AMSA SUPER VAN OPERATOR AWARDS NOMINATION APPLICATION

Transcription

1 AMSA SUPER VAN OPERATOR AWARDS NOMINATION APPLICATION SELECT THE CATEGORY FOR WHICH YOU ARE APPLYING (SEE CONTEST RULES FOR ELIGIBILITY): Household Goods Lifetime Achievement Rookie of the Year SECTION 1: PERSONAL DATA (if applying as a team, team member must complete his/her own application form) If applying as a team, each team member must complete his/her own application form. Name of team driver (if applicable): Special Commodities Winning entrants will be based on objective criteria as provided in the contest rules. There are six (6) pages to this application. All questions must be fully and accurately answered. First and Last Name Street Address City, State, ZIP Home Phone Number Mobile Phone Number Address Social Security Number Date of Birth CDL Number State of Issue Endorsements Currently Driving for Address of Company Phone Number of Company Van Line Affiliation Have you won an AMSA Super Van Operator Contest before? Yes No If so, which year?

2 Spouse/Guest name Name(s)/age(s) of child(ren) Hometown newspaper (with city and state) Jacket size In the past seven (7) years, have you filed for bankruptcy? Yes No If yes, supply details below. Do you have any assessments or penalties outstanding with the Internal Revenue Service, state assessor, or other governmental agency? Yes No If yes, supply details below. SECTION 2: SAFETY RECORD In what year did you start driving a commercial motor vehicle? Have you driven commercial motor vehicles continuously since then? If not, give dates of other employment activity: How many years have you driven for/been contracted to your current company? How many miles have you driven commercial motor vehicles in your lifetime? How many carriers have you driven for or been leased to in the past ten (10) years? Average one-way miles per load (number of dispatches per year divided by miles per year) AS A PRIVATE VEHICLE OPERATOR: Total lifetime chargeable accidents in personal automobiles, and dates : Total lifetime moving violations in personal automobiles list date, type of moving violation, and disposition:

3 AS A COMMERCIAL VEHICLE OPERATOR: (through 8/31/17) Chargeable accidents* Non-chargeable accidents* Moving violations Out of service orders *see descriptions below Please supply details of out-of-service orders and moving violations (e.g., date, type of violation, and any fine paid). Use additional pages if more space is needed. * The federal standard for accident preventability appears in Appendix B to 49 CFR Part 385 as follows: If a driver, who exercises normal judgment and foresight could have foreseen the possibility of the accident that in fact occurred, and avoided it by taking steps within his/her control which would not have risked causing another kind of mishap, the accident was preventable. * For the purpose of this contest, a Chargeable (Preventable) accident is defined as: one resulting in personal injury or property damage or both and where (a) you have been charged or issued a citation by law enforcement officials (even if a charge was later dismissed or you were found not guilty); (b) the accident was determined to be preventable by your motor carrier or an accident review organization; or (c) the accident was ruled preventable by your motor carrier s insurance carrier. * A Non-Chargeable (Non-Preventable) accident is one for which you have not been charged or held responsible for injury or property damage by law enforcement officials, your motor carrier, an accident review organization, or your motor carrier s insurance carrier. DRIVING HISTORY How many years have you driven commercial motor vehicles in the HHG industry? How many miles have you driven commercial motor vehicles in the last five years (from September 1, 2012 through August 31, 2017)? How many miles have you driven commercial motor vehicles in the last 12 months (from September 1, 2016 through August 31, 2017)? IMPORTANT! A COPY OF YOUR OFFICIAL MOTOR VEHICLE RECORD FROM YOUR STATE, DATED AFTER AUGUST 31, 2017, MUST BE ATTACHED TO THIS APPLICATION.

4 SECTION 3: AWARDS AND ACHIEVEMENTS Please list (and include copies of) all awards, achievements, honors, or recognition you have received in your career as a driver or independent contractor. These may include safety, productivity, and fuel economy awards; truck driver championship awards; driver of the month awards; driver/trainer awards; and the like. List customer praise in the next section. Please use a separate page if more space is necessary. SECTION 4: CUSTOMER SERVICE List here your record of customer service, including shipper or customer letters of commendation or praise. No letter may be older than five (5) years (ten (10) years for Lifetime Achievement entrants). Include copies of letters with this application. SECTION 5: HUMANITARIAN ACTS Use this space to identify any humanitarian or heroic acts, which to the extent possible should be documented with media reports, letters from individuals or companies involved, law enforcement reports, etc. SECTION 6: COMMUNITY INVOLVEMENT Please list here your record of community involvement for the past ten (10) years. Include trucking industry activities and those that are not trucking industry related (e.g., church, sports, mentoring). Please use the back of this page if more space is needed.

5 SECTION 7: GENERAL COMMENTS Use this area to identify any other item that you feel the judges should know about and which you believe makes you deserving of being selected as a Super Van Operator winner. This could be an excellent record in cargo claims, for example, being a truck show winner, engaging in personal achievements, or other activities that are not community-oriented. SECTION 8: ESSAY (OPTIONAL) If you so choose, you may use a separate sheet only to state, in 500 words or less, why you believe you should be selected as a Super Van Operator winner. An essay is completely optional, and your decision not to include an essay will in no way affect your chances of being selected. SECTION 9: PUBLICITY - DRIVER APPLICANTS NOTE THE REQUEST FOR PICTURES OF YOURSELF IN THIS SECTION TO BE COMPLETED BY COMPANY PRESIDENT, CEO, or SAFETY DIRECTOR: Super Van Operator winners will generate publicity about the winner, your company, and the industry generally. Please supply an outline of what you believe to be your driver s positive qualities and attributes that can be conveyed to the media. Examples are that your driver consistently delivers on time and without damage; or that your driver possesses an exceptionally high work ethic; or that he or she possesses a particularly good understanding of the moving and storage industry.

6 TO BE NOTED BY CONTEST APPLICANTS: For publicity purposes, please enclose with this final application at least two, but no more than four, photographs of yourself taken within the past year. At least one picture should be of you in front of or alongside your truck; and another should be a close-up head-and-shoulders shot. Pictures can be black-and-white or color, but CANNOT be Polaroids. These photos will be used if you are selected as a contest winner. Photos become part of the application and cannot be returned. SECTION 10: Verification, Authorization and Release To the best of my knowledge, the information provided in this application is true, valid, complete, and correct. I understand and agree that false, misleading, or erroneous information shall be grounds for disqualification. By signing this form, I authorize the American Moving & Storage Association to conduct additional investigation with current and prior employers and service recipients, and with other private and public sources including but not limited to law enforcement agencies, motor vehicle record agencies, and consumer credit reporting agencies, to verify the information contained herein. NAME OF NOMINATOR Title Company name Company address Telephone number Fax number address NOMINATOR SIGNATURE DATE DRIVER APPLICANT SIGNATURE DATE RETURN TO AMSA WITH ALL ATTACHMENTS NO LATER THAN DECEMBER 1, 2017 BY MAIL TO: Super Van Operator Program American Moving and Storage Association 2800 Eisenhower Avenue, Ste. 200 Alexandria, VA QUESTIONS? CONTACT DANIEL HART AT (703) OR DHART@MOVING.ORG.

7 AMSA SUPER VAN OPERATOR AWARDS RULES & JUDGING CRITERIA The principal goal of the American Moving and Storage Association s Super Van Operator contest is to recognize and honor exemplary drivers and owner-operators in each of four categories who provide safe, reliable, and customer-oriented truck transportation in service to the nation s household goods carriers. Several finalists will be chosen from among all nominations received. From the finalists, and based on qualified applications received, a winner will be chosen in each of the four Super Van Operator categories for a total of four (4) Super Van Operator winners. These winners will be acknowledged and rewarded as outstanding drivers or independent contractors based on several criteria, including but not limited to the individual s ability to run a successful business, operate in a safe manner over public highways and enhance the public image of the household goods moving and storage industry. Eligibility Requirements Please Read Carefully This contest is open to any single driver, independent contractor, or team of drivers who own and/or operate, as a full-time occupation, a power unit used in a three-axle or more tractortrailer combination, or a straight truck with a gross vehicle weight rating of 10,001 lbs. or more, operates 25,000 miles or more in a year, hauls 30 shipments or more in a year, who drives for or is contracted to: a local moving and storage company; an independent household goods carrier; a national van line; or an agent of a national van line; which van line, carrier, agent, or local company is a current member in good standing of the American Moving and Storage Association ( AMSA ). A driver-nominee must hold a current and valid commercial driver license. Carriers or agents must have been AMSA members on January 1 of the previous year, and must have maintained, and must agree to maintain, their membership in AMSA continuously through August 31 of this year. There are four categories of Super Van Operator award winners: Household Goods, Special Commodities, Rookie of the Year, and Lifetime Achievement. Except as provided below, contest entrants must have at least five years experience operating Class 6, 7, or 8 commercial motor vehicles as a full-time occupation, the most recent three years of which must be spent driving for a household goods carrier Nominees for the Super Van Operator Lifetime Achievement award must possess a minimum of twenty (20) years of experience operating commercial motor vehicles interstate Nominees for the Super Van Operator Special Commodities award must currently be transporting special commodities as her or his primary duty; and have transported special commodities as her or his primary duty during the past five years. Primary is defined as more than fifty (50) percent, measured either in time or in mileage. Special commodities is defined as computer or tradeshow exhibits, furniture, temperature-controlled freight, artwork, loads requiring special handling, automobiles, or other commodities usually and customarily transported by a household goods carrier other than personal household belongings

8 Nominees for the Super Van Operator Rookie of the Year award may waive the five-year driving experience requirement prescribed in Paragraph 2 above, but must have at least two (2) years of service in the household goods industry as an operator of commercial motor vehicles for which a Class A or B license is required, and no more than five (5) years of experience as an operator of commercial motor vehicles Contest entrants cannot enter the contest themselves; they must be nominated by (a) the motor carrier for which she/he/they currently drive; (b) the agent for which he/she/they currently drive; or (c) a destination agent for whom the contest entrant has delivered a load in the prior twelve (12) months Winners are not eligible to re-enter the contest for a period of one (1) year from the date of receipt of their previous award, regardless of which of the AMSA awards (e.g., special commodities; rookie of the year) they may have won. Lifetime Achievement award winners are not eligible to re-enter the Super Van Operator contest One nominee may be submitted by each AMSA member van line or agent per award category Contest Rules Please Read Carefully All eligibility criteria are subject to verification The Super Van Operator Award Nomination form must be completed by all contest entrants in order to qualify. In addition, finalists may, if they choose, submit an essay of no more than 500 words in length explaining why the finalist should be chosen as a winner. Submission of an essay is optional but encouraged Applications must be complete. Incomplete or unreadable applications will be returned and not further considered for the contest Obtaining Forms Original forms are not required. Photocopies and computer-generated or downloaded forms may be used. Sending Forms Completed forms may be sent to AMSA by mail, courier or fax (see Contest Applications, following page). Faxed applications will be considered received only when an applicant receives a fax or confirmation from AMSA. When entering as a team, each team driver must submit a separate and complete application. Both drivers in a team will be considered for a single award Contest entrants must indicate on the form the category of Super Van Operator contest in which they wish to compete. Entrants may compete in only one category per contest year; entrants are not barred from competing in different categories in successive years Verification may include direct contact with the motor carrier for which the contest entrant drives, and may also include credit report histories, motor vehicle reports, commercial background inquiries, and other investigation to verify the accuracy of the information submitted. Additionally, all final applications must contain a statement of recommendation from the chief executive officer or safety director of the company to which he or she is under

9 contract, or for which he or she drives. AMSA will seek verification from the respective Van Line when applications are received from their agents The contest judge(s) will scrutinize claims of large numbers of miles driven annually. Any claim of miles driven exceeding 125,000 annually by a single driver must be accompanied by a statement from the carrier s or agent s safety director attesting that a log audit did not reveal any driver out-of-service violations Erroneous or false information supplied on the application will result in immediate disqualification, and may potentially bar the applicant from competing in future Super Van Operator contests Information must be supplied on the contest form. Information other than the form itself and supporting documentation requested on the form (e.g., MVR, customer appreciation letters) will not be considered and may result in rejection of the application. Supplementary information and unconventional or alternative presentation formats (e.g., notebooks, ring or plastic binding, explanatory summaries, section dividers) will NOT be accepted Contest information (e.g., mileage, accidents) must be current through August 31 of this year Except for Lifetime Achievement contest entrants, customer letters and testimonials older than five (5) years will NOT be accepted. For Lifetime Achievement contest entrants, customer letters and testimonials older than ten (10) years will NOT be accepted. This age limitation only applies to customer letters and testimonials; it does not apply to carrier awards, honors, and recognition given to a contest entrant throughout his or her driving career Prize winners are each responsible for any applicable federal, state, or local taxes on their awards One (1) ORIGINAL and THREE (3) copies of each application are required to be submitted to AMSA All applications and copies thereof become and remain the property of AMSA. No applications, pictures, or other contents will be returned The decision of AMSA and of its judges is final and may not be appealed Contest Applications All applications must be received at the offices of AMSA by the date specified in the application. Computer-generated forms may be used, but the completed forms must be sent to AMSA via mail, courier, or fax. Faxed applications will be considered received only when an applicant receives a fax or confirmation from AMSA. Judging Criteria Applications will be reviewed by AMSA based solely on objective criteria and judged based upon objective and subjective criteria by judges selected by AMSA who, in its sole judgment, are respected and knowledgeable members of the motor carrier safety community. Nominees may be contacted by judges to conduct a live or phone interview. Criteria for reviewing applications are based upon a variety of objective and subjective factors, including but not limited to: accident experience (preventable and non-preventable); historical motor vehicle record; out of service orders (e.g., hours of service and equipment violations);

10 financial responsibility; violations received while operating non-commercial motor vehicles; community involvement and service; customer service; driving awards; and outside interests and activities. Announcement of Winners Based on the qualified applications received and subject to the discretion of the judges, there will be four (4) winners, one in each of the four Super Van Operator categories. Contest winners will be notified in January and will be publicly announced during AMSA s Annual Education Conference & Expo. Prizes A complete listing of prizes will be announced as sponsors confirm their commitments. AMSA will offer complementary registration for the winner and his or her guest and two night s accommodations at the conference hotel. AMSA requires that the sponsoring carrier cover the travel costs, additional lodging costs, and incidental expenses. Personal Appearances AMSA would like to recognize the contest winners and present their awards in person. While a personal appearance to receive an award is not required, we strongly encourage winners to attend the Annual Educational Conference and Expo, if at all possible. In addition, winners may wish to attend the AMSA National Safety & Operations Conference, where they will have the opportunity to participate in a program detailing their achievements and receive recognition for their selection as Super Van Operator winners. Questions? Contact Daniel Hart at (703) or dhart@moving.org.