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Let Elite Freight help you earn a six-digit annual income as a freight broker agent. Contact us today at 920-686-8200 or email
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Agents
Forms
Application
Authorization for Background Inquiry:
By filling out the following form,
I authorize Elite Freight Solutions, LLC. 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 Elite Freight Solutions, LLC. 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 accepted as an independent agent with our company.
To all my previous employers and holders of public records:
Please accept this document as an original authorization for release of all employment records including reason for termination or resignation, criminal records, past drug and alcohol test results and transcripts of educational accomplishments.
Applicant:
The request for your date of birth is to be used in performing a criminal record search only. It is not used by the client in consideration of offering an independent agent position.
Signature Authorization:
(This box must be checked in order to authorize Elite Freight Solutions, LLC. to perform their background check.)
Agency Name
Office Phone
Office Phone
Submitted by
None
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OK
ON
OR
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PE
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Office Fax
SS #
Office Email
Fed ID #
DL #
Home Phone
DL State
Home Cell
Date of Birth
Home Fax
Home Email
Office will be located at:
Office building
Home
Physical Address:
City:
State/Zip:
None
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AK
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CA
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DE
FL
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HI
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IN
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KY
LA
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MD
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MI
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MO
MS
MT
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NB
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NE
NF
NH
NJ
NM
NS
NT
NV
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OH
OK
ON
OR
PA
PE
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RI
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UT
VA
VT
WA
WI
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WY
YT
/
Mailing Address:
City:
State/Zip:
None
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IA
ID
IL
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KS
KY
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MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
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TN
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VA
VT
WA
WI
WV
WY
YT
/
Home Address:
City:
State/Zip:
None
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
/
Your agency contact people:
Name
Name
Title
Title
Phone
Phone
Name
Name
Title
Title
Phone
Phone
Name
Name
Title
Title
Phone
Phone
How or where did you hear about Elite Freight Solutions?
How many loads of the following commodities have you handled in the last year?
Reefer
Dry Van
Other
Flatbed
Produce
What are the totals for the last year and last month?
Loads
Gross Revenue
Pay to Truck
Spread
Last Year:
Last Month:
Do you have a customer base?
Yes
No
If Yes, please list your top three:
Name
None
AB
AK
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AR
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BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Name
None
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
City
City
State & Zip
State & Zip
Phone
Phone
Contact
Contact
Name
None
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
City
State & Zip
Phone
Contact
If No, How do you plan on building one?
Do you have a Carrier Following?
Yes
No
If Yes, How Many?
Do you have prior agency affiliations?
Yes
No
If Yes, please list:
Name
None
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Name
None
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
City
City
State & Zip
State & Zip
Phone
Phone
Contact
Contact
Name
None
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
Name
None
AB
AK
AL
AR
AZ
BC
CA
CO
CT
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MI
MN
MO
MS
MT
MX
NB
NC
ND
NE
NF
NH
NJ
NM
NS
NT
NV
NY
OH
OK
ON
OR
PA
PE
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YT
City
City
State & Zip
State & Zip
Phone
Phone
Contact
Contact
May we contact your prior affiliations?
Yes
No
Do you have experience with computers and the internet?
Yes
No
How many of the following do you have?
Computers
Printers
Fax Machines
Copiers
Phone lines
Who is your Internet Provider?
What date would you like to begin with EFS?
Why?
Additional Comments:
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