www.HarrisQuality.com

Harris Quality - P.O. Box 457 Gretna, NE 68028 - Phone 402-332-2533 - Toll Free 888-332-2533 - Fax 402-332-2647

Application Form ...

If you are looking for the ONE PAGE APPLICATION CLICK HERE
Fax to 402-332-2543

If you are looking for the RELEASE FORM CLICK HERE
Fax to 402-332-2543

To fill out this application you will need to know the following: social security number, current drivers license number & driving record history including accidents, employment history for three years, criminal history, DUI conviction, reckless driving & any license suspension.

Personal Information
Full Name:
Email:
Social Security #
Home Phone:
Cell Phone:
Date of Birth:	(MM/DD/YY)
State:
Driver's License #
Type of License
Expiration Date	(MM/DD/YY)

Addresses
Street Address:
City:
State:
Zip:

Experience
Do you have OTR experience?	Yes No
DAC Authorized?	Yes No
HazMat?	Yes No
CDL Class A?	Yes No
Do you have Refrigerated experience?	Yes No
Other experience:	Yes No
Tractor/Semi experience which can be verified	Years Months

Employment History
Present/Last Employer
Employed From: TO Leave the "TO" month and year blank if you are still employed at the company
Position Held
Supervisor
Company
Street Address
City
State
Phone #
# of States Driven In
Reason For Leaving
May we contact your present employer*?	Yes No

Second Most Recent Employer
Employed From: TO
Position Held
Supervisor
Company
Street Address
City
State
Phone #
# of States Driven In
Reason For Leaving
May we contact your present employer*?	Yes No

Third Most Recent Employer
Employed From: TO
Position Held
Supervisor
Company
Street Address
City
State
Phone #
# of States Driven In
Reason For Leaving
May we contact your present employer*?	Yes No

Fourth Most Recent Employer
Employed From: TO
Position Held
Supervisor
Company
Street Address
City
State
Phone #
# of States Driven In
Reason For Leaving
May we contact your present employer*?	Yes No

*Additional Information*
Have you, within the last 3 years, tested positive for a controlled substance?	yes no
Have you, within the last 3 years, had a Breath Alcohol Concentration (BAC) final test of 0.04 or greater?	yes no
Have you, within the last 3 years, ever refused a required test for alcohol or controlled substances?	yes no
Have you violated any other DOT drug/alcohol regulations?	yes no
If yes to any of the the above questions please explain
Do you have any Felony Convictions?	yes no
If yes, date of last felony:
and please list all felony charges with their dates(mm/yy) and a brief description include country, city, and state.
Do you have any Misdemeanor Convictions?	yes no
If yes, date of last misdemeanor:
and please list all misdemeanor charges with their dates (mm/yy) and a brief description:
Number of Moving Violations in past 3 years*:
Number of Accidents in past 3 years*:

Please tell us how you heard about Harris Quality Inc.

If you were referred by a Harris Quality driver please provide
Name & Tractor Number

Full Name

Tractor #

Please don't forget to fill out the driver release form
CLICK HERE FOR RELEASE & Fax to 402-332-2543

Welcome to Harris Quality
If you take pride in your profession come drive for Harris Quality.

Bill Harris - President of Harris Quality Inc.

Come join our team of professional drivers. Drive the finest equipment made & work with people who care about fulfilling your needs as a driver. Equal Opportunity Employer.

P.O. Box 457 Gretna, NE 68028 - Phone 402-332-2533 - Toll Free 888-332-2533 - Fax 402-332-2543