2015 National Driver of the Year

Transcription

1 2015 National Driver of the Year Nomination Workbook Sponsored by Driver s Name Company Nominating State Association

2 Requirements: National Driver of the Year Award 1. Nominations may be made by ATA affiliated state trucking associations only. The nominee must be the official State Truck Driver of the Year and must be employed as a professional truck driver at the time of the nomination. 2. Nominated drivers must be employed by an ATA member company. 3. All forms contained herein must be completed and signed as required. 4. A photograph of the driver and his company executive must accompany the nomination. IMPORTANT: The photograph should be a head and shoulders shot. An ed photo is also encouraged. 5. Information furnished in support of this nomination must be verified by the nominating state trucking association to assure accuracy. General Information: 1. Selection of the state truck driver of the year may be based on any of the following: a. Outstanding contribution to highway safety b. Long standing record of courteous and safe driving c. Item d should always be required in combination with any others listed. Outstanding deed of heroism d. Outstanding acts of courtesy on the highway IMPORTANT: The following documentary materials must be provided to qualify State Truck Drivers of the Year for the National program. State Association Checklist: (Information on each are shown on the following pages) 1. Basic Driver Information a. Awards Received b. Truck Driving Championships History c. Driver Educational Training d. Background Information 2. Accident Record 3. Drivers actions on which nomination is based 4. Other Outstanding Activities of the nominee 5. Required Documents a. Military records b. Photographs c. Driver Record 6. State Association Official Nomination Form 7. Driver Certification and Agreement 8. Company Certification and Agreement 1

3 In addition to the foregoing, an investigation should be made to verify the accuracy of information furnished in support of the nomination. 2

4 Driver Information Sheets Information must be furnished for each item on both pages of this form. If the information requested does not pertain, enter N/A to indicate that the item has not been overlooked. The form must be signed by the driver and by a company official. Nominating State Assn.: Driver s Name: Age Commercial Driving Years of Experience: Type of Equipment Regularly Operated: Usual Run: road from: to: Type of Run: local turn around peddle Annual Mileage: Career Mileage: Accident-Free Miles: Total Preventable Accidents: Total Non-preventable: Awards Received as a Professional Driver (other than no-accident awards) add lines as needed

5 Championships Competition (list championships competed in, class and standing) add lines as needed Championship Class Standing 4

6 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 Safety 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 5

7 Married? Yes No If Yes, spouse s name: Employment History Present Employer: Dates 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) 6

8 Police Record (list all convictions other than minor traffic violations, but include speeding, reckless driving, etc.-place, date, and sentence) Place Date Sentence 7

9 Driver s Name: Accident Record A. List required information for last four accidents in which driver was involved: Date: Number of Persons Injured: Accident #1 Property Damage Cost: Number of Fatalities: Type of vehicle driver was operating: truck car Accident classified as: preventable non-preventable Date: Number of Persons Injured: Accident #2 Property Damage Cost: Number of Fatalities: Type of vehicle driver was operating: truck car Accident classified as: preventable non-preventable Date: Number of Persons Injured: Accident #3 Property Damage Cost: Number of Fatalities: Type of vehicle driver was operating: truck car Accident classified as: preventable non-preventable Date: Number of Persons Injured: Accident #4 Property Damage Cost: Number of Fatalities: Type of vehicle driver was operating: truck car Accident classified as: preventable non-preventable B. Show Total Number of Accidents in which driver was involved: (Submit a copy of reports for each accident with damage totaling $250 or more) Total Number of Accident while driving trucks: Total Number of Accidents while driving car 8

10 Please Include the Following Requirements on Additional Pages Section A Driver Action(s) On Which Nomination Is Based Required: Provide a complete detailed and accurate description of the event(s) on which the nomination is based (description boxes below expand as you type). Provide dates, locations and names of persons involved, present at the scene or supervisory personnel who can verify records or deeds. Use additional pages if necessary. Event #1: Date: Location: Persons Involved: Description: Event #2: Date: Location: Persons Involved: Description: Event #3: Date: Location: Persons Involved: Description: Following this description, insert supporting documentary material, such as letters of commendation, statements of witnesses, police reports, etc. Original copies of photostats are acceptable. 9

11 Section B Other Outstanding Activities of the Nominee A summary of the nominee s outstanding deeds, activities or record achieved as a professional truck driver, passenger car operator or private citizen. Provide a brief description of each event and include dates, locations and other pertinent facts (description boxes below expand as you type). Summary should include any worthwhile civic activities. Activity #1: Date: Location: Description: Activity #2: Date: Location: Description: Activity #3: Date: Location: Description: 10

12 Section C Required Documents Military: Photograph: Submit photocopies of letters, citations or discharge papers to support military service claims. A photograph of the driver and his company executive MUST accompany the nomination or be ed separately. IMPORTANT: The photograph should be a head and shoulders shot. Please identify who is who in the photo? Driver Record: Investigation should be made to verify accuracy of information furnished by the driver. A check of the traffic record and criminal record should be included. If copies of official traffic and criminal record are available, they should be included with the nomination. 11

13 Driver s Name: State Association Official Nomination Driver s Company: State Trucking Association: This nomination is based upon the personal character and reputation of the driver and upon his/her record and deeds as a professional truck driver. Information contained herein has been verified as to accuracy and completeness by the state trucking association, or by its agents. The nominee has been interviewed and found to be of good character. It is agreed that, should this driver be selected for the title National Driver of the Year, publicity and advertising originated by the state association will be in line with policies developed by American Trucking Associations. Signed: Association Safety Management Council Chairman 12

14 Driver Certification and Agreement In consideration of my being allowed to participate in this program of American Trucking Associations and to be eligible for any awards and recognition offered in the program, I hereby certify and agree to the following. 1. All of the statements contained in the material submitted in support of my nomination are true. I authorize American Trucking Associations and its representatives to make an independent check of all information contained herein. 2. I authorize American Trucking Associations and its designated agencies to make full use of the above described information about myself and the photographs supplied with this application, along with photographs subsequently taken under ATA s direction, in publicity enterprises arranged by American Trucking Associations with newspapers, magazine writers and radio and television and internet personnel. 3. I agree to travel to the ATA Safety Management Council s Safety & Human Resources National Conference and ATA Management Conference & Exhibition and/or such other place or places, and at such time or times, as arranged by American Trucking Associations. 4. I will always conduct myself in such a way as to protect and maintain the high status of the honor bestowed upon me and I agree that this recognition may not be used in any advertising, promotion or exhibition except those sanctioned in writing by American Trucking Associations. Name of Nominee (printed): Signature of Nominee: Company: Driver of the Year for the State of: 13

15 Company Certification and Agreement In consideration of our driver being allowed to participate in this program, this company does certify and agree to the following: 1. All of the statements contained in the material submitted in support of this 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. 2. It is understood and agreed to, by the company that our driver may travel to the ATA Safety Management Council s Safety & Human Resources National Conference and the ATA Management Conference & Exhibition and/or such other place or places, and at such time or times, as arranged by American Trucking Associations. 3. It is agreed that should our driver receive the title National Driver of the Year the company will work to protect and maintain the high status of his recognition and will not use this recognition in any advertising promotion or exhibition except those sanctioned in writing by American Trucking Associations. The driver interview and investigation of the facts submitted in support of this nomination have been made by: Name: Title: Company: Signed: Company Executive Officer Driver s Name: Nominated by: Name of State Trucking Association 14