Bravo Application for Employment

  • Application for Employment

    Work for Bravo Environmental
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  • Employment Record

    DOT requires that employment for at least 3 years and/or Commercial Driving experience (CDL) for the past 10 years be shown.

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  • Position Held: From: To:   Salary/Wage:      

  • Position Held: From: To:   Salary/Wage:      

  • To be read and signed by Applicant

    This certifies that 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
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  • Violation and Review Record

  • Certification of Violations

    I certify that the following is a true and complete list of all traffic violations (including revocation, suspension or withdrawal of an operator's license, but not parking violations) for which I have been convicted or forfeited bond or collateral during the past 36 months.
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  • Operators's License:

  • Revoked Suspended Withdrawn   Date      Restored      

  • License Number State Date      

  • If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral, during the past 36 months, because of any violation required to be listed.

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  • Review & Evaluation of Driver's Record

    In accordance with Section 391.25 of the Federal Motor Carrier Safety Regulations, all information pertinent to the driver's safety of operations, including the list of violations furnished by him/her in accordance with Section 391.27, has been reviewed for the past 12 months. Actions taken are detailed below (and on the reverse side of this form if additional room was necessary).
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  • Alcohol and/or Controlled Substance Test Notification

    Part 382-Controlled Substances and Alcohol Use Testing applies to drivers of this company.

  • 382.113 Requirement for notice.

    Before performing an alcohol or controlled substances test under this part, each employer shall notify a driver that the alcohol or controlled substances test is required by this part. No employer shall falsely represent that a test is administered under this part. 

    Company Name: Bravo Enviornmental NW, Inc. 

  • You are hereby notified the following test will be administered in compliance with the Federal Motor Carrier Safety Regulations.

    Type of test: Controlled Substance

    Reason for test: Pre-employment

     

    Bravo also conducts alcohol/controlled substance tests under the following circumstances: random, reasonable suspicion/cause, post-accident, return to duty, and follow-up. 

     

    I understand that as a condition of my employment with this company, the above tests are required.

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  • Request/Consent for information from previous employer or service agent on alcohol & controlled substances testing

    For CDL/Operators Only

  • Section 1: To be completed by Prospective Employee

    (Section 1 must be completed to avoid delay in processing. This form will be returned if incomplete)

  • I, (print name) Social Security # (required)

  • hereby authorize that:

  • Previous Employer or Service Agent:
    Address:
    City/State/Zip:      
    Phone #:      Fax #:      

  • may release and forward information requested by section 2 (below) of this document concerning my Alcohol and Controlled Substances Testing records to:

  • Company Name:
    Address:
    City/State/Zip:      
    Phone #:      Fax #:      

  • I understand that the information to be released by my previous employer or service agent is limited to the DOT-regulated testing items listed in section 2 (below). This release is in accordance with the DOT 49 CFR Part 40 and Part 391.

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  • [Do not write below this line. Section 2 and 3 are for Previous Employer/Service agent.]

    40.25 As an employer or service agent you must release information under the following circumstances: (a) If you receive a specific, written consent from an employee authorizing the release of information about that employee's drug or alcohol tests to an identified person, you must provide the information to the identified person. For example, as an employer, when you receive a written request form a former employee to provide information to a subsequent employer, you must do so. In providing the information, you must comply with the terms of the employee's consent. 

  • Section 2: To be completed by Previous Employer or service agent and transmitted by mail or fax

  • If "yes" to item 4, you must provide the previous employer's report. If answered "yes" to item 6, you must also transmit the Return-to-Duty documentation (eg., SAP reports(s), follow-up testing records).

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  • Section 3: To be completed by company

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  • Complete below when information is obtained:

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  • Authorization for Release of Background Information

  • I, , Social Security Number authorize you, the prospective employer, Bravo Environmental NW, Inc and/or it's investigative representative and Century Insurance Group, LLC with any and all information that you have concerning my driving record and background. Information is confidential, personal and/or privileged nature may be included.

    You reply will be used to assist in determining my qualifications and fitness for employment.

    I herby release and hold harmless any person/agencies including you, your organization and persons within your organizations from any claims or liability alleged to result from furnishing the information requested.

    A photocopied reproduction or facsimile transmission of this document shall be, for all intents and purposes, as valid as the original.

    NOTE: All information provided by you will be kept confidential.

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