Atlantic Logistics Management

6350 Lake Oconee Pkwy, Suite 102 #22

Greensboro, GA 30642

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 BE READ AND SIGNED BY APPLICANT

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:

·     Review information provided by previous employers;

·     Have errors in the information 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.

INSTRUCTIONS:

When employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2 paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations includes time performing any other work in the capacity of, or in the employ or service of, a common, contract or private motor carrier, and performing any compensated work for any non-motor carrier entity.

MOTOR CARRIER INSTRUCTIONS:

The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing or rated at 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing or rated at 10,001 pounds or more, can transport more than 15 people(or more than 8 people when there is direct compensation), or transports hazardous materials that require placarding. DRIVER REQUIREMENTS:Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain certain driver licensing requirements that you as a driver must comply with, including the following:

1) POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possessmore than one motor vehicle operator’s license.

2) NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION:Sections 391.15(b) and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation, suspension, cancellation,or disqualification of your driver’s license or driving privilege. In addition, Section 383.31requires that any time you are convicted of violating a state or local traffic law (other thanparking), you must report it within 30 days to your employing motor carrier. The notificationmust be in writing.

3) CDL DOMICILE REQUIREMENT: Section 383.23(a)(2) requires that your commercial driver’s license be issued by your legal state of domicile, where you have your true, fixed, and permanent home and principal residence and to which you have the intention of returning whenever you are absent. If you establish a new domicile in another state, you must apply to transfer your CDL within 30 days.

MOTOR CARRIER INSTRUCTIONS:

Each motor carrier shall at least once every 12 months, require each driver it employs to prepare and furnish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted, or on account of which he/she has forfeited bond or collateral during the preceding 12 months (Section 391.27). Drivers who have provided information required by Section 383.31 need not repeat that information on this form.

DRIVER REQUIREMENTS:

Each driver shall furnish the list as required by the motor carrier above. If the driver has not been convicted of, or forfeited bond or collateral on account of any violation which must be listed, he/she shall so certify (Section 391.27).

INSTRUCTIONS:

Motor carriers, when using a driver for the first time, must obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and the time at which the driver was last relieved from duty prior to beginning work for the carrier, as required by section 395.8(j)(2) of the Federal Motor Carrier Safety Regulations. NOTE: Hours for any work during the preceding 7 days, including any compensated work for a non-motor carrier, must be recorded on this form.

This form should be completed on the day the driver is scheduled to being driving a commercial motor vehicle and must be kept on file for at least 6 months.

DISCLOSURE REGARDING BACKGROUND INVESTIGATION 

I acknowledge receipt of document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FIAR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of *consumer reports* and/or *investigative consumer reports* by the Employer at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administration, state, or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to release any and all background information requested by Atlantic Logistics Management, 6350 Lake Oconee Pkwy, Suite 102, #22 Greensboro, GA 30642. I agree that a facsimile (*fax*), electronic or photographic copy of this Authorization shall be as valid as the original. New York applicants only: Upon request, you will be informed whether a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency, disclosed to you by employer, directly. By signing below, you acknowledge receipt of Article 23-A of the New Your Correction Law. Washington State applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. Minnesota and Oklahoma applicants only: Please write yes below if you would like a copy of a consumer report if one is obtained by the Company. ___________ California applicants only: Under California Civil Code section 1786.22, you are entitled to find out what is in the CRA’s file on you with proper identification, as follows: - In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a copy of the information in person. The CRA may not charge you more than the actual copying costs for providing you with a copy of your file. - A summary of all information contained in the CRA file on you that is required to be provided by the California Civil Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you. - By requesting a copy be sent to a specified addressee by certified mail, CRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the CRA. - *Proper Identification* Includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the CRA require additional information concerning your employment and personal or family history in order to verify your identity. The CRA will provide trained personnel to explain any information furnished to you and will provide written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who mush furnish reasonable identification. A CRA may require you to furnish a written statement granting permission to the CRA to discuss your file in such persons’ presence. Please answer yes in the area below if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law. _______________ DISCLOSURE REGARDING BACKGROUND INVESTIGATION TEST Atlantic Logistics Management (*the Company*) may obtain information about you from a third-party consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “Investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as you neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (*driving records*), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. A consumer report will be conducted by Atlantic Logistics Management, 6350 Lake Oconee Pkwy, Suite 102, #22 Greensboro, GA 30642. The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law.

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 Sec. 40.25(b)(5) and (e))

     MOTOR CARRIER INSTRUCTIONS:

For each Medical Examiner’s Certificate issued to a commercial motor vehicle driver, the motor carrier must verify that the medical examiner who signed the driver’s medical card is listed on the National Registry. This requirement is prescribed in §391.23 and §391.51.

     §391.23 Investigation and inquiries. (m)(1) The motor carrier must obtain an original or copy of the medical examiner’s certificate issued in accordance with §391.43, and any medical variance on which the certification is based, and, beginning on or after May 21 2014, verify the driver was certified by a medical examiner listed on the National Registry of Certified Medical Examiners as of the date of issuance of the medical examiner’s certificate, and place the records in the driver qualification file, before allowing the driver to operate a CMV.

     §391.51 General requirements for driver qualification files. (b)(9)(i) For drivers not required to have a CDL, a note relating to verification of medical examiner listing on the National Registry for Certified Medical Examiners required by §391.23(m)(1). (b)(9)(ii) Until June 22, 2018, for drivers required to have a CDL, a note relating to the verification of medical examiner listing on the National Registry for Certified Medical Examiners required by §391.23(m)(2).

RETENTION: This form is to be kept in the driver’s qualification file for 3 years.

     MOTOR CARRIER VERIFICATION:

The following medical examiner has been verified as being listed on the National Registry of Certified Medical Examiners (NRCME) as of the date of issuance of the medical examiner’s certificate for the named driver.

I hereby certify that all this medical history is correct and complete to the best of my knowledge. I willingly submit this information and understand that it will become part of my medical record. I hereby authorize Atlantic Logistics Management to obtain any medical documentation or information concerning my past, present, or future medical condition from any provider of such information. I hereby release all such persons from any liability or damages.

We want to extend our best wishes to you on your newemployment endeavor. Several items need to be addressed concerning your newemployment including your understanding about your employment, yourresponsibilities, and the payroll process. Each employee shall be considered as an “independentcontractor” engaged in providing service to Atlantic Logistics Management(hereafter known as ALM) and any client company that you are referred to foremployment purposes. As an independent contractor, each employee shall beresponsible for any cost involved or associated with the incident or accidentand/or any injury or injuries occurring during your contract employment period.Each driver shall operate their designated vehicle according to, and within theguidelines of the State and Federal Department of Transportation and theregulations under the Federal Motor Carrier Safety Regulations guidelines asdirected by US DOT. Each contract employee is required to have and wear ‘steeltoe’ boots or shoes at all times when working. Understand that for the purpose of contractemployment, any assignment(s) shall be considered as a ‘casual’ assignment anda one-time occurrence, whether they are daily, ‘temp to perm’ or long-termlease assignment(s). ALM does not dispatch. All dispatch and workassignments are given to you directly by the client. ALL contract employeesshall report to their assigned position at the client’s location and at thedesignated time as directed by the client. Failure to report on time or failureto report at all without advance notice could result in reduction of pay ortermination. We are paying top wages for your assignment and expect yourfullest attention and professionalism. The assigned client determines your payroll. Theycompute your time and turn it in to our payroll personnel. It is best that youturn in all necessary paperwork required by the client as soon as possible. Youare responsible for getting your time in to your immediate supervisor. Be sureyour logbooks (if required) are completed and returned as directed by theclient. Any delay in receiving your time could delay in the receipt of yourpay. Your client will submit your time worked for the previous week to us eachMonday. Please verify that your client has sent us your time. Any errors thatoccur could create payment delay. We will not pay on “verbal” authorization. You will be paid on a weekly basis. Our weeks areSunday morning, 12:00:01 AM through Saturday 12:00:00 AM (midnight). Rememberthat you will be paid the Friday following the previous work week. You will bepaid via direct deposit. We do not issue advances. Your paystub will be sent tothe email address on file. Please inform us of any address, phone number oremail address changes. If you leave your assignment or your assignmentcompletes, please call us so we can follow up on final pay issues. You will notbe issued a final paycheck until we have received clearance from the client.The client must inform us that you have returned all issued equipment (cellphone, fuel card, etc.) Again, be sure that you call after the end of yourassignment. If you are not happy with your current assignment, please call andspeak with us. We may be able to offer you a different assignment. Do not leavewithout informing your direct supervisor and ALM. Contract drivers are subject to periodic drugscreening, as well as initial and periodic MVR and Criminal Background checksper DOT requirements. If we find that you have not reported an accident,citation, or license suspension, you may be subject to immediate terminationand final pay may be forfeited. Drive safely and keep the MVRs clean. Best of Luck, have fun and be safe!Atlantic Logistics Management The signature below shall acknowledge that forpurposes of contract employees, I have received and understand theseinstructions and that I will follow and abide by them to the best of myability.