We're required to verify that you haven't failed or refused to take and controlled substances or alcohol tests with each of your prior DOT regulated employers from the last 3 years. We're also required to have you list all of your employers for the prior 10 years.

Please provide us with the names and contact information for each of these employers:

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

I understand as required by the Federal Motor Carrier Safety Regulations, 49 CFR part 391.103, and company policy, all prospective drivers must submit to a controlled substance test involving collection of a urine sample which will be tested for the following controlled substances: marijuana, cocaine, opiates, amphetamines and phencyclidine (PCP I understand I am also subject to regulatory alcohol testing and any other Substance Abuse Testing in accordance with the company policy and/or regulatory requirements.

I understand, if I test positive for use of controlled substances, I am not medically qualified to operate a commercial motor vehicle in interstate commerce. I also understand I will be given a reasonable opportunity to confer with the company’s Medical Review Officer before any positive test is reported to the company. I further understand that once a positive has been confirmed by the Medical Review Officer, I must at my own expense be evaluated by a Substance Abuse Professional (SAP), submit to any treatment, and obtain a release by the Substance Abuse Professional prior to operating a commercial motor vehicle in the interstate commerce.

The result of any Substance Abuse test will be maintained by the Medical Review Officer for the company who will report whether the test result was negative or positive to the motor carrier. The Medical Review Officer or the company may also release the result to my examining physician in connection with my DOT – required physical. The results will only be released to any additional parties in accordance with the regulations.

I hereby agree to submit to required Substance Abuse Testing (drug and/or alcohol)

I hereby acknowledge that Savannah River Logistics, LLC (collectively referred to as the ‘Company’) Department of Transportation Federal Highway Administration Substance Abuse Policy has been reviewed and explained to me and that the Company has presented and I have attended a Substance Abuse Education Program on the topics listed below. I further acknowledge receipt of educational materials which discuss in detail the following topics:

• 1. 2.The categories of employees subject to the company’s DOT Substance Abuse Policy. 3.Sufficient information about the safety-sensitive functions and periods of the workday that compliance is required. 4.Specific information concerning prohibited employee conduct. 5.Circumstances under which an employee will be tested. 6.Test procedures, employee protection and integrity of the testing processes, and safeguarding the validity of the test. 7.The requirement that tests be administered in accordance with DOT regulations. 8.An explanation of what will be considered a refusal to submit to a test and the consequences. 9.The consequences for Part 382 Subpart B violations including removal from safety-sensitive functions and §382.605 procedures. 10.The consequences for covered employees found to have an alcohol concentration of 0.02 or greater but less than 0.04. 11.Information on the affects of alcohol and controlled substances use on:

• An individual’s health
• Work
• Personal life
• Signs & symptoms of a problem
• Available methods of intervening when a problem is suspected

The designated person to answer question about the materials.

I further agree that as a condition of continued employment, I will abide by the Company’s DOT Substance Abuse Policy, including the provision for random testing of all employees. I agree that as an employee, if I refuse to submit to any drug test or if I fail an alcohol and/or drug test, I will be removed from the job and referred to rehabilitation or employee assistance at my own expense. Any refusal to be referred to rehabilitation will result in immediate termination. Also, I agree that if convicted of a violation of a criminal drug statute in the workplace, I will notify the Company within five (5) days of the conviction.

I acknowledge and consent freely and voluntarily to the Company’s right to conduct unannounced searches for illegal drugs and alcohol on Company property, in its facilities and vehicles on job sites. I understand that the Company has the right to inspect: company lockers, desks, work areas, vehicles and other containers and objects on Company property that might conceal illegal drugs/alcohol. I further acknowledge and consent freely and voluntarily to reasonable searches of my person and my personal property. I understand ta failure to cooperate fully with the Company in this regard will result I disciplinary action including possible termination.

I understand and agree to the above terms and conditions of employment. I understand that the above in no way creates an obligation or contract of employment and that I, as well as the Company, have the right to end the employment relationship at any time.

I hereby acknowledge that I have been informed of Savannah River Logistics, LLC's ("The Company") DOT Substance Abuse Policy and agree to be bound by this policy for purposes of applying for, accepting, or continuing employment with the Company. I also hereby state that I am not a user of controlled substances except as listed below under medical supervision.

I understand and consent freely and voluntarily to the Company’s request for a urine or other specimen or sample. I hereby release and hold harmless the Company, the medical review officer, medical professionals, the laboratory, their employees, agents and contractors from any liability arising from this request to furnish this or any specimen or sample, the testing of the specimen or sample, and any decisions made concerning my application for employment or my continued employment, based upon the results of the test.

I consent to allow the laboratory, hospital, medical review officer or other medical professional to perform appropriate chemical tests for the presence of alcohol, drugs or other controlled substances. I give my permission to any Company employee, laboratory, hospital, medical review officer or other medical professional to release the results of these tests to the Company and I release any such designated institution or person from any liability whatsoever arising from the release of this information.

I have taken the following medications within the past thirty (30) days:

I hereby consent and allow the Company or its designated representative to verify and/or confirm the above information with the prescribing physician listed above.

I certify that if I have been furnished a specimen kit, the bottle in that kit was personally given to me by the collection site or laboratory personnel and contained a specimen of my urine. Further, I attest that the specimen was sealed in my presence.

The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

Parts 383 & 391 of the Federal Motor Carrier Safety Regulations contain certain driver licensing requirements that you as a driver must comply with, including the following:

1.POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motor vehicle operator’s license.

2.NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 391.15(b2) and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver’s license.

In addition, Section 383.31 requires that any time you are convicted of violating a state or local traffic law (other than parking), you must report it within 30 days to: 1) your employing motor carrier, and 2) the state that issued your license (if the violation occurs in a state other than the one which issued your licenseThe notification to both the employer and state must be in writing.

3) CDL DOMICILE REQUIREMENT: Section 383.23(a2) requires that your commercial driver’s license be issued by your legal state of domicile, where you have your true, fixed, and permanent home and principal residence and to which you have the intention of returning whenever you are absent. If you establish new domicile in another state, you must apply to transfer your CDL within 30 days.

I hereby certify that I only possess the license listed.

I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.

In accordance with the provisions of Section 604(b2A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Savannah River Logistics, LLC. ("Prospectve 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.

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize Savannah River Logistics, LLC (“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.

I hereby provide consent to Savannah River Logistics, LLC to conduct a 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.

This consent applies to any and all Drug and Alcohol Clearinghouse queries that may be conducted throughout the duration of my employment relationship with this motor carrier.

I understand that if a limited query conducted by Savannah River Logistics indicates that drug or alcohol violation information about me exists in the Clearinghouse, the FMCSA will not disclose that information to this company without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for this motor carrier to conduct a limited query of the Clearinghouse, then the company must prohibit me from performing safety- sensitive functions, including driving a commercial motor vehicle, as required by the FMCSA’s drug and alcohol program regulations.

By completing an application on this platform, you are signing this Agreement electronically.

You agree your electronic signature is the legal equivalent of your manual signature
on this Agreement. By completing this application, you consent to be legally bound by thisapplication’s statements.

You further agree that your use of a keypad, mouse or other device to select an item, button, icon or similar act/action, or to otherwise provide Carrier Risk Solutions, or in accessing or making any transaction regarding any agreement, acknowledgment, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "E-Signature"), acceptance and agreement as if
actually signed by you in writing.

You also agree that no certification authority or other third-party verification is necessary to validate your E-Signature and that the lack of such certification or third-party verification will not in any way affect the enforceability of your E-Signature or any resulting contract between you and Carrier Risk Solutions.

You also represent that you are authorized to complete this application for all persons who own or are authorized to access any of your accounts and that such persons will be bound by the terms of this Agreement.

You further agree that each use of your E-Signature in completing an application with Carrier Risk Solutions constitutes your agreement to be bound by the terms and conditions of the company’s Terms of Service and Privacy Policy as they exist on the date of your E-Signature.