Work History Request

This is information is very important. Many of the insurance companies will require this information.
Our goal is to be able to request as many quotes as we can for you to help you find the best-priced insurance policy.
This information is very important to help us do just that.
Please confirm your DOT#(Required)
Please confirm your Email(Required)
Where will you be getting your loads?(Required)
Check all that apply.
- Load Boards
- Amazon
- Contract with a Shipper or Company
Which company or companies are you contracting with to pull loads?(Required)
What type of Cargo have you pulled?(Required)
2 or 3 examples: Beverage, Autos, Dry Van, General Freight, Hazmat, Reefer, Construction, Flatbed (if flatbed - steel or coils), etc.
Which states have you driven through in the past or are currently hauling through.(Required)
Give us 3 states. If you are not driving out of your home state. Please state so.
Work History
This is important. In many cases the underwriters will give you credit, which could save you money, based upon your transportation industry worked history.
If you have driven for someone, work as a dispatcher or any other job related experiences could save you money on your premium.
JDW will not contact your present or past employers without your permission. This is merely to give the underwriters an ideal of your work history so we can try to get you the best rate.
Company name, city and state?(Required)
State date Job #1(Required)
Month/Year
End date Job #1(Required)
Month/Year
Duties at Job #1(Required)
Add job reference #2(Required)
- Yes
- No
Company name, city and state? Job #2
State date Job #2(Required)
Month/Year
End date Job #2(Required)
Month/Year
Duties at Job #2(Required)
Add job reference #3
- Yes
- No
Company name, city and state? Job #3(Required)
Start date Job #3(Required)
Month/Year
End date Job #3(Required)
Month/Year
Duties at Job #3(Required)
Comments or Questions
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