Employment Form

DCI Agent Pre-Qualification Form
Please fill this form out as complete as possible, this information is held in the strictest confidence and will not be released or used other than to contact you in regards to this submittal

Name:
Address
City
State/Province
Zip Code/Postal Code
Phone:
Cell Phone:
Fax:
Email Address:
SSN:
Birthdate:
Do you have experience in the transportation industry?	Yes No- If yes, explain briefly

How long have you been in the transportaion industry?
Are you currently an agent for another company?	Yes No
Do you broker your freight?	Yes No- If yes, what percentage?
What areas of transportation have you worked in during your past? Please explain:
Have you ever owned your own business or worked from a home office?	Yes No
Are you comfortable working with MS Office Products and other software?	Yes No
Choose the service(s) you are most interested in representing
If other, please explain:
Do you know any other brokers who might be interested in working with you?	Yes No

How did you hear about this business opportunity?

Please read and sign(type) below: "As part of it's pre-qualification process, DCI will obtain an investigative consumer report on you. The report may include information regarding your character, general reputation, personal characteristics, and mode of living. DCI may use the investigative consumer report in whole or in part for the evaluation of the proposed business relationship, including acting on your pre-qualification. When you click the submit application button below, you authorize DCI to obtain an investigative consumer report and acknowledge your understanding that DCI may use the report for pre-qualification purposes. You may request that DCI completely and accurately disclose to you the nature and scope of the investigation requested. You may also request a written summary of your rights under the Fair Credit Reporting Act. Such requests must be made in writing to the Qualification Department of DCI within a reasonable time after you submit this authorization for permission to obtain an investigative consumer report."
Please sign(type) here:
Signing Date:
I am interested in representing

Last Updated on Monday, 25 January 2016 13:47