Driver Job Application

DRIVER APPLICATION
M&G COMPLETE ENTIRE APPLICATION
Name*

First NameLast Name
Current Address*

Street Address

Street Address Line 2

CityState

Zip Code
How Long Have You lived at Your Current Address?*
How long have you had your Commercial Driver License?*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Social Security
When can you Start?*

MonthDayYear
Date
LIST ALL DRIVER LICENSES HELD IN THE LAST THREE YEARS*
Driving Experience
List Any Crashes You Have Had in The Last Three Years
Has your driver license or driving privilege ever been revoked, or suspended?*

YesNo
Have you ever been denied the issuance of a driver license, permit, or privilege to operate a motor vehicle?*

YesNo
If you answered yes to either of the above questions, please explain below.
Employment Record (Attach Additional Sheet if Needed) CDL Drivers Must List All Prior Employers for the Proceeding 10 Years
Previous Employer
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.
Signature*
AUTHORIZATION TO RELEASE EMPLOYMENT INQUIRY INFORMATION FROM MY FORMER EMPLOYERS
I Full Name* authorize M & G Transportation LLC to make such investigations in
accordance with 49 CFR part 391, and inquiries of my personal, employment or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, former employers and other persons from all liability in responding to inquiries and releasing information in connection with my application. I understand that you will contact my former employers and obtain any positive drug or alcohol results.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by DOT regulations. I also authorize M & G Transportation LLC or their representative to access my state CDL records in
accordance with the federal regulations found in part 391 for employment and annual review as long as I am employed with the M & G Transportation LLC. I understand that I have the right to:
- Review information provided by previous employers
- Have errors corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
- have a rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree on the accuracy of the information.
I also authorize my Previous Employers to release and forward information requested under 49 CFR section 382.405(f) and (h) concerning my alcohol and controlled substances testing records to: M & G Transportation LLC or Steve Talkington Consulting that is a representative of M & G Transportation LLC, my prospective employer.

I understand the following information from my previous employers include requirements of 49 CFR 382.413: My former employers will be asked the following:
- Have I had an alcohol test with a result of 0.04 alcohol concentration or greater within the past two years?
- Have I had a controlled substances test with a verified positive controlled substances test result within the past two years?
- Have I refused to be tested for alcohol or controlled substances within the past two years?
I also give permission to my former employers to release the name and address of any Substance Abuser Professional that I have seen.

Driver Signature* Date*
AUTHORIZATION TO ALLOW M&G TRANSPORTATION TO OBTAIN MY DRIVER LICENSE AND BACKGROUND INQUIRY INFORMATION
I Full Name* authorize M&G TRANSPORTATION to make such investigations in accordance with 49 CFR part 391, regarding inquiries of my driving records (MVR) for the purpose of new employment and ongoing Annual Reviews as required by Part 391 CFR 49. I authorize M&G TRANSPORTATION to conduct my driver inquiries and drug and alcohol inquiries with my former employers. I understand that M&G TRANSPORTATION will not release my driving record or personal information regarding my prior employment to anyone outside of M & G Transportation LLC.

Signature* Date*
PSP Disclosure and Authorization Form

The below disclosure and authorization language is for mandatory uses by account holders
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with M&G Transportation (“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 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 codriver 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 M&G Transportation (“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 codriver 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.

Date* Signature*

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.
ACKNOWLEDGEMENT OF COMPANY POLICY ON CONTROLLED SUBSTANCE/ALCOHOL TESTING
I, First Name* Last Name*, hereby acknowledge that I have received a copy of M & G Transportation LLC’s policy and procedures regarding controlled substance and alcohol testing and education program.

I have read and understand the terms and procedures contained in it.

I understand that adherence to this policy is a requirement for continued employment or independent contractor status with M & G Transportation LLC, and that any violation of this agreement may be grounds for termination of my employment or contract with the company.

I authorize the companies’ processing lab and medical review officer to release the test result information to the designated company representative(s) as required under the Federal Department of Transportation regulations. I authorize my former employers to release any prior positive drug of alcohol results to the company.

I also understand that the costs associated with treatment, rehabilitation and/or re-testing split samples is the driver’s responsibility.

Date* Drivers Signature*
CRIMINAL BACKGROUND AUTHORIZATION FORM
Position(s) Applied for: *
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Previous Address (If different in the last 7 Years)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Social Security Number
Drivers License Number*
State Issued*
Have you ever been convicted of a crime?*

YesNo
If Yes, Explain!
Signature* Date*
New Hire 180 Day Probation Requirement
M&G Transportation
First Name* Last Name*
We are pleased that you have chosen to accept our offer of employment for Professional
Truck driver and look forward to your first day of work on   Date. We believe you will find working at M & G Transportation LLC to be a rewarding experience. M&G Transportation uses a 180-day probation time frame for new employees with less than 2 yrs. experience. This time frame lets you assess your readiness for the position as well as allows us to determine your ability to do the job. You must not have any citations, accidents, or incidents of any kind during your 180- day probationary period. You will be provided an employee handbook, documentation, training and performance feedback during that time frame as part of your on-boarding. At the end of the probationary period, if we have confirmed that you are able to meet all job requirements, you will be eligible to receive all normal and customary benefits offered to regular [full time/part time] employees as outlined in the employee handbook. You, like all employees of M & G Transportation LLC, will become a regular [full-time/part-time] employee, subject to the at will employment doctrine described in our employee handbook. We wish you great success in your new position.

Directory of Safety   Date

I,First Name*   Last Name*, have read and understood the
probationary policy.
Signature*    Date*
Should be Empty:

DRIVER APPLICATION

M&G COMPLETE ENTIRE APPLICATION

Employment Record (Attach Additional Sheet if Needed) CDL Drivers Must List All Prior Employers for the Proceeding 10 Years

AUTHORIZATION TO RELEASE EMPLOYMENT INQUIRY INFORMATION FROM MY FORMER EMPLOYERS

AUTHORIZATION TO ALLOW M&G TRANSPORTATION TO OBTAIN MY DRIVER LICENSE AND BACKGROUND INQUIRY INFORMATION

PSP Disclosure and Authorization Form

IMPORTANT DISCLOSUREREGARDING BACKGROUND REPORTS FROM THE PSP Online Service

Authorization

ACKNOWLEDGEMENT OF COMPANY POLICY ON CONTROLLED SUBSTANCE/ALCOHOL TESTING

CRIMINAL BACKGROUND AUTHORIZATION FORM

New Hire 180 Day Probation Requirement

IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service