Onboarding Drivers Section

Counselman Automotive Recycling, LLC
Driver SOP
Please read the documents above and type and sign your name below to indicate you have read the document.
Employee Name
Signature

Clear
Date

MonthDayYear
Date
Driver Policy
Driver's License Number
Date Issued

MonthDayYear
Date
Date Expire

MonthDayYear
Date
Issuing State
SSN
Birth Date

MonthDayYear
Date
Signature

Clear
Application For Employment
Today's Date

MonthDayYear
Date
Position Applied For
Driver Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
Address For Past Three years
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have the legal right to work in the US?
Can you provide proof of your age?

YesNo
Who referred you?
Rate of pay expected?
Is there any reason you might be unable to perform the job as listed in the above SOP?
If yes, please explain
Have you tested positive or refused to test on any pre-employment drug or alcohol test administered by an employer to which you applied for but did not obtain safety-sensitive transortation work covered by DOT drug and alcohol rules during the past 2 years?

YesNo
If you answered "YES" to the above question, can you provide documentation of successful completion of DOT return to duty requirements (including follow up tests)?

YesNo
Have you ever been convicted of a felony or Misdemeanor which resulted in imprisonment within the last 7 years?

YesNo
If you have been convicted, please attach a separate page providing us with an explanation of all relevant circumstances
Employment History
Employer 1
Phone Number

Area CodePhone Number
Work Start Date

MonthDayYear
Date
Work End Date

MonthDayYear
Date
Position
Salary
Reason for leaving
Employer 2
Employer Name
Contact Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Work Start Date

MonthDayYear
Date
Work End Date

MonthDayYear
Date
Position
Salary
Reason for leaving
Employer 3
Employer Name
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Salary / Wage
Contact Person
Phone Number
Reason for Leaving
Employer 4
Employer Name
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Salary / Wages
Contact Person
Phone Number
Reason for Leaving
Employer 5
Employer Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Position
Salary / Wage
Contact Person
Phone Number
Reason for Leaving
Employer 6
Employer Name
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Salary / Wage
Contact Person
Phone Number
Reason for Leaving
Employer 7
Employer Name
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Salary / Wage
Contact Person
Phone Number
Reason for Leaving
Employer 8
Employer Name
From Date

MonthDayYear
Date
To Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Position
Salary / Wage
Contact Person
Phone Number
Reason for Leaving
Accident Record

Please list any driving accidents starting with the most recent
Accident Date

MonthDayYear
Date
Nature of Accident
Head on, rear end, upset, etc.
Fatalities
Injuries
Accident Date

MonthDayYear
Date
Nature of Accident
Fatalities
Injuries
Date

MonthDayYear
Date
Nature of Accident
(head-on, rear-end, upset, etc.)
Fatalities
Injuries
Traffic Convictions and Forfeitures (Last 3 years)

Please list any convictions starting with the most recent. Do not include parking violations.
Location
Violation Date

MonthDayYear
Date
Charge
Penalty
Location
Violation Date

MonthDayYear
Date
Charge
Penalty
Location
Date

MonthDayYear
Date
Charge
Penalty
Education
Last Year Completed

High School 9thHigh School 10thHigh School 11thHigh School 12thCollege Year 1College Year 2College Year 3College Year 4
Last School Attended
City
Licenses
License 1
State:
License #:
Type:
Expiration Date:   Date
License 2
State:
License #:
Type:
Expiration Date:   Date
License 3
State:
License #:
Type:
Expiration Date:   Date
License Problems
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

YesNo
Has any license, permit, or driving privilege every been suspended or revoked?

YesNo
Driving Experience
Straight Truck
Type of Equipment:
Date From:   Date
Date To:   Date
Approximate number of miles:
Tractor/Semi Trailer
Type of Equipment:
Date From:   Date
Date To:   Date
Approximate number of miles:
Tractor/Two Traliers
Type of Equipment:
Date From:   Date
Date To:   Date
Approximate number of miles:
List all states operated in for the past five years
List any special courses of training that will help you as a driver
List any safe driving awards you hold
List any trucking, transportation, or other experience that may help you in your work
List any courses or training
List special equipment or technical materials that you can work with
Signature

Clear
Signature Date

MonthDayYear
Date
Certificate of Compliance

I hereby Certify that I have read and understand the above requirements and that the following license is the only one that I will possess.
Driver's License No.blanks
Issuing State blank
Expiration Date Date
Signature

Clear
Request for Check of Driving Record

I hereby authorize you to release the following information to (prospective employer) Counselman Automotive Recycling for the purpose of investigation as required by section 391.23 of the federal motor carrier safety regulations. You are hereby released from any and all liability which may result from furnishing such information.
Signature

Clear
Date

MonthDayYear
Date
Name
Social Security No.
I blanks, do hereby authorize my previous employers to release information from my drug and alcohol records in accordance with DOT regulation 49 CFR Part 40, Section 40.25. I also authorize release of all other records of employment including job performance to Motor Carrier Consultants, Inc., in connection with my application for employment. I hereby release my former employers from any and all liability of any type as a result of providing the above requested information.
Signature

Clear
Date

MonthDayYear
Date
Name blanks
Social Security No.blank
Motor Vehicle Operator's License Number
Type of License   Type of License
Issuing State Issuing State
Fill in the date and hours you worked, driving or not, for the past seven days. Put your total hours in the "TOTAL" column.
Date 1Date 1
Date 2Date
Date 3Date
Date 4Date
Date 5Date 5
Date 6Date 6
Date 7Date 7
Hours Worked 1   Day 1 hours
Hours Worked 2   Day 2 hours
Hours Worked 3   Day 3 hours
Hours Worked 4   Day 4 hours
Hours Worked 5   Day 5 hours
Hours Worked 6   Day 6 hours
Hours Worked 7   Day 7 hours
Total Hours Worked in seven days   Total hours
Time

:HourMinutesAM/PM Option
Date

MonthDayYear
Date
Signature

Clear
Name of Driver
Social Security Number
Home Terminal (City & State)
Driver's License Number & State
Expiration Date

MonthDayYear
Date
I certify that the following is a true and complete list of traffic violations required to be listed (other than those I have provided under Part 383) for which I have been convicted or forfeited bond or collateral during the past 12 months.
No Violations
Date Date
Offense
Location
Vehicle Type

Date   Date
Offense
Location
Vehicle Type

Date   Date
Offense
Location
Vehicle Type

Date   Date
Offense
Location
Vehicle Type

Date   Date
Offense
Location
Vehicle Type
If no violations are listed above, I certify that I have not been convicted nor forfeited bond or collateral on account of any violation (other than those I have provided under Part 383) required to be listed during the past 12 months.

MonthDayYear
Date
Signature

Clear
I, blanks, understand and agree to abide by the above requirements and statements as a condition of employment.
Signature

Clear
Date

MonthDayYear
Date
I, blanks, understand and agree to abide by the above requirements and statement as a condition of employment.
Signature

Clear
Date

MonthDayYear
Date
I, blanks, voluntarily agree to undergo a physical examination, including a urine test and/or breath/saliva test (when performed under the guidelines specified in CFR 49, §40) by a doctor, medical center, hospital, or medically qualified personnel.
Signature

Clear
Date

MonthDayYear
Date

Counselman Automotive Recycling, LLC

Driver SOP

Please read the documents above and type and sign your name below to indicate you have read the document.

Driver Policy

Application For Employment

Address For Past Three years

Employment History

Employer 1

Employer 2

Employer 3

Employer 4

Employer 5

Employer 6

Employer 7

Employer 8

Accident Record

Traffic Convictions and Forfeitures (Last 3 years)

Education

Licenses

License Problems

Driving Experience

Certificate of Compliance

Request for Check of Driving Record