2018 Driver of the Year Nomination Form - Ohio Trucking Association

2018 Driver of the Year Nomination Form

Thank you for nominating your driver for the OTA Driver of the Year award. To complete the nomination, please complete this form and submit a Motor Vehicle Record (MVR). Nominations are due by February 1, 2019. Return to: Ohio Trucking Association, 21 East State Street, Suite 900, Columbus, Ohio 43215 or e-mail to bradie@ohiotrucking.org.

All nominees must be employed by or leased to an OTA member company.

Fields marked with an * are required.

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DRIVER INFORMATION:

Driver's Full Name *

Birthdate *

Driver's Address *

Driver's Email Address *

License # *

State *

Last four digits of SSN# *

Ring Size *

This measurement should be verified with a jeweler. Driver of the Year ring is NOT returnable.

Driver's Phone Number *

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EMPLOYMENT INFORMATION:

Employer's Name *

Employer's Address *

Employer's Phone Number *

Previous Employer's (driving only) *

Equipment Driven *

Truck

Tractor Trailer

Type of Driving *

Local

OTR

Years of Commercial Driving with PRESENT Employer *

Commercial Mileage with PRESENT Employer *

Years of Commercial Driving with PREVIOUS Employers *

Commercial Mileage with PREVIOUS Employer *

Number of Preventable Accidents with PRESENT Employer *

Number of Non-Preventable Accidents with PRESENT Employer *

Number of Preventable Accidents with PREVIOUS Employers *

Number of Non-Preventable Accidents with PREVIOUS Employers *

Date of Last Crash *

Date of Last Traffic Violation of Citation *

Offense Description *

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ADDITIONAL INFORMATION:

Awards the driver has won (include year)

Organizations in which the driver belongs(civic, religious, charitable)

List industry activities (TDC, Safety Council, Maintenance Council, No Zone, Driver Trainer, etc.)

List any other information the judges should know. (250 words or less)

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SPONSORING EMPLOYER AGREEMENT AND DRIVER SIGNATURE

Sponsoring Company *

Nominator's Name *

Sponsor Address *

Nominator's Email Address *

Nominator's Phone Number *

Statement of Agreement *

In consideration of your driver being allowed to participate in the program, the company and driver certifies and agrees to the following:

All of the statements contained in the application submitted in support of the driver’s nomination are true to the best of the company’s knowledge. The company to the best of its ability has investigated these statements and a company representative has personally reviewed with the driver the facts contained herein.
It is understood and agreed to by the company that the driver will attend the awards banquet, April 5, 2019, Location Grand Event Center, 820 Goodale Blvd., Columbus, Ohio 43212.
It is agreed that should the nominee receive the title of “Driver of the Year” the company will work to protect and maintain the high status of this recognition and will use this recognition to promote this event.
All finalist and employers agree to being photographed and videotaped during the awards banquet for event promotion.
Adhere to the Ohio Trucking Association’s Antitrust guidelines.

Please verify that you have checked the “I'm not a robot” checkbox.

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