Driver Application Form - Rush Express

Log in

Client Services Login

20 Tarlington Pl, Smithfield NSW 2164

Don't Just Send It! Telephone: 1300 787-448 E-mail: sales@rushexpress.com.au

Home
Services
Service Area
Technology
- Freight Management
  System
- Warehouse Management
  System
Online Bookings
Contact Us

Driver Application Form

Step 1 of 7

14%

Personal Details
Applicant Name*
FirstLast
Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal Code
Mobile Phone*
Email*
Date of Birth*
License Number*
License Expiry Date*

Company Details
Do you operate under an ABN?*
- Yes
- No
Business Name*
Trading Name (If Applicable)
Company Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal Code
Company Phone*
Tax File Number*
ABN Number*
ABN Expiry Date*
Does your business have an ACN?*
- Yes
- No
ACN Number*
ACN Expiry Date*
Work Cover
Does your business have a Work Cover policy?*
- Yes
- No
Company*
Policy Number*
Policy Expiry Date*

Bank Payment Details
Bank*
Branch*
Account Name*
BSB Number*
Account Number*
Are you GST Registered?*
- Yes
- No

Next of Kin
Contact 1
Name*
FirstLast
Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal Code
Mobile Phone Number*
Home Phone Number
Work Phone Number
Contact 2
Name*
FirstLast
Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal Code
Mobile Phone Number*
Home Phone Number
Work Phone Number

Vehicle Details
Vehicle Type*
- Ute
- Van
- Hatchback
- Ridged Sized Truck
- Station Wagon
Vehicle Make*
Vehicle Model*
Vehicle Year*
Vehicle Class*
Company Driver*
- Yes
- No
Vehicle Registration Number*
Vehicle Registration Expiry Date*
GVM*
Tare*
Payload*
Weight*
Equipment*
If none type N/A
Does your vehicle have insurance?*
- Yes
- No
Insurance Company*
Policy Number*
Policy Expiry Date*

Application For Engagement As a Subcontractor / Haulier
Pre-Engagement Medical Questionnaire
Do you play sports?*
- Yes
- No
What sport/s do you play?*
Do you have a personal physician?*
- Yes
- No
Personal Physician Name*
FirstLast
Personal Physician Address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal Code
Have you ever been?
Seriously Injured?*
- Yes
- No
Refused employment for health reasons?*
- Yes
- No
On workers compensation/work care/work cover*
- Yes
- No
Refused Life Insurance?*
- Yes
- No
Refused a drivers license*
- Yes
- No
Attended by a chiropractor?*
- Yes
- No
Do you have any allergies to
Solvents*
- Yes
- No
Dust*
- Yes
- No
Oils*
- Yes
- No
Other Allergies*
If none, type N/A
Have you ever
Injured your back*
- Yes
- No
Had a head injury*
- Yes
- No
Had a hernia or rupture*
- Yes
- No
Had nerve trouble*
- Yes
- No
Taken medicine regularly*
- Yes
- No
Suffered from high blood pressure*
- Yes
- No
Suffered from fainting spells or dizziness*
- Yes
- No
Had shortness of breath*
- Yes
- No
Suffered from heart trouble*
- Yes
- No
Had joint pain or stiffness*
- Yes
- No
Suffered from any hearing impairment*
- Yes
- No
Are you aware of any existing or pre-existing medical condition that would affect your duties as a sub-contractor to Rush Express?*
- Yes
- No
Details*

Terms & Conditions
I*
FirstLast
On behalf of*
Company Name
*
- I agree that dkcb Pty Ltd T/as Rush Express shall not be liable in any respect if my engagement as a contractor is terminated because of falsity of statements, answers or omissions wilfully made by me in the questionnaire.
*
- I also state that I have received the dkcb Pty Ltd T/as Rush Express operating manual / OHS / Policy & Procedures manual.
*
- I fully accept the terms and conditions Rush Express have provided

Site

Home
Services
Service Area
Employment
Policy
General Trading Terms
Contact Us

Services

Services
Service Area
Couriers
Taxi Trucks
Warehousing
Pick – Pack
Distribution
Technology
Warehouse Management System
Warehousing & logistics Sydney

Forms

Forms
Online Bookings
Credit Application Form
Customer Satisfaction Survey
Driver Application Form
Employee Application Form
Incident/Accident and Investigation Report

Copyright ©2014-2021 RUSH EXPRESS