"*" indicates required fields CommentsThis field is for validation purposes and should be left unchanged.Date Enter Referral CodeRoleUser EmailCompany InformationDOT #*Motor Carrier Name*Main Phone*Fax*TaglineWebsite Social Media Carrier Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country GeocoderDate Founded Carrier Type— Select —PrivateFor-HireDOT Type— Select —InterstateIntrastateBlendedAsset Type— Select —Asset basedNon Asset BasedBlendedBrokerTrucking type— Select —LocalRegionalOTRMixLoad Type— Select —TruckloadLTLMixRun PSPs on drivers— Select —YesNoDo you require a TWIC— Select —YesNoNo, but its helpfulFelony OK?— Select —YesNoDUI OK?— Select —YesNoReckless OK?— Select —YesNoJob hopper OK?— Select —YesNoMinimum Age of Applicant— Select —None18212325Use drug pool as pre-employ— Select —YesNo# Trucks# DriversHow recently must a driver have driven, for insurance purposes?— Select —No Restrictions – We'll hire them regardless90 days6 months12 monthsCase by CaseHow often do you want to rescreen drivers?— Select —Every 6 monthsEvery 12 monthsStandard is 1 year. Best practice is 6 months.Do you conduct road tests on drivers or use their CDL as an equivalent?— Select —We conduct road testsWe use CDLs as equivalentsCase by caseStates where you operate Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other Where else do you operate?Benefits Offered Pet Friendly Rider Friendly Vacation (1 week) Vacation (2 weeks) Vacation (3 weeks) Medical Insurance Dental Insurance Vision Insurance Life Insurance Disability Insurance 401K PTO Unlimited PTO Flexible Work Arrangements Tuition Reimbursement Wellness Programs (gym) Parking/Transit Subsidies Flex Spending Accounts Stock Options/Profit Sharing Childcare Assistance Employee Assistance Programs (EAP) Other What other benefits do you offer?What types of drivers do you use? Truck Drivers Contract Drivers Owner Operators Owner Ops (W2) ***DEFINITIONS*** Truck driver = W2 Driver, no Truck Contract driver = 1099 Driver, no Truck Owner Operator = 1099 Driver + Truck W2 Owner Op = W2 Driver + Truck (Cali)What license classes do drivers utilize? Class A Class B Class C What vehicle types do you utilize? Commercial Pickups Box/Straight Trucks Tractor Trailers LCVs What driver categories do you use? Vacation Drivers Contingency Drivers Linehaul Drivers P & D Drivers OnDemand Drivers Seasonal Drivers Long Haul Drivers Regional Drivers Shag Drivers Delivery Drivers Overflow Drivers Team Drivers What trailer types do you use? Belly Dump Car Hauler Conestoga Dry Van End Dump Flatbed Gooseneck Intermodal Low-Boy Passenger Pneumatic Reefer Roll-off School Bus Side Dump Specialized Straight Truck Tanker Vocational Other Contact InformationName* First Name Last Name Preferred NameWhat is your title?Email* Enter Email Confirm Email Cell PhoneWork PhonePassword Enter Password Confirm Password Years in businessPublic Contact Name First Last DOT Number (Scrubbed)Driver InformationAccident ThresholdViolation ThresholdMinimum Years of Experience— Select —01234571015Minimum Miles of Experience— Select —050,000100,000200,000250,000300,000500,000750,0001,000,000What products do you haul? General Freight Household Goods Metal; Sheets, Coils, Rolls Motor Vehicles Drive Away/Towaway Logs, Poles, Beams, Lumber Building Materials Mobile Homes Machinery, Large Objects Fresh Produce Liquids/Gases Intermodal Containers Passengers Oil Field Equipment Livestock Grain, Feed, Hay Coal, Coke Meat Garbage, Refuse, Trash U.S. Mail Chemicals Commodities Dry Bulk Refrigerated Food Beverages Paper Products Utility Farm Supplies Construction Water Well Recyclable Metals Other What other cargo do you carry?Select Must-Have Driver Experience (Deal Breakers)Select experience(s) that you seek in all of your drivers Tractor Trailer Box Truck Boom Truck Bus Car Carrier Dump Truck Fire Truck Fuel Truck Garbage Truck Mixer Plow Truck Service Truck Tank Truck Tow Truck Water Truck Wrecker Yard Dog Pallet Jack Fork Lift (certified) Fork Lift (uncertified) Front Loader Skid Steer Back Hoe Scissor Lift Telehandler Excavator Rain Snow Mountains Desert Flatbed Reefer Tarping Blind Backing Ports Rail yards Other What experience must a driver have?Select Preferred Driver Experience (Value Add)Select experience(s) that would add value to your operation Tractor Trailer Box Truck Boom Truck Bus Car Carrier Dump Truck Fire Truck Fuel Truck Garbage Truck Mixer Plow Truck Service Truck Tank Truck Tow Truck Water Truck Wrecker Yard Dog Pallet Jack Fork Lift (certified) Fork Lift (uncertified) Front Loader Skid Steer Back Hoe Scissor Lift Telehandler Excavator Rain Snow Mountains Desert Flatbed Reefer Tarping Blind Backing Ports Rail yards Other What other experience should the ideal candidate haveAI AgentsAgentic Team Maude = AI Ops Assistant + Hiring Automation = Supercharged DriverOps Mira = Hiring Intelligence + Oversight = Make Better, Faster Decisions Diane = AI Driver Recruiter + Visibility Boost = More Relevant Drivers Maude + Mira + Diane = Turbocharged Hiring All 3 Agents are includedSelect Team* Maude + Mira + Diane DQF ManagementEnter DQF Email Enter Email Confirm Email This email will receive DQF docs Name of DQF Manager First Last DQF Phone Country Phone Number DQF Fax Country Phone Number Master EmailThis email will be copied on all Maude correspondence Enter Catch-All Email Enter Email Confirm Email TPA ProvidersDo you use a company like HireRight to qualify drivers? Select TPA ProviderHireRightDISA Global SolutionsFirst AdvantageSterling CheckVerified FirstSambaSafetyScoutLogicDriver iQ (Cisive)OtherNonePlease confirm that the TPA information below is correctPlease add your TPA’s information belowPlease add your information below to use it on DQF paperworkTPA NameTPA Phone Country Phone Number TPA AddressPlease verify your location Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country AdmininstrativeAdministrative IntegrationRenewal Days (6 mo)Renewal Days (12 mo)Renewal DaysInsurance 90Insurance 180Insurance 360Insurance Days
