | | | | |

| | | | | |

| | | | | |

A, Have you ever been denied a license, permit or privilege to operate a motor vehicle? ( Yes ( No

B. Has any license, permit or privilege ever been suspended or revoked? ( Yes ( No

B. Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations? ( Yes ( No D, Do you hold more than one license to operate a motor vehicle? ( Yes ( No

If the answers to A, B, C or D is YES, give details below:

DRIVING EXPERIENCE

| |TYPE OF EQUIPMENT |DATE: FROM |DATES: TO |APPROX NUMBER OF MILES |

| |Auto Carrier, Van, Tank, Etc. | | |OR HOURS TOTAL) |

|( Straight Truck | | | | |

|( Tractor Semi-Trailer | | | | |

(qð Tractor 2APPROX NUMBER OF MILES

OR HOURS TOTAL)( Straight Truck( Tractor — Semi-Trailer

|(θ Tractor — 2 Trailers | | | | |

| (Auto Carrier | | | | |

|( Other | | | | |

List states operated in for last 5 years:______________________________________________________________________________________

. ...... . .......

ACCIDENT RECORD FOR PAST 5 YEARS

If none, write NONE. Do Not leave blank. (Commercial & Private Auto)

|DATE |TYPE 0F VEHICLE |DESCRIBE ACCIDENT |NUMBER OF |NUMBER OF |NUMBER OF |

| |(Auto, Commercial |(Head-on, Rear-End, Lane Change, etc.) |FATALITIES |VEHICLES TOWED |INJURIES |

| |Vehicle) | | | | |

|Last | | | | | |

|Accident. | | | | | |

|Next | | | | | |

|Previous | | | | | |

|Next | | | | | |

|Previous | | | | | |

|Next | | | | | |

|Previous | | | | | |

TRAFFIC CONVICTIONS & FORFEITURES FOR THE PAST 5 YEARS (other than parking violations) NONE, Do Not leave blank (Commercial & Private Auto

|LOCATION |TYPE OF VEHICLE |DATE | |PENALTY |

| |(Auto, Commercial Vehicle) | |CHARGE | |

| | | | | |

| | | | | |

| | | | | |

| | | | | |

Page 2 of 10

|3 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

| 1 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

PLEASE PRINT. FORM MUST BE COMPLETE AND LEGIBLE.

TF-06-02-04: Date, 6-5-2008, Rev. LA 00

• Motor carriers are required to obtain and review the "safety performance history" of each applicant per FMCSR 391

• Provide 10 years of employment history.

• A complete listing of Past Employers for the preceding 3 years and

• Drivers are required to provide an additional 7 years of information regarding previous employers for whom the driver operated commercial motor vehicles.

• Time GAPS are not acceptable. If unemployed, list the dates. If self employed (Owner Operators), provide Tax Statement and complete an additional form.

Attach additional sheets if necessary.

|2 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

Page 3 of 10

Page 4 of 10

|6 - Present or Previous Employer: |Phone #: |

|Address: |

|Dates: Start: / / End: / / |Supervisor: |

|Reason for Leaving: |Pay Rate: |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner| |

|OOp | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO |

|List any accident with this company: |

[pic]

|7 - Present or Previous Employer: |Phone #: |

|Address: |

|Dates: Start: / / End: / / |Supervisor: |

|Reason for Leaving: |Pay Rate: |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner| |

|OOp | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO |

|List any accident with this company: |

TF-06-0244 D3= 6-5-2(X)8: Rev. I.V1. 00

|5 - Present or Previous Employer: |Phone #: |

|Address: |

|Dates: Start: / / End: / / |Supervisor: |

|Reason for Leaving: |Pay Rate: |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO |

|List any accident with this company: |

|4 - Present or Previous Employer: |Phone #: |

|Address: | |

|Dates: Start: / / End: / / |Supervisor: | |

|Reason for Leaving: |Pay Rate: | |

|Position, check one: (Company Driver (Owner Operator (Driver Employed by Owner OOp | |Operator ( Other | |

|Equipment Operated, check one: ( Tractor Trailer ( Auto Carrier ( Other | | |

|Were you subject to DOT / FMSCA Regulations? ( YES ( NO Were you subject to Drug / Alcohol Testing ( YES ( NO | |

|List any accident with this company: | |

Applicant Printed Name: _________________________________ _______________________

Social Security Number

Applicant's Signature: __________________________________

Date: ______________________________

TF W 02- 09 Date; 6-6-2008

Rev. Lvl. 00

Page 6 of 10

[pic]

INM "~ INTELLIGikE

. I INMOITY

Applicant Printed Name:

APPLICANT MUST READ AND SIGN

I certify that I have read and understand all of the driver application. It is agreed and understood that the company or its agents may investigate my background, including criminal record checks, to ascertain any and all information of concern to my previous employment history, whether same is of record or not, I release employers, supervisors, personal references and all other persons from any liability for providing truthful and accurate responses to any such inquiry. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job. I also understand that if offered a job, the offer may be conditioned on the results of a physical examination and drug/alcohol tests,

I further certify that I am a genuine applicant for a driving position and this application is being submitted solely for the purpose of seeking a driving position with the company and for no other reason.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living,

I agree to furnish such additional information and complete such examinations as may be required to complete my driver qualification application and file. I also understand that misrepresentation or omission of information or facts may result in the rejection of my application for a driving position.

If I accept a driving position, I agree to abide by all the rules and policies of the company.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signing this document certifies that I completed this application and that all of the information I have supplied or will supply in this application and associated documents to Chesnut Cargo, Inc.. (the company), its affiliates or its agents, is a full and complete statement of facts. It is understood that if any falsification is discovered, it will constitute grounds for termination as a driver upon discovery thereof. I also understand that this application is not a contract of employment. I understand that if I begin a driving position for the company I will be utilized as an at-will driver and I may voluntarily leave my position as a driver or cancel my owner operator contract or the driving position or the owner operator contract may be terminated at any time for any reason. I acknowledge that no written or oral statements have been made to or relied upon by me regarding the length of the term of the driving position or owner operator contract or the reasons for which my driving position or owner operator contract can be terminated.

AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS

In consideration of this application for driver qualification and during any future driving position or owner operator contract with this company, I hereby authorize any physician, dentist, hospital, clinic, pharmacy, medical provider, insurance company, or other entity to provide to this company or any representative or agent thereof any and all information which may be requested regarding my physical and/or mental condition. If requested, I authorize same to provide this company or its representative or agent with a photocopy of any and all medical records, bills, and other documentation or materials in their possession pertaining to examination, evaluation, treatment, therapy or rehabilitation rendered by them and to allow this company or any representative or agent thereof or any physician appointed by them to examine any and all records, reports, slides, radiographs, test results or other materials in their possession. I agree that a photocopy of this authorization is as valid as the original.

Applicant Signature:

Date:

Page 7 of 10

Signature:

Date:

***THIS SECTION IS ONLY FOR***

OWNER OPERATOR / LEASE DRIVERS (driver for an owner operator or contractor)

Position Applying for: ( Owner Operator ( Lease Driver (driver for an Owner Operator or Contractor)

(If you checked Owner Operator or Lease Driver, you are not a company employee and not eligible for company employee benefits.)

I agree and understand, that I am an (check one)

( Owner Operator ( Lease Driver (driver for an Owner Operator or Contractor,

I further understand that I will not be treated as an employee for social security taxes, federal tax purposes, state tax purposes, workers' compensation coverage, company employee benefits (i.e. medical Insurance, dental insurance, retirement plan, vacation pay, etc—) or, for that matter, for any other reason,

Printed Name: [pic]

*** Please provide the following information if you have operated under your own DOT Authority within the last ten years.

Complete the following information, as it is listed with the Department Of Transportation, Your Company's US DOT Number: __________________

Name of YOUR company:

Address of record:

Dates: Start End

Name of Insurance Company;

Address: Phone:

Name of your Drug Consortium:

Address: Phone:

Page 8 of 10

New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified above directly.

NOTICE AND ACKNOWLEDGMENT

[IMPORTANT .. PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT]

NOTICE REGARDING BACKGROUND INVESTIGATION

CHESNUT CARGO, INC. ("the Company") may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report, Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by Aurico Reports Inc., 116 W. Eastman St., Suite 101, Arlington Heights, Illinois, 60004, (866) 255-1852 or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report,

ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Aurico Reports Inc., 116 W. Eastman St., Suite 101, Arlington Heights, Illinois, 60004, (866) 255.1852, another outside organization acting on behalf of the Company, and/or the Company itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.

Page 9 of 10

P'l Or Q i, I' M

Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company. (

California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law. (

3.

Maiden Name: Date Changed:

Other last names used: __________________________________________

Name date changed

Printed Name: ____________________________________________________________________

First Middle Last

List all cities and states where vote have lived for the past 7 years - Attach additional sheet if necessary

Street City County State ZIP HOW LONG?

Current: ____________________________________________________________________________________

2. __________________________________________________________________________________________

3. ___________________________________________________________________________________________

4. ___________________________________________________________________________________________

Present Phone Number: Social Security Number: ____________

Date of Birth* (for Identification Purpose, only) (MM/DD/YYYY): ______________________________

SEX*: Male Female: _______ Driver's License Number: State: _____

*This information will be used for background screening purposes only and will not be used as hiring criteria.

Page 10 of 10

Page 10 of 10

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