Please provide employment history for the proceeding preceding 10 years. (NOTE: List all employers in order starting with the most recent. Add another
Also, please explain any lapses in employment history.
ANNUAL CERTIFICATE OF VIOLATIONS AND REVIEW OF DRIVING RECORD
lf no violations are listed above, I certify that I have not been convicted or forfeíted bond or col!ateral on account of any víolation required to be listed during the past 12 months.
ANNUAL REVIEW OF DRIVING RECORD
In accordance with 49 Code of Federal Regulations Section 391.25, (Federal Motor Carríer Safety Regulations), al! information pertínent to the above driver's safety of operation, including the líst of violations furnished by him in accordance with 49 CFR Section 391.27, has been reviewed for the past 12 months.
I certify 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. I authorize BRAVO MOTOR CARRIERS INC. to make such investigations and inquiries of my personal, employment, financial, medical, criminal histories and other related matters. I have the full understanding that BRAVO MOTOR CARRIERS INC. reserves the right to arrive at a decision based on any information obtained from such inquiries and investigations. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. I understand that false or misleading information given in my application or interview(s) may result in termination of contract. I understand that I am required to abide by all of the policies and procedures of BRAVO MOTOR CARRIERS INC. and regulations set forth by the Federal Motor Carrier Safety Administration.
Sec. 40.25(j) As the company, you must ask the contractor whether her or she has tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the contractor 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 contractor admits that he or she had a positive test or refusal to test, you must not use the contractor to perform safety sensitive functions for you until and unless the contractor documents successful completion of the return-to duty process (see Sec. 40.25(b5) and (e).
BRAVO MOTOR CARRIERS INC.
9009 NORTH LOOP EAST STE 200 HOUSTON, TX 77029
The prospective driver is required by Sec. 40.25(j) to respond to the following questions:
I authorize you, BRAVO MOTOR CARRIERS INC. (CARRIER), to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) hereby release employers, schools, health care providers and other persons from all liability in- responding to inquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
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 49 CFR 391.23(d) and (e I understand that I have the right to:
In answering these questions, include any required DOT drug or alcohol testing information obtained from prior previous employers in the previous 3 years prior to the application date shown on page 1
Complete below when information is obtained:
Affidavit of Gap in Employment
By Signing below, I certify the facts on thís documentare true and complete to the best of my knowledge and understand that any misrepresentation or omission of facts on this application shall be grounds for dismissal.
Witness my hand and official seal here to affixed this blanks day of blank , 20 Type a label
General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA)
, hereby provide consent to Bravo Motor Carriers to conduct a
limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse ("Cleaiinghouse") to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand and agree that such consent will remain valid at all times while I continue to operate vehicles under either Company's motor carrier authority.
I understand that if the limited query conducted by Bravo Motor Carriers indicates that drugor alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Bravo Motor Carriers without first obtaining additional specific consent from me
I further understand that if I refuse to provide consent for Bravo Motor Carríers to conducta limited query of the Clearinghouse, the Company requesting consent must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.
1) DRUG AND ALCOHOL POLICY 2} DRIVER QUALIFICATION POLICY 3} DRIVER'S PROCESSING PROCEDURE 4) HOURS OF SERVICE- DRIVER'S RESPONSIBILITIES- LOG VIOLATIONS 5) DISCIPLINARY POLICY 6) VEHICLE AND ROADSIDE INSPECTIONS 7) MAINTENANCE POLICY 8) ACCIDENT AND INCIDENT PROCEDURES AND REPORT 9} SAFETY POLICY 10} SAFETY MEETINGS 11) THE PROFESSIONAL TRUCK DRIVER 12) NO RIDER POLICY 13} CELL PHONE USE/TEXTING
I, the undersigned, certify that I have read and understand BRAVO MOTOR CARRIERS Statement of Policies and Procedures outlined above.
I understand that my failure to honor the terms of this Agreement will be grounds for the termination of my leased services or the consideration of my application for leased services.