-DRIVER APPLICATION-

Driver Qualification Application
Thank you for your interest in Great American Logistics Inc. 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. Must list all your previous employers in past 10 years. If you encounter any errors during this process and cannot continue, please contact us at 312-885-5253.
Applicant Name*

First NameMiddle NameLast Name
Present Street Address*
City*
State*
Zip*
Years Living There?*
If your current address is less than 3 years, list other address in past three years if not skip to next:
Previous Address - Street: City
State
Zip
How long?
2 Previous Address - Street: City
State
Zip
How long?
3 Address - Street: City
State
Zip
How long?
Social Security Number*
Date of birth*

MonthDayYear
Date
Driver's License Number*
State Issued*
Date Issued*

MonthDayYear
Date
Expiration Date*

MonthDayYear
Date
Contact Cell Phone #*
Email*
example@example.com
Position you're applying for:*
If you have your Business and EIN number, enter it here
Bussiness Name ( Corp, LLC, Sole Proprietor)

Business NameBusiness AddressEIN NUMBER
Are you authorized to work in the United States:*

YesNo
Have you ever applied to be qualified as a driver by Great American Logistics?*

YesNo
How did you heard about us?*
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?*

YesNo
Has your motor vehicle operator's license, permit, or privilege been suspended or revoked?*

YesNo
Have you ever been disqualified from driving a motor vehicle under the DOT regulations?*

YesNo
Have you ever been convicted for driving under the influence of alcohol or drugs?*

YesNo
Have you ever been convicted of a crime involving or related to drugs or alcohol?*

YesNo
Have you ever been convicted of a serious traffic violation, as in careless/reckless driving etc.?*

YesNo
Have you ever been convicted of any other felony or misdemeanor?*

YesNo
Have you, within the five years preceding the date of this application: 1. Undergone an alcohol test in which a concentration of 0.02 or greater has been indicated?*

YesNo
2. Undergone a controlled substance test in which a positive result has been verified?*

YesNo
3. Refused to undergo either an alcohol or controlled substance test?*

YesNo
EMPLOYMENT RECORD FOR LAST 10 YEARS
Begin with your present or most recent job and work, backwards in order, listing your employer for at least ten years, including all full and part- time employment. All time must be accounted for, including military services, self-employment, and periods of unemployment. Use supplementary sheet if necessary. Begin With Most Recent or Current Employer
1 COMPANY NAME*
From*

MonthDayYear
Date
To*

MonthDayYear
Date
Address*

Address

Street Address Line 2

CityState

Zip
Phone Number*
Please enter a valid phone number.
Position( Company driver, Owner Operator etc.)*
Equipment type: (Dryvan, Flatbed, Reefer etc.)*
Regions in which you drove*
Number of Accidents/Incidents*
Reason for Leaving this Company*
Were you subject to the FMCSR's while employed by this company?*

YesNo
Were you subject to the FMCSR's drug and alcohol testing criteria while employed by this company?*

YesNo
2 COMPANY NAME
From

MonthDayYear
Date
To

MonthDayYear
Date
Address

Address

Street Address Line 2

CityState

Zip
Phone Number
Please enter a valid phone number.
Position (Company driver, Owner Operator etc.)
Equipment type (Dryvan, Flatbed etc.)
Regions in which you drove
Number of Accidents/Incidents
Reason for Leaving this Company
Were you subject to the FMCSR's while employed by this company?

YesNo
Were you subject to the FMCSR's drug and alcohol testing criteria while employed by this company?

YesNo
3 COMPANY NAME
From

MonthDayYear
Date
To

MonthDayYear
Date
Address

Address

Street Address Line 2

CityState

Zip
Phone Number
Please enter a valid phone number.
Equipment type:
Number of Accidents/Incidents
Reason for Leaving this Company
Were you subject to the FMCSR's while employed by this company?

YesNo
Were you subject to the FMCSR's drug and alcohol testing criteria while employed by this company?

YesNo
4 COMPANY NAME
From

MonthDayYear
Date
To

MonthDayYear
Date
Address

Address

Street Address Line 2

CityState

Zip
Phone Number
Please enter a valid phone number.
Equipment type:
Number of Accidents/Violations
Reason for Leaving this Company
Were you subject to the FMCSR's while employed by this company?

YesNo
Were you subject to the FMCSR's drug and alcohol testing criteria while employed by this company?

YesNo
Education/Training

List Driver Training courses or driving schools attended:
1. Driving school/course name:
City & State
Date

MonthDayYear
Date
DRIVER'S LICENSE - LIST ALL DRIVER LICENSES YOU HAD IN ALL STATES
CURRENT CDL NUMBER
State Issued:
Endorsements(Tanker, Hazmat, Double-Tripple)
If none, write NONE
Expiration Date

MonthDayYear
Date
2. DRIVER LICENSE NUMBER
State Issued:
Class:
Expiration date:
TRAFFIC CONVICTIONS AND FORFEITURES - LIST FOR PAST TEN YEARS

Includes On-Duty and Off-Duty and while in personal vehicle, other than parking violation. If none, write NONE.
Include Date, Location and Charge*
ACCIDENT RECORD - LIST FOR THE PAST TEN YEARS

List any involvement with truck or car, including property damage, preventable and non-preventable. If none, write NONE.
Include Date, City, State, Description*
PHYSICAL CONDITION
Are you physically capable of performing all the duties of a Commercial Truck Driver?*

YesNo
Are you able to lift, squat, bend, climb, turn and/or walk in the course of performing the duties of a Commertional Driver which may or may not include the loading and unloading of cargo and the operation of over the road tractors and semi-trailers?*

YesNo
Would you say you are capable of lifting 60 lbs onto the back of a trailer? If accommodations are required, please explain*

YesNoOther
APPLICANT'S STATEMENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND,AND AGREE TO THE PROCEDING STATEMENT
I hereby acknowledge that prior to submitting this application, I have been informed that the information provided herein may be used, and that my references and prior employers may be contacted, for the purpose of investigation my background.

I hereby authorize Great American Logistics inc. to investigate all statements in this application and to secure any necessary information from any of my references, prior employers, or other sources identified herein.

I hereby release Great American Logistics inc. and any of my references, prior employers, or other sources identified herein from any and all liability arising from their giving or receiving information about me or my driving record or employment history. I hereby authorize any law enforcement agency or court of record to furnish Great American Logistics inc. information concerning my motor vehicle records, or any felony or misdemeanors of which I have been convicted.

I understand that any false or misleading statements in this application will be sufficient cause for rejection of my application if Great American Logistics inc. has not already qualified me and for immediate disqualification if it has.

If this application is for qualification as a Company Driver, I agree Great American Logistics inc. is not obligated to employ me. I further agree that, if I am employed as a Company Driver, I have the right to terminate my employment at any time for any reason and that Great American Logistics inc. has the same right. Any false, misleading or incomplete statement of the information requested in this application will be sufficient ground for termination.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

I agree to furnish such additional information and complete such examinations as may be required to complete my Employment file.

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.
SIGNATURE OF APPLICANT:
Signature*

Clear
DATE*

MonthDayYear
Date
AUTHORIZATION FOR RELEASE FOR EMPLOYMENT PURPOSES

Part I-Consumer Reports and Investigative Consumer Report Disclosure
In connection with your employment or application for employment (including contract for services), and in accordance with applicable laws, USIS may obtain or assemble consumer reports and/or investigate consumer reports. These reports may include the following type of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, academic history, professional credentials, and drugs/alcohol use. Such reports may contain public record information concerning your driving record, workers’ compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from concerning previous driving record requests made by others from such state agencies, educational intuitions, USIS clients, personal references, personal interviews and other information suppliers and state provided driving records. You have the right to make a request to USIS,

Upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including, but not limited to: (1) the sources of information and the recipients of any reports on you that USIS to other parties (2) identification of any suppliers utilized by USIS in compiling such Reports, and (3) identification of any recipients of reports that has previously furnished within the (3) -year period preceding your request. USIS may be contacted by mail at P. O. Box 33181, Tulsa, OK, 74153 or by phone at (800)381-0645
Part I - Authorization for Release of information

USIS is authorized to disclose all information obtained to the requesting entity for the purpose of making a determination as to my eligibility for employment with Great American Logistics inc., I authorize that such information which USIS and Great American Logistics inc. to retain this document on file to act as an ongoing authorization for the procurement and possession of Reports at any time during my employment or contracted period. I fully release Great American Logistics inc. USIS and Suppliers from all claims of damages related to the investigation of my background and provisions of information as set forth in this disclosure and authorization.

By signing below, I certify that I have read and fully understand this release, that prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction, and that I executed this release voluntarily and with the knowledge that the information being released could affect my being hired, my employment, or my eligibility for promotion.
Signature*

Clear
Date*

MonthDayYear
Date
DISCLOSURE AND AUTHORIZATION FOR RELEASE FOR EMPLOYMENT PURPOSES Part II-Disclosure and Authorization Release of Dot Drug and Alcohol Testing -49 CRF Parts 391.23

In accordance with DOT Regulation 49 CFR Part 391.23, I hereby authorize release of my DOT-regulated drug and alcohol testing to Great American Logistics inc.. I understand that information/documents released pursuant to this Part II is limited to the following DOT-regulated testing items, including pre-employment testing results, occurring during the previous three (3) years: (1) alcohol tests with a result of 0.04 or higher; (2) verified positive drug tests; (3) refusals to be tested (including adulterated and/or substituted tests); (4) other violations of DOT drug and alcohol testing regulations (i.e., violations of 49 CFR 382 Subpart B); (5) information obtained from previous employers of a drug and alcohol rule violation; and (6) any documentation of completion of the return-to-duty process following a rule violation. If any company listed below furnishes Great American Logistics inc. with information concerning items (1) through (6) above, I also authorize such company to furnish the following information to Great American Logistics inc., if applicable: (1) dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 (3) the name and phone number of any substance abuse professional who evaluated me during the previous three (3) years. List All DOT-regulated employers you have applied with and/or worked for in a safety-sensitive function during the previous three (3) years
1 Previous DOT - Regulated Employer

Company Name

Phone Number/ E-mail

CityState

Zip Code
2 Previous DOT - Regulated Employer

Company Name

Phone Number/E-mail

CityState

Zip Code
3 Previous DOT - Regulated Employer

Company Name

Phone Number / E-mail

CityState

Zip Code
4 Previous DOT - Regulated Employer

Company Name

Phone Number / E-mail

CityState

Zip Code
By signing below, I certify that: (1) all information provided herein is complete and accurate; (2) I have read and fully understand this Part II disclosure and authorization for release: (3) I execute this authorization voluntarily and with the knowledge that the information obtained pursuant to this authorization could affect my eligibility for employment with Great American Logistics inc..; (4) photographic copies of this authorization are as valid as an original.

I hereby give authorization to my previous employer(s) to release to Great American Logistics inc., dates of employment, accident records, and copies of this alcohol and controlled substance test results and all related information compiled during my term of employment.
Name

First NameLast Name
Signature*

Clear
Date

MonthDayYear
Date
Motor Vehicles Driver’s

CERTIFICATION OF COMPLIANCE

WITH DRIVER LICENSE REQUIREMENTS

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:

1) POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motor vehicle operator’s license. If you have more than one license, keep the license from your state of residence and return the additional licenses to the states that issued them. DESTROYING a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, close your record

by notifying the state of issuance that you no longer want to be licensed by that state.

2) NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION:

Sections 391.15(b)(2) 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 violate 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 license). The notification to both the employer and state must be in writing.

DRIVER CERTIFICATION: I certify that I have read and understood the above requirements.
The following license is the only one I will possess:
Driver's License No.*
Expiration Date*

MonthDayYear
Date
State*
Driver's Name (Printed)*
Driver's Signature*

Clear
Today's Date

MonthDayYear
Date
Motor Vehicle Driver's Certification of Violations

DRIVERREQUIREMENTS: Each driver shall furnish the list as required by the motor carrierabove. If the driver has not beenconvicted of, or forfeited bond or collateral on account of any violation whichmust be listed, he shall so certify. (Section 391.27) I certify that the following is atrue an complete list of traffic violations (other than parking violations) forwhich I have been convicted orforfeited bond or collateral during the past 12 months. MUST WRITE NONE, IF NONE TO REPORT
List: Date - Offence- Location - Type of Vehicle (Commercial or personal)
CDL No.
State CDL Issued:
Expiration Date

MonthDayYear
Date
Today's Date

MonthDayYear
Date
Signature*

Clear
THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Great American Logistics inc.(“Prospective Employer”). ProspectiveEmployer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection historyfrom 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 FMCSAin a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provideyou with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit ReportingAct before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safetyreport, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on thisreport.When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employeruses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regardingyou, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronicnotification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, andthe toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provideyou the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copyof the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of adriver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, togetherwith proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rightsunder the Fair Credit Reporting Act.Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correctany safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request tohttps://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct thisdata. 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, orimply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crasheswere reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. Statecitations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of lawwill 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 Great American Logistics inc. (“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. Iunderstand that I am authorizing the release of safety performance information including crash data from the previous five (5) yearsand inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist theProspective 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 hasthe capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data bysubmitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannotchange 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 crasheswere reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on myPSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, andremain, on my PSP report.I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if Isign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I herebyauthorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
Prospective Employee Printed Name*
Prospective Employee Signature*

Clear
Date*

MonthDayYear
Date
Previous Pre-employment Employee Alcohol and Drug Test Statement

Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, 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 testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process (see paragraphs (b)(5) and (e) of this section).
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? Check one:*

YESNO
2. If you answered yes, can you provide/obtain proof that you’ve successfully completed the DOT return to duty requirements (SAP Program)? Check one:*

YESNONO SAP
I certify that the information provided on this document is true and correct.
Signature*

Clear
Date*

MonthDayYear
Date
FORMER EMPLOYER VERIFICATION

I hereby authorize to release the following requested information to for the purpose of investigation for qualifying me to drive a commercial motor vehicle as required by the U.S. Department of Transportation & Federal Motor Carrier Safety Regulations Parts 382, 391, 392 & 49 CFR Part 40. You are hereby released from any and all liability that may result from furnishing such information. Your quick response to the request will be greatly appreciated.
Signature*

Clear
Date*

MonthDayYear
Date
Great American Logistics inc. 13748 Sandra Ln. Crestwood, IL 60418
Fair Credit Reporting Act Disclosure Statement

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.
Aplicant's Signature*

Clear
Date*

MonthDayYear
Date
Print Name*
Social Security Number*
EMERGENCY CONTACT NAME*

First NameLast Name
EMERGENCY CONTACT RELATIONSHIP:*
Emergency Cointact Phone Number*
Please enter a valid phone number.
UPLOAD PICTURE FROM YOUR CDL*

FRONT AND BACK PLEASE
Cancelof
UPLOAD PICTURE FROM YOUR DOT MEDICAL CERTIFICATE*

Cancelof
Should be Empty:

EMPLOYMENT RECORD FOR LAST 10 YEARS

Education/Training

DRIVER'S LICENSE - LIST ALL DRIVER LICENSES YOU HAD IN ALL STATES

TRAFFIC CONVICTIONS AND FORFEITURES - LIST FOR PAST TEN YEARS

ACCIDENT RECORD - LIST FOR THE PAST TEN YEARS

PHYSICAL CONDITION

APPLICANT'S STATEMENT

I HEREBY ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND,AND AGREE TO THE PROCEDING STATEMENT

SIGNATURE OF APPLICANT:

AUTHORIZATION FOR RELEASE FOR EMPLOYMENT PURPOSES

DISCLOSURE AND AUTHORIZATION FOR RELEASE FOR EMPLOYMENT PURPOSES Part II-Disclosure and Authorization Release of Dot Drug and Alcohol Testing -49 CRF Parts 391.23

Motor Vehicle Driver's Certification of Violations

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

Previous Pre-employment Employee Alcohol and Drug Test Statement