Skip to content
Core Values
Services
Shippers
Carriers
Loads
Agents
Testimonials
Blog
Payment
FT Credit
New Agents
Menu
Core Values
Services
Shippers
Carriers
Loads
Agents
Testimonials
Blog
Payment
FT Credit
New Agents
Contact
Freight Tec
New Agent Application
"
*
" indicates required fields
GENERAL INFORMATION
Please answer the following questions
Name
*
First
Middle
Last
Primary Phone Number
*
Fax Number
*
Emergency Contact Name and Phone Number
*
Email Address
*
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
EMPLOYMENT HISTORY
Please fill in your Employment History covering the last 3 years (attach additional file/s if necessary)
1. Company
*
1. Job Title / Responsibilities
*
1. Location (City and State)
*
1. Company Phone Number
*
1. Annual Salary / Hourly Rate
*
1. Reason for Leaving
*
2. Company
*
2. Job Title / Responsibilities
*
2. Location (City and State)
*
2. Company Phone Number
*
2 Annual Salary / Hourly Rate
*
2. Reason for Leaving
*
upload additional employment history file/s if necessary
Drop files here or
Select files
Max. file size: 50 MB.
AGENT EXPERIENCE
Answer the following questions
Do you have a Non-Complete Agreement with another company?
*
Yes
No
If YES, when does it expire?
*
MM slash DD slash YYYY
How long have you been an Active Freight Broker?
*
What kind of freight do you specialize in moving?
*
Are you best at? (check one)
*
Taking care of existing accounts
Inside Sales developing new account relationships
Please explain answer from above
*
Have you ever managed other people?
*
Yes
No
If Yes, How many People?
*
When?
*
For Whom?
*
Have you ever worked out of your own home before?
*
Yes
No
If YES, for how long?
*
How many hours per day did you work?
*
What kind of money did you make? $ /month (average)
*
Do you consider yourself a Self-Starter, and Why?
*
Do you have existing accounts?
*
Yes
No
If YES, How many accounts?
*
Estimated Monthly Volume:
Revenue: $
*
Gross Profit: $
*
G/P Margin: %
*
How much have you earned in
a slow month? $
*
a good month? $
*
Please fill in for the past 3 years:
Year 1
*
Y1 Gross Revenue
*
Y1 Gross Profit
*
Y1 Number of Loads
*
Year 2
*
Y2 Gross Revenue
*
Y2 Gross Profit
*
Y2 Number of Loads
*
Year 3
*
Y3 Gross Revenue
*
Y3 Gross Profit
*
Y3 Number of Loads
*
Have you Incorporated or formed an LLC?
*
Yes
No
If YES, What is the Company name?
*
Federal I.D. #
*
CHARACTER REFERENCES
List two persons NOT RELATED whom you have known for atleast one year.
1. Full Name
*
1. Occupation
*
1. Phone Number
*
2. Full Name
*
2. Occupation
*
2. Phone Number
*
Have you ever been dismissed or forced to resign from any employment or agency relationship?
*
Yes
No
If YES, please explain
*
upload additional file/s if necessary
Drop files here or
Select files
Max. file size: 50 MB.
Have you ever been convicted of a crime?
*
Yes
No
Have you ever had adjudication withheld for a crime?
*
Yes
No
If YES to either of the two previous questions, please explain giving full details of crime, and date.
*
upload additional file/s if necessary
Drop files here or
Select files
Max. file size: 50 MB.
I CERTIFY ALL NFORMATION HEREIN IS TRUE AND COMPLETE. BY SUBMITTING THIS APPLICATION I AUTHORIZE FREIGHT TEC MANAGEMENT GROUP, INC., AND ANY COMPANIES IT MAY HIRE TO CONDUCT SEARCH OF MY BACKGROUND, TO INVESTIGATE ALL MATTERS HEREIN.
Signature
*
Date
*
MM slash DD slash YYYY
Print Name
*
Social Security Number
*
Date of Birth
*
MM slash DD slash YYYY
Driver's License Number
*
State
*
Expiration Date
*
MM slash DD slash YYYY