must be of the same name - Carroll Fulmer Logistics Corporation

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1. Paid by 70% of the gross, pulling our trailer plus 95% of the fuel surcharge.
2. Weekly pay on Comdata Card or Direct Deposit.
3. Comdata Fuel card that includes rebates and discounts.
4. Rider Program. (Must be 12 years old minimum)
5. Transflow - unimited scanning of bills, logs, lumper receipts, etc. to
Groveland office for faster pay.
6. Tags, Permits, Fuel Tax, Occupational Accident Insurance, Physical
Damage Insurance, Bobtail Insurance, Qualcomm and
Open Road. (legal assistance, hotel, restaurant and rental car discounts)
All taken out in a convenient weekly payment from your settlement.
7. No Hazmat endorsement needed.
8. No Forced Dispatch.
9. Pre-loaded fuel card while under dispatch.
10. $200 Monthly Safety Bonus.
11. $1000 Referral Bonus.
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LEASING PAPERWORK CHECKLIST
What new Owners need to produce for truck documentation
before leasing on to Carroll Fulmer Logistics Corporation
� Truck has to be 10 years old or newer…
� If requiring a tag from the company we need:
_____1.Copy of original title in current owner’s name (titled owner
of truck and W-9 must be of the same name)
_____2.If just purchasing truck, then we will need the title
application in current owner’s name
_____3.If a Lease Purchase – need a copy of the original title and a
copy of the Lease Purchase Agreement
_____4.Copy of stamped schedule 1 2290 (Hwy use tax) for 2012-
2013 year
_____5.Copy of DOT annual inspection-no more than 6 months old.
� If you have your own tag:
_____1. Copy of current Cab Card Registration
_____2. Copy of stamped schedule 1 2290 (Hwy use tax) for 2012-
2013 year
_____3. Copy of DOT annual inspection-no more than 6 months
old.
Other required paperwork needed to process application:
_____1. Owner/Equipment input sheet
_____2. Permit request form
_____3. W-9 (titled owner of truck and W-9 must be of the same
name).
_____4. Occupational/Accidental form
_____5. Program sheet

FAX: 352-429-6179 G.F.
Page: 1
Name: ____________________________________ Social Security#: ________________________
Present Address: _________________________________________________ How long? ________
City: ________________________________________ State: _______ Zip: __________________
Telephone#: ___________________/Cell____________________ Date of Birth: ________________
Check one: Owner Operator Lease Purchase Company Driver
Expected Starting Date: __________________________________
DRIVER’S LICENSE INFORMATION:
State: ________ #___________________________________________ Exp Date ______________
List Endorsements____________________________________
List all license(s) held in last three years: ________________________________________________
Ever tested positive or refuse DOT drug/alcohol test? Yes No
Any DWI’s or DUI’s? Yes No If yes, list dates _______________________________________
List all tickets in last three years: ______________________________________________________
Any felony convictions? Yes No If yes, list dates_____________________________________
List all accidents in last 5 years and dates: _______________________________________________
Chargeable ___________________ Non-Chargeable _______________________
EMPLOYMENT HISTORY (include any other OTR experience on a separate sheet of paper)
Present Employment From: _________________ To: _____________________
Employer: ________________________________________________________________________
Address: _______________________________ City: ___________________ State: ____________
Telephone#:___________________ Position Held ___________________ # of States: ___________
Is it okay to check current employer? Yes No Type of Trailer _________________
When will you be ready for orientation? _________________________________________________
Previous Employment From: _________________ To: _____________________
Employer: ________________________________________________________________________
Address: _______________________________ City: ___________________ State: ____________
Telephone#:___________________ Position Held ___________________ # of States: ___________
Reason for leaving _____________________________________ Type of Trailer _______________
Previous Employment From: _________________ To: _____________________
Employer: ________________________________________________________________________
Address: _______________________________ City: ___________________ State: ____________
Telephone#:___________________ Position Held ___________________ # of States: ___________
Reason for leaving _______________________________________ Type of Trailer
I hereby certify that I personally completed this form, and that the information is true and correct and
complete to the best of my knowledge. I authorize Carroll Fulmer Logistics Corporation to obtain
information relating to my past or present work history and to do a complete background investigation
in accordance with state and federal laws. Furthermore, I give my express consent for Carroll Fulmer
Logistics Corporation, any previous employer, their agent, or medical review officer or their agent to
release information concerning my past controlled substance tests and training records, by any former
employers and hold them harmless of any liability from release of said information.
______________________________________________ ___________________________
Signature Date

