Truck Driver Application 2021

APPLICATION FOR QUALIFICATION
Thank you for your interest in TDR Logistics. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

To fill out this form, you will need to know the following:
- Social Security Number
- Home address history for the past 3 years
- Current driver license number and driver license history for the past 3 years
- Employment history up to 10 years
- History of traffic accidents, violations and/or convictions from the last 3 years (including DUI or reckless driving conviction and license suspension)
Required entry fields are followed by *, meaning you must provide the requested information to continue. If you encounter any errors during this process and cannot continue, please contact us at (509) 822-6795

PERSONAL INFORMATION
Full Name*

First NameLast Name
Social Security Number *
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Residence address for 3 or more years?

YesNo
Please list prior 3 year addresses here and please be complete
Contact phone*
Email Address*
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utm_campaign
utm_medium
utm_content
utm_term
job_position
our_offer

Request for Driver’s Safety Performance History Information from DOT Regulated Previous Employer(s)
Driver to Complete This Section

As a Commercial Motor Vehicle (CMV) Driver, I understand that per, the Federal Motor Carrier Safety Regulations (FMCSRs) Part 391.21, the following information will be requested from all previous employers for which I operated a CMV, subject to the FMCSR Parts 390 and/or 40, 382 & 383, within the past three years, from the date shown below. I also acknowledge that this information will be used in determining my eligibility to be hired, that I have the right to review this information and rebut any errors in these statements from my prior employers, as described in the FMCSR Part 391.23.
Full Name*

First NameLast Name
hereby authorize this company to release all records of employment, including assessments of my job performance, ability and fitness, including dates of any and all alcohol or drug tests. Those confirmed results and/or my refusal to submit to any alcohol or drug tests and any rehabilitation completion under direction of (SAP/MRO) to each and every company (or their authorized agents) which may request such information in connection with my application for employment with said company. I hereby release this company, and its employees, officers, directors, and agents from any and all liability of any type as a result of providing information to TDR Logistics.
Applicant Signature*
Social Security Number
D.O.B

MonthDayYear
Date
Date

MonthDayYear
Date

DRIVING EXPERIENCE
How many years of Class A CDL experience do you have?*
How many years of Dry Van experience do you have?*
How many years of Reefer experience do you have?*
How many years of ice/snow driving experience do you have? *
How many years of "Other" class of equipment experience do you have? *
Other experience
List states operated in, for the last five years:
List special courses/training competed (PTD/DDC, Haz Mat, etc.):
Which safe driving awards do you hold and from whom?

ACCIDENT HISTORY

Accident Record for past three years
Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?*

YesNo
Date of Accident / Incident

MonthDayYear
Nature of Accidents
(Head on, rear end, upset, etc.)
Location of Accident
Were you in a commercial vehicle?

YesNo
Please enter detailed information about this accident, whether the accident was chargeable, recordable, reportable, or your fault
Date of Accident / Incident

MonthDayYear
Nature of Accidents
(Head on, rear end, upset, etc.)
Location of Accident
Were you in a commercial vehicle?

YesNo
Please enter detailed information about this accident, whether the accident was chargeable, recordable, reportable, or your fault

TRAFFIC CONVICTION / VIOLATION HISTORY

Traffic Convictions and Forfeitures for the last three years
Have you had any moving violations or traffic convictions in the past 3 Years?*

YesNo
Date

MonthDayYear
Location
Charge / Description:
Were you in a Commercial Vehicle?

YesNo
Penalty
Additional space,Please enter it here and include ALL information previously asked for.
Date

MonthDayYear
Location
Charge / Description:
Were you in a Commercial Vehicle?

YesNo
Penalty
Additional space,Please enter it here and include ALL information previously asked for.

PERSONAL REFERENCE
Name
Phone Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
Comments
Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Comments
Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Comments

To Be Read and Signed by Applicant
It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.

It is agreed and understood that the motor carrier or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file.

It is agreed and understood that this Application for Qualification in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.

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.
Applicant Name*
( Please Print)
Date

MonthDayYear
Date
Applicant Signature*

DRIVER’S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23
Motor carriers have the responsibility to make the following investigations and inquiries with respect to each driver employed, other than a person who has been a regularly employed driver of the motor carrier for a continuous period

which began before January 1, 1971.
- (a) (1) An inquiry into the driver’s driving record during the preceding three years to the appropriate agency of every State in which the driver held a motor vehicle operator’s license or permit during those three years; and
- (a) (2) An investigation of the driver’s employment record during the preceding three years.
- (b) A copy of the driver record(s) obtained in response to the inquiry or inquiries to each State driver record agency as required must be placed in the Driver Qualification File within 30 days of the date the driver’s employment begins and be retained in compliance with 391.51.
- (c) Replies to the investigations of the driver’s safety performance history must be placed in the Driver Investigation History File within 30 days of the date the driver’s employment begins. This goes into effect after October 29, 2004.
- (d) Prospective motor carrier must investigate the information from all previous employers of the applicant that employed the driver to operate a CMV within the previous three years. This information must cover general driver identification and employment verification information, data elements as specified in 390.15 for accident involving the driver that occurred in the three-year period preceding the date of the employment application, and any accidents the previous employer may wish to provide.
- (e) Prospective motor carrier must investigate the information from all previous DOT regulated employers that employed the driver within the previous three years from the date of the employment application in a safety-sensitive function that required alcohol and controlled substance testing specified by 49 CFR Part 40.
Drivers have the following rights:
1. The right to review the information provided by previous employers.
2. The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer.
3. The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.
Drivers who wish to review previous employer-provided investigative information must submit a written request to the prospective employer when applying or as late as 30 days after employed or being notified of the denial of employment. The prospective employer must provide this information to the applicant within five business days of receiving the written request. If the driver has not arranged to pick up or receive the requested records within 30 days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records.

Drivers wishing to request correction of erroneous information in records must send the request for the correction to the previous employer that provided the records. After October 29, 2004, the previous employer must either correct and forward the information to the prospective motor carrier employer or notify the driver within 15 days of receiving the driver’s request to correct the data that it does not agree to correct the data. Drivers wishing to rebut information in records must send the rebuttal to the previous employer with instruction to include the rebuttal in the driver’s Safety Performance History.

I acknowledge that I have read and understood the contents of this document
Applicant Name*
( Please Print)
Date

MonthDayYear
Date
Applicant Signature*

PSP ONLINE SERVICE
IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with TDR Logistics (“ Prospective Employer”), 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 nhttps://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 TDR Logistics (“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.
Applicant Name*
( Please Print)
Date

MonthDayYear
Date
Applicant Signature*

DRIVER APPLICANT DRUG AND ALCOHOL PRE-EMPLOYMENT STATEMENT

CFR Part 40.25(j) requires the employer to ask any applicant, whether he or she has tested positive, or refused totest, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for,but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol rules during thepast two years. If the potential employee admits that he or she had a positive test or refusal to test, we must not usethe employee to perform safety-sensitive functions, until and unless the potential employee provides documentationof successful completion of the return-to-duty process.(See Section 40.25(b)(5) and (e).
Applicant Name*
( Please Print)
Social Security Number
As an applicant, applying to perform safety-sensitive functions for our company, you are required by CFR Part

40.25(j) to respond to the following questions.
1. 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 transportation work covered by DOT agency drug and alcohol testing rules during the past two years?Applicant Name*

YesNo
2. If you answered yes, to the above question, can you provide proof that you have successfully completed the DOT return-to-duty requirements?

YesNo
My signature below certifies that the information provided is true and correct.
Applicant Signature*
Date

MonthDayYear
Date

CONTROLLED SUBSTANCE & ALCOHOL TESTING INFORMATION ACKNOWLEDGEMENT

As a condition of employment with TDR Logistics (Motor Carrier), Commercial Motor Vehicle (CMV)Driver Applicants must submit to a pre-employment controlled substances test as required by the Federal Motor CarrierSafety Regulations (FMCSR) Section 382.301. A motor carrier must receive verified negative test results for the applicant driver for the applicant to be eligible for employment.
If you are hired, you will be subject to laws requiring additional controlled substances and alcohol testing on you under numerous situations including, but not limited to, the following:
- Post-Accident – Section 382.303
- Random– Section 382.305
- Reasonable Suspicion – Section 382.307
- Return to Duty – Section 382.309
- Follow-up – Section 382.311
A driver who tests positive for a controlled substance(s) and/or alcohol test, will be immediately removed from a safety-sensitive position as required by Part 382 of the FMCSR. Federal law prohibits a driver from returning to a safety-sensitive position for any motor carrier until and unless the driver completes the Substance Abuse Professionals (SAP) evaluation, referral, and educational/treatment process, as described in FMCSR Part 40, Subpart O.
The following is a referral list of Substance Abuse Professionals:

American Mobile Drug Testing

10905 E Montgomery Dr, Suite 4 Spokane Valley, WA 99206
Phone: (509) 892-6904
Fax: (509) 892-6904
All controlled substances and alcohol testing will be conducted in accordance with Parts 40 and 382 of the FMCSR.
Applicant Name*
( Please Print)
have read the above-controlled substances and alcohol testing requirements and understand them. I acknowledge receipt of the referral list of Substance Abuse Professionals.
Applicant Signature*
Date

MonthDayYear
Date
Employer’s Representative
Date

MonthDayYear
Date

SEVEN-DAY PRIOR LOG

Instructions:At the time of initial employment as a driver, or when being employed occasionally, the regulations of the Department of Transportation [Section 395.8 (j)(2)] require the motor carrier to obtain from you a signed statement giving the total time on duty during the immediately preceding 7 days and the time at which you were last relieved from duty prior to beginning work for the motor carrier. In the spaces below, show the number of hours worked (on duty) in each of the last 7 days.
Full Name

First NameLast Name
Social Security Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
Contact phone
License Number
State of Issue

	Day 1	Day 2	Day 3	Day 4	Day 5	Day 6	Day 7	Total
Date
Hours Worked

I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at:*

	Time	Day	Month	Year

Applicant Signature*
Employer’s Representative
Date

MonthDayYear
Date

FINALIZATION
By checking this box, I acknowledge that I have read and understood the Disclosure Statement & Summary of Rights
What is state above*

I acknowledgeI do not acknowledge
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.
Name*
( Please Print)
Date

MonthDayYear
Date
Should be Empty:

APPLICATION FOR QUALIFICATION

PERSONAL INFORMATION

GENERAL INFORMATION

EDUCATION

EMERGENCY CONTACT

EMPLOYMENT HISTORY

Request for Driver’s Safety Performance History Information from DOT Regulated Previous Employer(s)

DRIVER’S LICENSE INFORMATION

DRIVING EXPERIENCE

DRIVER TRAINING

ACCIDENT HISTORY

TRAFFIC CONVICTION / VIOLATION HISTORY

MOTOR VEHICLE RECORD

PERSONAL REFERENCE

To Be Read and Signed by Applicant

DRIVER’S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23

PSP ONLINE SERVICE

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

DRIVER APPLICANT DRUG AND ALCOHOL PRE-EMPLOYMENT STATEMENT

CONTROLLED SUBSTANCE & ALCOHOL TESTING INFORMATION ACKNOWLEDGEMENT

SEVEN-DAY PRIOR LOG

FINALIZATION