Candidate Road Team Application - Alabama Trucking Association

Candidate Information

Name

Home Address

Home Phone

Cell

E-mail

CDL #

DOB

Nominated by:

Nominator's Employer:

Candidate Profile

Candidate's Employer

Local Business Address

Candidate's Supervisor/Primary Contact

Cell

Supervisor/Primary Contact Email

Type of Carrier

Describe the candidate's driving assignment:

What commodities does the candidate typically carry?

Is the candidate an owner-operator?

How many years has the candidate driven professionally?

Years with current employer:

What are the candidate's truck-driving career miles?

Current Employer Miles:

Number of preventable and non-preventable accidents while driving a truck:

How many miles since the candidate's last accident?

If accidents listed, please describe each accident below making sure to include: 1. Date of the accident, 2. Circumstances, 3. Preventability

Please attach a copy of the candidate's Motor Vehicle Record:

Candidate's Industry Activities

Please list any industry-related honors or awards, including company awards, the candidate has received:

Please describe the candidate's involvement in company or industry-related programs:

Candidate's Community Service

Please list any community service activities:

Please list any affiliation with civic groups:

Please list any additional hobbies or interests:

Please list any previous speaking experience or media training:

Tell us why you would like to represent the trucking industry as a member of Alabama's Road Team.

Please upload a current photograph of yourself to be used in supporting materials: