RvTransport.com - Application

RV Transport Contractor Application
Name		Phone:
Mail Address:
City:		State:
E-Mail Address:

List Previous addresses for past 10 years.
Address 1:		Address 2:
Address 3:		Address 4:
Address 5:		Address 6:

Age:		DOB:
SS#:
Weight:		Height

Driver License Number:		State:
Class:		Expires

In Case of Emergency Notify:		Phone:

Previous Employer:

Have you delivered RV's for another company?

yes
no

If so who:

address & phone:

Do you own a pick-up truck? yes no

Make

Model:

Year:

Turbo Diesel:

yes no

Equipped to tow travel trailers and fifth wheel trailers?

Goose neck trailer?

Do you own an RV:

yes no

If so what type:

Do you belong to an RV Club:

yes no

If so what club:

What is your education?		Have you ever been convicted of a felony?	yes no
Have you ever been bonded?	yes no
How many points are on your driving record for the past 10 years?		Why?
Have you had an accident or DUI in the past 10 years?		If "yes", Please explain:
What driving experience do you have to quality you for this work?

How much money do you want to earn each week?		Annually?
Do you have a bank account with an ATM card?	yes no	Do you have a credit card?	yes no
Do you have the $500 deposit?	yes no	Do you have a valid DOT medical card?	yes no
Do you have enough money to operate on until you get your first paycheck?	yes no	How many days can you stay out "On the Road" before you need to return home?
Will you deliver units to the North East? (ME, NY, CT, MA, VT, NH, etc.)	yes no maybe	Are you willing to operate your vehicle according to the Federal Motor Carrier Safety Regulations?	yes no
When do you want to start work?

Equipment Check List
Does your pick-up have a diesel engine?	yes no	Does your pick-up have a stock pick-up bed on it?	yes no
Is the bed 96 inches (8ft.) long?	yes no	Is there 54 inches clearance, center of 5W hitch to truck cab?	yes no

Do you have the following items installed?
Fifth wheel hitch (minimum 14K rated)?	yes no	2x2 reciever hitch (10K rated)?	yes no
Seven wire "RV Style" electrical connector in the truck bed?	yes no	Seven wire "RV Style" electrical connector near the ball mount?	yes no
Electric brake controller for trailers with six brakes?	yes no	Towing mirrors suitable for trailers 102" wide?	yes no
Rear mud flaps (or rock guard) no higher then 4" above ground?	yes no	Fire extinguisher mounted in cab?	yes no

Do you have the following items on hand?
2x2 solid shank adj. ball mount (10K rated)	yes no	2 5/16 inch ball (10K rated) mounted with top 18" from ground?	yes no
Load equalizing torsion bars rated at 500 lbs. each?	yes no	2x2 hollow shank with 2 inch ball (5K rated)?	yes no
Battery (standard group 24 RV batter w/ top studs)?	yes no	Reflective triangles (for road side emergency)?	yes no
Hyd. bottle jack, 12 ton capacity?	yes no	Torque wrench, 1/2 sq. drive click stop, 100# min. rating?	yes no
3/4", 13/16", & 7/8 inch deep thin wall sockets for wheel lug nuts?	yes no	Disposable (or digital type) camera?	yes no
Cell Phone?	yes no

Do you have the following "optional" items?
Goose neck hitch?	yes no	Extra 100 gallon fuel tank (in from of bed)?	yes no
Tool box (V-Box mounted in rear of truck bed)?	yes no