ADDITIONAL EMPLOYMENT IF NEEDED Page: 2
Company Name: ______________________________________________ Street Address: _____________________________
City, State, Zip: _______________________________________________ Telephone Number: __________________________
Date of Employment: From: _____________ To:___ __________ Salary/%/mileage $ ___________________
Your Position/Title: _____________________________ Supervisor Name: ________________________________________
Type of truck/trailer: _______________________ Reason For Leaving: _______________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? ____yes ____No
Was this position designated as a “safety sensitive function” in any DOT regulated mode subject to alcohol and drug
testing required by 49 CFR Part 40? ____yes _____No
Company Name: ______________________________________________ Street Address: _____________________________
City, State, Zip: _______________________________________________ Telephone Number: __________________________
Date of Employment: From: _____________ To:___ __________ Salary/%/mileage $ ___________________
Your Position/Title: _____________________________ Supervisor Name: ________________________________________
Type of truck/trailer: _______________________ Reason For Leaving: _______________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? ____yes ____No
Was this position designated as a “safety sensitive function” in any DOT regulated mode subject to alcohol and drug
testing required by 49 CFR Part 40? ____yes _____No
Company Name: ______________________________________________ Street Address: _____________________________
City, State, Zip: _______________________________________________ Telephone Number: __________________________
Date of Employment: From: _____________ To:___ __________ Salary/%/mileage $ ___________________
Your Position/Title: _____________________________ Supervisor Name: ________________________________________
Type of truck/trailer: _______________________ Reason For Leaving: _______________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? ____yes ____No
Was this position designated as a “safety sensitive function” in any DOT regulated mode subject to alcohol and drug
testing required by 49 CFR Part 40? ____yes _____No
Company Name: ______________________________________________ Street Address: _____________________________
City, State, Zip: _______________________________________________ Telephone Number: __________________________
Date of Employment: From: _____________ To:___ __________ Salary/%/mileage $ ___________________
Your Position/Title: _____________________________ Supervisor Name: ________________________________________
Type of truck/trailer: _______________________ Reason For Leaving: _______________________________________________
Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? ____yes ____No
Was this position designated as a “safety sensitive function” in any DOT regulated mode subject to alcohol and drug
testing required by 49 CFR Part 40? ____yes _____No
� Includes vehicles having a GVWR of 26,001 lbs or more, vehicles designed to transport 15 or more passengers, or any
size vehicle used to transport hazardous materials in a quantity requiring placarding.

RELEASE AND AUTHORIZATION TO OBTAIN CONSUMER AND/OR INVESTIGATIVE CONSUMER REPORT
I, the undersigned, hereby consent, authorize and release _CARROLL FULMER LOGISTICS CORP, its affiliated
companies, and/or its agents (collectively, herein after referred to as “ the Company”) to procure consumer reports on me
including, but not limited to information concerning my credit worthiness and standing, character, general reputation,
personal characteristics, and mode of living. These reports may be obtained through, but not limited to the following
sources: employment and education verifications, personal credit history based on reports from any of the credit bureaus,
personal interviews, personal references, motor vehicle reports, social security number verifications, present and former
addresses, criminal and civil history/records, and any other public records.
I hereby release any and all persons, business entities, third party agencies, and governmental agencies providing
information, whether public or private, from any and all liability, claims and/or demands, by me, my heirs or others making
such claim or demand on my behalf for providing consumer reports(s) and/or investigative consumer report(s) authorized
therein.
Further, if I am selected as an employee or independent contractor for the Company I understand and authorize that a
periodic investigation may be requested for the duration of my association with the Company. I understand that this
release and authorization shall remain in effect for the duration of my association with the company. Additionally, I hereby
authorize the Company to investigate any incidents of workplace misconduct made against or involving me both during
and after the term of my association with the Company.
I understand and agree that any information provided by me that is found to be false, incomplete or misrepresented in any
respect in the Company’s sole judgment, will be cause to cancel further consideration of my application for employment
and/or contracting services whenever such discrepancies are discovered. Further, I understand that by requesting this
information that no promise of employment is being made. I am willing that a photocopy of this authorization will be
accepted with the same authority as the original.
I HEREBY CERTIFY THAT THIS FORM WAS COMPLETED BY ME, AND THAT THE INFORMATION PROVIDED IS
TRUE AND CORRECT AS OF THE DATE HEREOF.
Signature: _________________________________________________ Date:__________________________
Please Print:
Name:______________________________________________________ *Date of Birth:____________________
First Middle Last
Social Security Number:_______ - ________ - ________ Gender (check one): _______ ________
Male Female
Driver’s License # _______________________________ Issuing State ____
Daytime Phone Number ______________________________________
Other Names Used (alias, maiden, nickname): ___________________________________________________________
Current Address: ___________________________________________________________________________________
Street Number and Name City State Zip Dates
List Any other Addresses that you have used in the last 7 years:
___________________________________________________________________________________
Street Number and Name City State Zip Dates
___________________________________________________________________________________
Street Number and Name City State Zip Dates
___________________________________________________________________________________
Street Number and Name City State Zip Dates
Are you applying for a position in California, Minnesota, or Oklahoma? Yes ___ No ______
If yes, would you like a copy of any consumer reports requested sent to you? Yes______ No______
* Note: Date of Birth information is required for identification purposes only, and is in no manner used as qualifying for joining the Company. The
Company does not discriminate on the basis of sex, religion, veteran status, age, or disability.

Revised 07/14/2011
Page: 4
I understand and acknowledge that if I am considered for pre-employment by
CFLC, that any pre-employment offered is a conditional offer to me and is an at will
relationship and CFLC may terminate my employment at any time, with or without
cause.
The pre-employment process will include a full application packet and an
orientation program at which time a complete evaluation of my application will be
conducted at CFLC in Groveland, FL Corporate Office. It will include a Criminal
Background Investigation, Road Test, DOT Medical Physical with physical agility
assessment, and Past Work History including Drug History.
I further acknowledge that, as an applicant for conditional employment at CFLC,
and during this orientation process, I will be required to take a drug test.
I understand that if my drug test is positive or I have failed to notify CFLC of a
positive drug test in my past employment, I will be disqualified from employment at
CFLC and I will no longer participate in orientation.
I further understand and agree that in the event that any of my drug test results are
positive, or my application is denied for any reason or I elect not to work for CFLC
after arriving for orientation, CFLC will not pay for my transportation expenses in
connection with my return home from orientation and that I will be solely
responsible for paying my own transportation expenses in returning home from
CFLC orientation.
I understand this form must be signed and returned to CFLC in order for my preemployment
application to be considered by CFLC.
_________________ _________________________________________
Date CFLC Prospective Employment Applicant Signature
_________________________________________
Applicant Print Your Name

