MGR Freight System, INC

5151 W. Lawndale Ave
Summit, IL 60501
(224) 558-5668

MGR Freight is a company that provides full logistics across the United States and Canada. Starting as a small family-owned business based in Illinois, MGR Freight is expanding into a nation-wide recognized company. With 24-hour call center availability, multiple locations and central located terminals, our growing network of skilled staff provide dependable and smart logistics solutions with steady freight to keep you on the road.
Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address - Must list all addresses for last 3 years

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Social Security Number*
Date of Birth:*

MonthDayYear
Date
Email*
example@example.com
Emergency Contact Name:

First NameLast Name
Relation:
Emergency Contact Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Phone Number

Area CodePhone Number
DRIVER’S LICENSE INFORMATION
State*
abbreviation
License #*
Expiration Date*

MonthDayYear
Date
Type
DRIVER EXPERIENCE
Type of Equipment*
From (Date)*
To (Date)*
Approx # of Miles*
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*

YesNo
Has any license, permit or privilege ever been suspended or revoked?*

YesNo
Position Applying For:*
Accident Record for Past 3 Years:
Date:
Description:
# of Injuries / Fatalities:
Traffic Convictions & Forfeitures for Past 3 Years
Location
Date
Charge
Penalty
HISTORY WITH COMPANY WHICH YOU ARE APPLYING FOR
Have you worked with MGR previously?

YesNo
Have you applied to work with MGR previously?

YesNo
How did you hear about MGR?
Type a question
EMPLOYMENT RECORD

DOT requires employment for 3 years previous and/or commercial driving experience for past 10 years to be shown
Employer #1 (most recent)*
From:
To:
Address:
Supervisor:
Position:
Reason for Leaving:
Phone Number

Area CodePhone Number
Were you subject to the FMCSRs while employed?

YesNo
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

YesNo
Employer #2
From:
To:
Address:
Supervisor:
Position:
Reason for Leaving:
Phone Number

Area CodePhone Number
Were you subject to the FMCSRs while employed?

YesNo
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

YesNo
Employer #3
From:
To:
Address:
Supervisor:
Position:
Reason for Leaving:
Phone Number

Area CodePhone Number
Were you subject to the FMCSRs while employed?

YesNo
Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40?

YesNo
To Be Read and Signed By Applicant

Provided by USDOT / FMCSA Distributed by DOT Compliance Help, Inc. (847) 836-6063 version updated March 24, 2009
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e I understand that I have the right to:

Review information provided by the previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and ●Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

This certifies this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.
Signature*

Clear
Date

MonthDayYear
Date
SAFETY PERFORMANCE HISTORY RECORDS REQUEST

Section 1: TO BE COMPLETED BY PROSPECTIVE EMPLOYEE
To release and forward the information requested by section 3 of this document concerning my Alcohol and Controlled Substance Testing records within the previous 3 years of previous employers.

In compliance with §40.25(g) and 391.23(h), release of this information must be made in a written form that ensures confidentiality, such as fax, letter, or email.
Employer #1 (most recent)
Address :
Phone Number:

Area CodePhone Number
Name 2

First NameLast Name
Social Security Number 3
Date of Birth 3:

MonthDayYear
Date
Applicant's Signature*

Clear
Date

MonthDayYear
Date
THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS
IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service
In connection with your application for employment with MGR Freight System / RD, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.
AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:
I authorize MGR Freight System / RD Expedited to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.
I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
Signature*

Clear
auth
auth
Name 3*

First NameLast Name
Date

MonthDayYear
Date
NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.
WRITTEN CONSENT FOR CDLIS INQUIRY
I, the undersigned commercial driver, hereby authorize EXPLORE INFORMATION SERVICES, LLC to request or access data pertaining to me within the CDLIS Central Site, to obtain all CDLIS Master Pointer Record data relating to me (CDLIS Data), and to request and obtain my driver record from the jurisdiction identified in the CDLIS Data in accordance with applicable state law and the Driver Privacy Protection Act. I hereby further authorize the disclosure of my CDLIS Data and driver record to MGR Freight System / RD EXPEDITED, INC.
Social Security Number 2
Name 4*

First NameLast Name
Date of Birth 2

MonthDayYear
Date
Signature*

Clear
Date of Consent

MonthDayYear
Date
DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES

Please Read Carefully Before Signing Authorization
DISCLOSURE

In considering you for employment and, if you are employed, in considering you for subsequent promotion, assignment, reassignment, retention, or discipline, MGR Freight System / RD EXPEDITED, INC. may request and rely upon one or more consumer reports or investigative consumer reports, consisting of motor vehicle records, about you that we obtain from Explore Information Services, LLC, a consumer reporting agency.

Definitions used in this authorization form:
- a “consumer report” is a written, oral or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in making an employment-related decision about you. Such information may include, for example, credit information, criminal history reports, or driving records; and
- an “investigative consumer report” is a consumer report in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your prior employers, neighbors, friends, or associates, or with others who may have knowledge concerning any such items of information. In the event an investigative consumer report is requested about you, you are entitled to additional disclosures regarding the nature and scope of the investigation requested, as well as a written summary of your rights under the Fair Credit Reporting Act (“FCRA”).
Under the FCRA, before MGR / RD can obtain a consumer report or investigative consumer report about you for employment purposes, we must have your written authorization. Before we take adverse action on the basis, in whole or in part, of information in that report, you will be provided a copy of that report, the name, address, and telephone number of the consumer reporting agency that provided such report to Company, and a summary of your rights under the FCRA.

MGR / RD will monitor your driving record and license status on an ongoing basis during your employment, membership, or contract period with the Company.

AUTHORIZATION

I have read and understand the foregoing Disclosure, and authorize RD EXPEDITED, INC. to obtain and rely upon consumer reports or investigative consumer reports, obtained from Explore Information Services, LLC, consisting of motor vehicle records, and as an employee of the Company, in considering me for subsequent promotion, assignment, reassignment, retention, or discipline. By my signature below, I authorize RD EXPEDITED, INC. to obtain any such motor vehicle records and to share the information received with any person involved in the employment decision about me. This authorization shall serve as an ongoing authorization to procure consumer report information, including motor vehicle records, on an ongoing basis during my employment, until termination of the contract period with MGR / RD.

I also agree that this Disclosure and Authorization in original, faxed, photocopied, or electronic (including electronically signed) form will be valid for any consumer reports or investigative consumer reports, consisting of motor vehicle records, that MGR /RD may request about me directly or through Explore Information Services, LLC.

I certify that all elements of the personal data I have provided are true, accurate, and complete. I understand and agree that any omission, false statement, misleading statement, or answer made by me on my application or any supplements to it and in any interviews will be sufficient grounds for rejection of employment and my discharge after employment
SIGNATURE*

Clear
DATE

MonthDayYear
Date
Name 5*

First NameLast Name
Social Security Number 5
DATE OF BIRTH 5:

MonthDayYear
Date
DRIVER'S LICENSE #:
STATE:
EMAIL ADDRESS:
example@example.com
Please upload front and back of CDL, or text to: 224-558-5668

Browse Files

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Should be Empty:

DRIVER’S LICENSE INFORMATION

DRIVER EXPERIENCE

Accident Record for Past 3 Years:

Traffic Convictions & Forfeitures for Past 3 Years

HISTORY WITH COMPANY WHICH YOU ARE APPLYING FOR

EMPLOYMENT RECORD

To Be Read and Signed By Applicant

SAFETY PERFORMANCE HISTORY RECORDS REQUEST

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

IMPORTANT DISCLOSURE

AUTHORIZATION

WRITTEN CONSENT FOR CDLIS INQUIRY

DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES