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Agent Application

September 23, 2011Leave a reply

VHITRANSPORT AGENT APPLICATION

Applicants are considered for Brokerage Agents without regard to race, color, religion, sex, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or handicap. Please fill this form out as complete as possible. (Please print)

Date of application: ____ / ____ / ____

Position(s) applied for: AUTHORIZED BROKERAGE VHI TRANSPORT INC.

Name: ________________________________________________________________________________

(Last) (First) (Middle)

Address: ______________________________________________________________________________

(Number) (Street) (City) (State) (Zip)

Telephone: _________________________ Cell phone: __________________ Fax: __________________

Social Security Number: _____________________ Drivers License Number: _______________________

Have you ever pled “ guilty” or “ no-contest” to or been convicted of a crime? ______ Yes ______ No

Date you can start? ______ / ______/ ______ Are you employed now _______ Yes _______ No

If so may we contact your present employer? _______ Yes _______ No

Are you currently a Brokerage Agent for another company? _______ Yes _______ No

Are you currently contracted to that company? _______ Yes _______ No

If yes, what company? ___________________________________________________________________

Do you have your own authority? _______ Yes _______ No

Give the name, address and telephone number of three references that are not related to you and are not previous employers.

1. ____________________________________________________________________________________________________________________________________________________________________

2. ____________________________________________________________________________________________________________________________________________________________________

3. ____________________________________________________________________________________________________________________________________________________________________

BROKERAGE AGENT EXPERIENCE

Start with your present Brokerage Agent position.

Company

1. Name: _______________________________ From: _____/ _____ / _____To: _____/ _____/ _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Agent Program Representative: _____________________________________________

Reason for leaving: ______________________________________________________________________

2. Name: _______________________________ From: _____/ _____ / _____To: _____ / _____/ _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Agent Program Representative: _____________________________________________

Reason for leaving: ______________________________________________________________________

3. Name: _____________________________ From: _____ / _____ / _____ To: _____ / _____ / _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Agent Program Representative: ____________________________________________________________

Reason for leaving: ______________________________________________________________________

EMPLOYMENT EXPERIENCE

Start with your present or last job. Include military service assignments and volunteer activities.

Employer

1. Name: _____________________________ From: _____ / _____ / _____ To: _____ / _____ / _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Position Held: __________________________________________________________________________

Supervisor: ____________________________________________________________________________

Responsibilities: ________________________________________________________________________

Reason for leaving: ______________________________________________________

2. Name: _______________________________ From: _____/ _____ / _____ To: _____ / _____/ _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Position Held: __________________________________________________________________________

Supervisor: ____________________________________________________________________________

Responsibilities: ________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Reason for leaving: ______________________________________________________________________

3. Name: _______________________________ From: _____/ _____ / _____To: _____/ _____/ _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Position Held: __________________________________________________________________________

Supervisor: ____________________________________________________________________________

Responsibilities: ________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Reason for leaving: ______________________________________________________________________

4. Name: _______________________________ From: _____/ _____ / _____ To: _____/ _____/ _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Position Held: __________________________________________________________________________

Supervisor: ____________________________________________________________________________

Responsibilities: ________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Reason for leaving: ______________________________________________________

5. Name: _______________________________ From: _____/ _____ / _____To: _____ / _____/ _____

Address: ______________________________________________________________________________

Phone Number _________________________________________________________________________

Position Held: __________________________________________________________________________

Supervisor: ____________________________________________________________________________

Responsibilities: ________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Reason for leaving: ______________________________________________________________________

EDUCATION

School Name Years Completed Major

______________________________________________________________________________________

High School

______________________________________________________________________________________

College / University

______________________________________________________________________________________

Honors received: ________________________________________________________________________

Degree(s) received: ______________________________________________________________________

Number of years in business or Brokerage experience: _________________________

Do you presently have a customer following? _______ Yes _______ No

Approximate number of shipper  customers? ________________________

Approximate number of loads per week you feel you can move?_____________________

Anticipated gross revenue annually would you expect?_______________Commission Rate_______on the above, estimated___________________

Type of freight handled, %, estimate.

Dry Van ________ Flatbed ________Refrigerated___________Container________

Other, please specifiy____________________________

BACKGROUND INQUIRY AUTHORIZATION AND AGREEMENT

I certify that the answers given herein are true and complete to the best of my knowledge. I understand that this application is not intended to be a contract or agreement to be an authorized Brokerage Agent for VHI Transport Inc. In the event of an executed contract, I understand that false or misleading information given in my application or interview(s) may result in the termination of the Brokerage Agency Agreement. By filling out this Brokerage Agent Application, I authorize VHI Transport Inc. to obtain any and all past employment records regarding previous employment and other areas of my background such as past employer inquiries, retail credit inquiries, criminal record inquiries, driving history, educational records, and drug testing results. I agree to hold VHI Transport Inc. harmless regarding any information that is obtained during the background inquiry. I am aware that this report is prepared under the guidelines of the Fair Credit Reporting Act (FCRA) and I am eligible to receive, upon written request, a copy of the report if not hired.

Signature Authorization: ____________________________________________________

Print Name: _____________________________________________________________

Date: ______ / ______ / ______

Thank you for your interest in VHITransport, Inc.  Please send to my attention your application. Should you not hear from me within one business day, please call my direct line at 804 414 1780.  I look forward to talking to you.

Best Regards,David (Bruce) Gee, CTB
President
brucegee@vhitransport.com
VHI Transport
4525 Lee Street, Chester, VA 23831
Phone: 804-414-1780 Fax: 804-233-6602
www.vhitransport.com
VHI Transport Agent Code of Ethics1. Agent shall deal fairly with customers, colleagues, fellow agents, and the general public. 

2. Agent shall conduct his or her professional life in accordance with the interests of VHI Transport, the third party transportation services industry, and the general transportation public.

3. Agent shall adhere to honesty and integrity and to generally accepted principles of professional conduct.

4. Agent shall not engage in any practice, which tends to corrupt, the integrity of VHI Transport, the third party transportation services industry or process of government.

5. Agent shall abide by all lawful agreements to which he or she is a party, including all agreements with shippers, carriers and VHI Transport.

6. If agent has evidence that another agent has been guilty of unethical, illegal or unfair practices, including those in violation of this Code, the agent shall present information promptly to VHI Transport.

As an agent for VHI Transport, I pledge:

To conduct business professionally with truth, fairness, and responsibility to all customers, suppliers, associations, and VHI Transport. To promote and actively participate in continuous improvement in both competence and knowledge within the third party transportation services profession. To subscribe to and offer to the public uniform and consistent service. To protect the interest of the shipping public. To promote greater productivity of and awareness in the areas of freight transport, logistics management, intermediary activities, and industry related asset utilization. To adhere to the articles of the Code of Ethics as promoted by VHI Transport. I here by acknowledge that these provisions govern my agent relationship with VHI Transport. I certify that I will actively practice the professional standards as outlined in the VHI Transport Code of Ethics. In addition, I certify that the above information is true and correct to the best of my knowledge and I understand that my agent affiliation with VHI Transport in good standing is contingent upon same.

Name (please print or type):_______________________________________________________

Signature: __________________________________________________ Date: _____________
CONFIDENTIALITY: This email and any attachments are confidential and may be privileged. If you are not a named recipient, please notify the sender immediately and do not disclose the contents to another person, use it for any purpose or store or copy the information in any medium.

 

The information contained herein is what is offered by the company (VHI) at the time of this draft. The company reserves all rights to alter, change or eliminate entirely any provision contained herein at any time. This document is intended to provide basic information to entice a potential Agent to consider affiliation with VHI. Should there be a meeting of minds between the parties a formal Agency Agreement between the parties is a more complete understanding in the relationship.

Agent Application