Driver of the Month/Year Application Nominating Company: Driver’s Name: Age Commercial Driving Years of Experience: Type of Equipment Regularly Operated: Type of Run (LOC, OTR, etc): Annual Mileage: Career Mileage: Accident-Free Miles: Career Preventable Accidents: Career Non-preventable Accidents: Preventable Accidents within previous 12 months: Non-preventable within previous 12 months: #CLEAN CSA Inspections in previous 12 months (attach reports): Awards Received as a Professional Driver (other than no-accident awards) – add lines as needed 1. 2. 3. 4. 5. Championships Competition (list championships competed in, class and standing) – add lines as needed Championship Class Standing Courses or Training on First Aid, Driver Education, and Safety Taken (show type of course/training, date(s) of course/training and Sponsor/Organization providing the course/training) – add lines as needed Course Dates Sponsor Community Activities Engaged In (such as neighborhood projects, civic programs, and give dates and brief description) Project/Program Dates Description List Memberships (church, lodges & clubs; and offices held, if any) Membership Organizations Offices Held (if applicable) Other Activities and Hobbies: Employment History (1 year) Present Dates Employer: Employed: Main Address: Terminal Address: Union? If yes: Local #: City: Driver’s Home Address: Previous employment (in reverse) Company Address Dates Military Record Branch of Service: Dates: Principal duty: Military Campaigns and citations (send supporting documents with nomination) Police Record- MVR (list all convictions other than minor traffic violations, but include speeding, reckless driving, etc.-place, date, and sentence) Attach MVR. Place Date Sentence I certify that the information submitted in this application is true and correct to the best of my knowledge: Driver: Date: Company Nominator: Date: Submission Instructions Mail: (Must arrive by 15th of each month) E-Mail: (Must be sent by 15th of each month) Illinois Trucking Association To: [email protected] Attn: Linda Blisset Subject: Illinois Driver of the Year 932 S. Spring St. Nomination Springfield, IL 62704 Program Generously Sponsored by: .