• DRIVER APPLICATION

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  • Annual Driver's Certificate of Violations

  • Exclude parking tickets. I certify that the above information is a true and complete list of violations required to be listed (other than those I have provided (under the 49 CFR 383) for which I have been convicted or forfeited bond or collateral during the past 12 months.

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  • Motor Vehicle Report Consent 

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  • Previous Employment History

    All applicants must provide complete information regarding three years previous employment history.Applicants to drive a commercial motor vehicle (includes vehicles having a GVWR of 26,001 lbs. or more, vehiclesdesigned to transport 15+ passengers, or any size vehicle used to transport hazardous materials in a quantityrequiring placarding) in intrastate or interstate commerce shall also provide:- A total of 3 years of previous employment if you did not drive a commercial vehicle and 10 yearsif you were employed as a commercial driver.- Or, if you have been employed for less than ten years as a driver, please provide employmentinformation for the period of time for which you have had your CDL.- If you have had your CDL less than three years, please provide at least three years of employmenthistory.Do not leave any gaps between places of employment. If there are gaps, please provide explanation for the gapson the following page. IF WE ARE NOT ALLOWED TO CONTACT YOUR EMPLOYER THERE IS A CHANCE YOUMAY NOT BE ABLE TO WORK FOR US!

  • General Consent for Limited Queries of the FMCSA Drug and Alcohol Clearinghouse

  •  I hereby provide consent to for the company listed above to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.

     I understand that if the limited query conducted by the company listed above indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information  without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for the company listed above to conduct a limited query of the Clearinghouse, the company listed above must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

     

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  • Drug & Alcohol Testing Policy Acknowledgement

    •  I know this organization is a Drug-free Workplace and I must submit to a pre-employmentdrug test.
    • I know that, if hired, I will be subject to random drug and alcohol testing. I also understand thatif I do not submit to the test when asked, that my refusal will be considered a positive result.
    •  I know that this organization has enacted a Zero Tolerance Policy for drug & alcohol use and if I test positive for either, I will be subject to immediate termination.
    • I know that if I begin work before the result of the pre-employment drug test is received and the results return positive, I will be terminated immediately.
    • I understand that if I accept employment and do not complete my first week of employment due to voluntarily resignation, my paycheck will reflect a deduction for the expense of drugtest, physical examination, hearing test, background check, driver record request, etc.
      I have read and understand each of the preceding items. I have had the opportunity to question any item that I did not understand.
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  • Certification of Statement

  • This certifies that this application was completed by me, and best of my knowledge, all information provided is true in its entirety. I authorize you to make such investigations and inquiries of my personal, and employment financial history as necessary in arriving at an employment decision. In the event that I have mislead the company based on false or inaccurate information provided within the application I have completed, I understand that I can be denied being hired or discharge from employment if I have already began employment with the company.

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  • In connection with your application for employment with Prospective Employer, 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 (“Prospective Employer”) ___________________________________________ 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.

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