Quick Approval

Name

Address

City, St, Zip

Home Phone         Cell Phone

Date of Birth

Social Security Number

CDL#           State: AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NF NS ON PE PQ SK

What year is your truck?   2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 Other

How often do you need to be home? Every   6 weeks 5 weeks 4 weeks 3 weeks 2 weeks 1 week Other

Do you have flatbed, stepdeck, rgn or specialized freight experience?   RGN Stepdeck Flatbed Multi-axle NO

How many moving violations in the last 3 years?   0 1 2 3 4 5 other

By submitting this form I certify that I have personally completed this form, and that all information is true and correct.  I hereby request and authorize Diamond Transportation System, Inc. to cause to be conducted at any time, an investigation of my background for DOT qualification purposes which may include, but is not limited to: any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results or any other information about me which may reflect upon my potential for qualification gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning such items of information. I have completed this questionnaire of my own free will and hold Diamond Transportation System, Inc. harmless of all liability for providing this questionnaire for my use.

Yes, I have read the above statements and agree with them and would like you to process the approval form.