Name:
Company Name:
Mailing Address: Physical Address:
City:     City:    
State: Zip: State: Zip:
Federal Tax ID/SSN:
Phone:
(xxx-xxx-xxxx)
*Phone:
(xxx-xxx-xxxx)
Fax#            
Email:            
Personal Information
Home Address:            
City:            
State: Zip:        
Contact Information
Office Manager:            
Broker/Dispatcher:     Broker/Dispatcher:    
Other:            

 

Experience  
Number of years of brokerage experience:
Number of years of dispatch (career) experience:
Number of years of sales (shipper) experience:
   
Productivity  
Number of loads per week: (average)
Gross sales (revenue) per week: (average)
Gross sales is defined as the dollar amount that is billed to the customer.
Gross margin per week: (average)
Gross margin is defined as the difference between what the shipper pays you for the load and what you pay the carrier.
For example, the shipper pays you $1,200 and you pay the carrier $1,000. The Gross Brokerage is $200
Margin (percentage) per load: (average)
In the example above the margin is 20% ($200 / $1000)
   
Type of Equipment and Freight  
Please mark each of the following types of equipment that you have worked with in your career

Van Reefer Flatbed Tanker Specialty

Type of freight, which percentage of your freight fits into each of the following categories (numbers should add up to 100%)
Truckload
LTL
100% Total
Shipper Relationships  
How many shippers do you have relationships with?
What percentage of your business comes from your top shipper?
What percentage of your business comes from your top 3 shippers?
What percentage of your business comes from your top 5 shippers?
   
Carrier Relationships  
How many carriers do you have relationships with?
What percentage of your business do you cover with your top 5 carriers?
   
Computer Skills  
What brokerage program are you familiar with?
What software programs are you familiar with?
   
Skill Analysis  
Do you have supervisory experience? Yes No
If yes, how many people do you supervise?
If you were to start up a new office, do you have any experienced staff that would join you?
Yes No
If yes, how many?
Do you have any special skills that you think make you an exceptional employee? (e.g., experience with Hazmat, OS/DD, blanket-wrap, etc.)
   
Education  
School:
Major:
Minor:
Degree:
(If earned)

 
High School:
How soon could you open a new office in your area?

Can you supply supporting documentation of your sales success into an independent third-party Yes No
How did you hear about this position?
 
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