Welcome To Mariner Distribution Inc.

Maryland Offices: 635 Old Philadelphia Road
Aberdeen, Maryland 21001
410.272.4747
Fax - 410.272.4799

Customized, Affordable Logistic Solutions Find out why more and more companies in the Eastern U.S. are turning to Mariner Distribution to handle their transportation, distribution, and warehousing.

On-Line Application

This application is in reference to the following positions: (Check all that apply)	Road Local Company Driver Employee of Contractor Contract Driver Part-Time Full-Time

Referred By:
Social Security Number:	No dashes, please
First Name:
Middle Name:
Last Name:
Primary Phone Number:	No dashes, please
Secondary Phone Number:	No dashes, please
Birth Date:
Do you have the legal right to work in the US?
Secondary Contact:
Secondary Contact's Phone Number:	No dashes, please

Address History

Please list all of your addresses for the past three years.
Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Years at this address:

Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Years at this address:

Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Years at this address:

Driver's Licenses

Please list all of your licenses for the past three years.
	Issuing State		License Number
License:
	Day	Month	Year
Expiration Date

	Issuing State		License Number
License:
	Day	Month	Year
Expiration Date

	Issuing State		License Number
License:
	Day	Month	Year
Expiration Date

Miscellaneous
Have you had any accidents or incidents, regardless of fault, in the past 5 years?
Have you had any moving violations, regardless of type of vehicle, in the past 3 years?
Are you currently employed?
Please check the regions you have driven in:	Northeast Lower 48 States Local

Accidents or Incidents
Please list up to three accidents or incidents, regardless of fault.
	Day	Month	Year
Date of Incident:
Incident Type:
Were any injuries involved? (Exclude Fatalities)
Were any fatalities involved?
Did you receive a citation?
Briefly Describe the Incident:


Please list up to three accidents or incidents, regardless of fault.
	Day	Month	Year
Date of Incident:
Incident Type:
Were any injuries involved? (Exclude Fatalities)
Were any fatalities involved?
Did you receive a citation?
Briefly Describe the Incident:


Please list up to three accidents or incidents, regardless of fault.
	Day	Month	Year
Date of Incident:
Incident Type:
Were any injuries involved? (Exclude Fatalities)
Were any fatalities involved?
Did you receive a citation?
Briefly Describe the Incident:

Moving Violations
Please list up to three violations.
	Day	Month	Year
Date of Violation:
City
State:
Commercial Vehicle?
Briefly Describe the Charge:
If speeding, list speed:
Outcome of Charge:



	Day	Month	Year
Date of Violation:
City
State:
Commercial Vehicle?
Briefly Describe the Charge:
If speeding, list speed:
Outcome of Charge:


	Day	Month	Year
Date of Violation:
City
State:
Commercial Vehicle?
Briefly Describe the Charge:
If speeding, list speed:
Outcome of Charge:

Employment History
Please list all employment for the past 10 years, beginning with the most recent and working backwards. All time must be accounted for, including military, schooling, self-employment, and periods of unemployment longer than 30 days. All listings must include dates and contact phone numbers. (If you drove as, or for, an independent contractor, list the company or companies the vehicle was leased to as 'employer'.) All employment will be verified.

Date Employment Began:
Date Employment Ended:
Name of Employer:
May we contact this employer?
Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Contact Name:
Contact Phone Number:	No dashes, please
Position Held:
Salary/Wage:
Were you subject to the FMCSR while at this employer to include alcohol and drug testing requirements as required by 49 CFR Part 40?
Equipment Operated:
Specific Reason for Leaving:



Date Employment Began:
Date Employment Ended:
Name of Employer:
May we contact this employer?
Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Contact Name:
Contact Phone Number:	No dashes, please
Position Held:
Salary/Wage:
Were you subject to the FMCSR while at this employer to include alcohol and drug testing requirements as required by 49 CFR Part 40?
Equipment Operated:
Specific Reason for Leaving:



Date Employment Began:
Date Employment Ended:
Name of Employer:
May we contact this employer?
Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Contact Name:
Contact Phone Number:	No dashes, please
Position Held:
Salary/Wage:
Were you subject to the FMCSR while at this employer to include alcohol and drug testing requirements as required by 49 CFR Part 40?
Equipment Operated:
Specific Reason for Leaving:



Date Employment Began:
Date Employment Ended:
Name of Employer:
May we contact this employer?
Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Contact Name:
Contact Phone Number:	No dashes, please
Position Held:
Salary/Wage:
Were you subject to the FMCSR while at this employer to include alcohol and drug testing requirements as required by 49 CFR Part 40?
Equipment Operated:
Specific Reason for Leaving:



Date Employment Began:
Date Employment Ended:
Name of Employer:
May we contact this employer?
Street Address
Street Address (2)
Street Address (3)
City
State:
ZIP:	No dashes, please
Contact Name:
Contact Phone Number:	No dashes, please
Position Held:
Salary/Wage:
Were you subject to the FMCSR while at this employer to include alcohol and drug testing requirements as required by 49 CFR Part 40?
Equipment Operated:
Specific Reason for Leaving:



Date Unemployment Began:
Date Unemployment Ended:
Are you collecting Unemployment Insurance?