Applicant's Name: Social Security Number: - -
Page: 5
You are hereby authorized to give Carroll Fulmer Logistics Corporation all information regarding my services/ character and conduct
while in your employ/lease and you are released from any liability, which may result from giving such information. In order to enable
Carroll Fulmer Logistics Corporation to comply with the requirements of 49 CFR, I hereby consent to Carroll Fulmer Logistics
Corporation obtaining from my prior employers/lessees the information pertaining to my employment regarding alcohol tests with a
concentration of 0.04 or greater, positive controlled substance test results and refusals to be tested within the three (3) years
preceding the date of this signed release. I hereby authorize and direct my prior employers to release such information to Carroll
Fulmer Logistics Corporation in personal interviews/ telephone interviews, letters or any other method that insures confidentiality. I
hereby authorize Carroll Fulmer Logistics Corporation to release any such information to any of its personnel whose duties require
them to assess this application or to make any recommendations or decisions with respect to it. I further authorize Carroll Fulmer
Logistics Corporation to photocopy this form as many times as required to obtain information from all my previous employers. A copy
of this form is as valid as the original.
Applicant's Signature: Date:
BELOW THIS LINE IS FOR OFFICE USE ONLY!
\NAME OF COMPANY: PHONE #:
ADDRESS:
PERIOD OF EMPLOYMENT: PER APPLICANT: FROM: TO:
WHAT POSITION HELD:
PER EMPLOYER: FROM: TO:
WAS DRIVER: [ ] PART TIME [ ] FULL TIME [ ] COMPANY DRIVER [ ] OWNER OPERATOR
[ ] DRIVER FOR OWNER /OPERATOR [ ] N/A
EQUIPMENT: [ ] TRACTOR TRAILER [ ] VAN [ ] REEFER [ ] FLAT BED [ ] TANKER
[ ] OTHER: [ ] N/A
LIST STATES IN WHICH APPLICANT DROVE REGULARLY:
LIST TYPE OF COMMODITIES APPLICANT HAULED:
ACCIDENTS: TOTAL NUMBER: PREVENTABLE: NON-PREVENTABLE:
WHY DID APPLICANT LEAVE YOUR EMPLOY?
IF DISCHARGED/ PLEASE DESCRIBE:
IS APPLICANT ELIGIBLE FOR REHIRE? [ ] YES [ ] NO
DRUG/ALCOHOL
HAS THIS PERSON TESTED POSITIVE FOR A CONTROLLED SUBSTANCE DURING THE PREVIOUS 3 YEARS? [ ] YES [ ] NO
HAS THIS PERSON HAD AN ALCOHOL TEST WITH A READING GREATER THAN .04 DURING THE PREVIOUS 3 YEARS? [ ] YES [ ] NO
HAS THIS PERSON REFUSED (INCLUDES VERIFIED ADULTERATED OR SUBSTITUTED RESULTS) A CONTROLLED SUBSTANCE TEST
AND/OR ALCOHOL TEST WITHIN THE PREVIOUS 3 YEARS? [ ] YES [ ] NO
HAS THIS PERSON VIOLATED OTHER DOT DRUG/ALCOHOL REGULATIONS? [ ] YES [ ] NO
HAVE YOU RECEIVED INFORMATION FROM A PREVIOUS EMPLOYER THAT THIS INDIVIDUAL VIOLATED D.O.T. DRUG AND ALCOHOL
REGULATIONS? [ ] YES [ ] NO
BY: DATE:
CARROLL FULMER LOGISTICS CORPORATION REPRESENTATIVE: DATE

OWNER/EQUIPMENT INPUT SHEET Page: 10
THIS FORM MUST BE COMPLETED BEFORE PROCESSING
Owner’s Full Name: ___________________________________________________________
Owner’s Full Address: _________________________________________________________
City: __________________________________ State: ____________ Zip: _______________
Social Security #:______________________ Federal ID#_______________________________
Home phone#:_____________________________ Cell phone #______________________________
EQUIPMENT INFORMATION
Tractor
______________Physical Damage Insurance ____________ Bobtail Insurance
(check if needed) (check if needed) (If no, proof of insurance is required)
Year: ________ Make: __________ Color: ________ VIN #: _________________________________
Unladen Weight: _________________ License Plate#:_________________ State:________
Purchase Price: _________________________ Date of Purchase: ______________________
Current Tractor Value: _________________ Lienholder Name: ______________________
Leinholder Address: ______________________________________________________________
Phone Number: __________________________ Fax Number: __________________________
OWNER’S SIGNATURE:___________________________ DATE:__________________

Page: 12
***** Please initial all states you are registered in. If taking our Plate, initial all
states. Also, please sign the form once you have selected the states*****
PERMIT REQUEST
ALABAMA __________ NEBRASKA __________
ARIZONA __________ NEVADA __________
ARKANSAS __________ NEW HAMPSHIRE __________
CALIFORNIA __________ NEW JERSEY __________
COLORADO __________ NEW MEXICO __________
CONNECTICUT __________ NEW YORK __________
DELAWARE __________ NORTH CAROLINA __________
FLORIDA __________ NORTH DAKOTA __________
GEORGIA __________ OHIO __________
IDAHO __________ OKLAHOMA __________
ILLINOIS __________ OREGON __________
INDIANA __________ PENNSYLVANIA __________
IOWA __________ RHODE ISLAND __________
KANSAS __________ SOUTH CAROLINA __________
KENTUCKY __________ SOUTH DAKOTA __________
LOUISIANA __________ TENNESSEE __________
MAINE __________ TEXAS __________
MARYLAND __________ UTAH __________
MASSACHUSETTS __________ VERMONT __________
MICHIGAN __________ VIRGINIA __________
MINNESOTA __________ WASHINGTON __________
MISSISSIPPI __________ WEST VIRGINIA __________
MISSOURI __________ WISCONSIN __________
MONTANA __________ WYOMING __________
SIGNATURE _____________________________________ BASE PLATE STATE __________

OWNER OPERATOR PROGRAM AND WEEKLY CHARGES
Please initial items you want, and put “NO” in the items declined. Page 13
ONCE IN EFFECT, THE PROGRAM WILL NOT BE CHANGED.
1. FUEL CARD/PAYROLL CARD
*Volume Rebates and at the pump discounts/Fuel cards are limited to 125 gallons of fuel daily
(No cash advances)
*Option of Direct Deposit or pay downloaded on card at 9am EST Thursday mornings and
Carroll Fulmer Logistics Corporation pays the fee
Advance load fee is $1.50, 1 st draw is free, each additional is $1.50
2. RIDER PROGRAM 15.00 per month
Riders must be at least 12 years old and sign a Rider permit and Release form.
Only one rider permitted on the truck/Safety must have paperwork before rider can get in the truck
3. LICENSE PLATES $27.00 _______
*(If you do not have your own tag and you need a Carroll Fulmer Wisconsin tag)
4. FUEL TAX REPORTING AND ADMINISTRATION FEE $30.00 Required
*$20.00 Fuel Tax & $10.00 Admin. Fee
5. PHYSICAL DAMAGE COVERAGE 3% of value _______
6. BOBTAIL COVERAGE $ 9.00 Required
*Must provide Certificate of Insurance with Carroll Fulmer Logistics Corp.
listed as Certificate Holder (if not using ours.) & it must be a 1 million combined single limit coverage.
7. PERMITS $ 7.00 Required
8. OCCUPATIONAL ACCIDENTAL INSURANCE $33.00 Required
*Must provide an Occupational Accidental Certificate if not taking ours.
9. TRANSFLO $ 3.00 Required
Unlimited scanning of bills, logs, lumper receipts, etc. to Groveland Office.
10. QUALCOMM (Will be installed after 60 days) $14.00 Required
*Cable deposit of $10.00 per week / $200.00 total Nonrefundable
11. OPEN ROAD $ 7.96 Optional
Bail Bonds, Attorney referrals, Legal Fees, Trip Guarantees, Family Services and Discounts,
Will need to complete an application in order to sign up for the program
12. ESCROW
Escrow will accrue at $.05 per mile until the maximum of $2,000.00 is satisfied Required
__________________________ __________________
Owner Signature Date
Effective 09/20/12