Date Unemployment Began:
Date Unemployment Ended:
Are you collecting Unemployment Insurance?



Date Unemployment Began:
Date Unemployment Ended:
Are you collecting Unemployment Insurance?

Equipment Experience

Class / Type Of Equipment

Tractor / 53' Trailer

Tractor / 48' Trailer

Tractor / 45' Trailer

Tractor / Double Trailer

Tractor / Flatbed Trailer

Straight Truck

Other

It 'Other', pleaseexplain:

Time Frame

Miles

From:

Time Frame

Miles

From:

Time Frame

Miles

From:

Time Frame

Miles

From:

Time Frame

Miles

From:

Time Frame

Miles

From:

Time Frame

Miles

From:

Education

Years of High School Completed:
Years of College Completed:
Type of Trade School Training (if applicable):
Last School Attended:
City:
State:
Did you graduate?
If yes, when?

Miscellaneous

Have you ever driven for Mariner Distribution before?
If yes, please enter the time frame:	to
If yes, please list the Mariner Distribution location(s) you worked at:
If yes, please list your reason for leaving:
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
Has your license, permit, or privilege ever been suspended or revoked?
Have you ever been convicted of a felony?
Please explain any 'Yes' answers:

Terms of Application

Please read the following, and check the box below to complete your application:

ALL APPLICANTS:I certify that this application was completed by me, and that all the entries on it and the information in it are true and complete to the best of my knowledge. I understand that Mariner Distribution is under no obligation to engage my driving services nor is Mariner Distribution obligated to provide me a reason for turning down my application. Further, Federal Motor Carrier Safety Regulations (382.301) require all Commercial Driver applicants to submit to a controlled substance urinalysis test prior to being engaged as a Company or Contract Driver. As a condition of my application processing, I agree to the urine sample collection and controlled substance testing. I understand that a confirmed positive result will medically disqualify me from further consideration as a driver applicant.
I hereby authorize any present or past employers to release to Mariner Distribution any and all pertinent information regarding my employment with those companies for the purposes of investigation as required by Section 382, 391.23, & 391.53 of the Federal Motor Carrier Safety Regulations. Any present or past employers are released from any and all liability that may result from furnishing this information.
I understand that I have the right to review information provided by previous employers. I understand that I have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send corrected information to Mariner Distribution. I understand that I have the right to have a rebuttal statement attached to any alleged erroneous information, if the previous employer and I cannot agree on the accuracy of information provided.
ALL CONTRACT DRIVER APPLICANTS ONLY:I understand that any Mariner Distribution engagement of my driving services as a independent owner-operator OR employee of a contractor will be governed by a signed and dated written Transportation Service Agreement (or any existing predecessor Agreement) specifying terms and conditions of my engagement as a driver. In the event of my engagement as a Contract Driver, I understand that any false or misleading information given by me on my application or during any interview may result in the immediate termination of the Transportation Service Agreement, regardless of when the information was discovered to be false or misleading.
ALL MILEAGE DRIVER APPLICANTS ONLY: I understand that any contract offered me will be as an contractor of Mariner Distribution, and any such employment will not be for any specified duration and, further, that my contract is terminable by either party at will with or without notice or cause. In the event of my contract by Mariner Distribution, I understand that any false or misleading information given by me on my application or during any interview may result in the immediate termination of my contract, regardless of when the information was discovered to be false or misleading. I further understand that the first ninety (90) days of my contract is a probationary period, and during that time, I will not be eligible for any contractor benefits.

Terms of Agreement

Please read the following, and check the box below to complete your application:

You are about to complete your application by answering a question 'Yes' or 'No' indicating you are in agreement ('Yes') or you are not in agreement ('No') to these Terms and Conditions, including your consent to the release of your background information, and past employers. IF YOU ANSWER THE QUESTION BELOW 'YES,' THEN YOU AGREE THAT YOU HAVE READ, UNDERSTOOD AND AGREE TO BE BOUND BY THESE TERMS, CONDITIONS AND CONSENTS. YOU MAY WITHDRAW YOUR CONSENT TO RELEASE BACKGROUND INFORMATION ANY TIME DURING THE APPLICATION INVESTIGATIVE PROCESS, by contacting patty.ward@marinerdistribution.com and stating that you wish to withdraw your consent. You may also use this email address to update your electronic address. IF YOU ANSWER THE QUESTION BELOW 'NO,' THEN YOUR APPLICATION WILL NO LONGER BE CONSIDERED. If you later withdraw your consent after completing your application, but prior to employment or engagement as a Contract Driver, your application will no longer be considered. You may not withdraw your consent after you have accepted employment or signed a Transportation Service Agreement.

To complete the processing of your on-line application, please download the following Abobe Acrobat document, print, complete your name and social security number at the top of the form and sign and date at the bottom. Please fax it to the number on the form or scan and image back to patty.ward@marinerdistribution.com

	Yes, I agree to these terms
	No, I do not agree to these terms

Enter Verified Code: