1. Fletcher’s Towing Inc - Driver Prelim App

Disclosures and Authorization

Fletcher's Towing Inc. - Prelim App
Name*

First NameLast Name
The purpose of this application is to determine whether or not the applicant is qualified to operate Motor Carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and Fletcher's Towing Inc. 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.
General Consent for Background Investigation

I authorize Fletcher's Towing Inc. to make such investigations and inquiries of my personal, employment, financial or medical history, and other related matters as may be necessary for 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.) I hereby release employers, schools, healthcare 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: Review information provided by previous employers; Have errors in the information corrected by previous employers and for those previous employers to resend 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.
Drug-Free Workplace - Pre-employment Agreement

I freely and voluntarily agree to submit to a urinalysis (drug screen) as part of my employment application. I understand that either refusal to submit to the urinalysis screen or failure to qualify according to the minimum standards established by the company for this screen may disqualify me from further consideration for employment. Fletcher’s Towing, Inc. is in agreement with the Federal Government that marijuana is an illegal controlled substance and will not recognize medical marijuana as a legitimate prescription. A positive test result for marijuana will be treated the same as any other positive test result, even if an applicant or an employee has a medical marijuana prescription. A negative pre-employment drug test result is a condition of employment with this company. Therefore, an applicant will be denied employment with this company if they test positive for marijuana even if they have a medical marijuana prescription that contains THC. I further understand that upon commencement of employment with the company I may again be required to submit to a urinalysis screen. I understand that refusal to take a requested urinalysis screen or failure to meet the minimum standards set for the screen may result in immediate suspension or discharge and loss of workers' compensation medical and indemnity benefits. I have read in full and understand the above statements and conditions of employment.
Date*

MonthDayYear
Date
Signature*

Clear

Fletcher's Towing Inc - Pensacola, FL

Pre-Qualification Employment Questionnaire
Position you are applying for:
Today's Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How many years at the address provided? (Years / Months)*
Cell Phone:*
Please enter a valid phone number.
Email:
example@example.com
Date of birth:*

MonthDayYear
Date
Drivers License State of Issue*
Drivers License #*
DL Photo (front and back)
DL Photo Upload (if using a computer)

Cancelof
Class of DL (Class A CDL, E, etc.)
CDL Holders Only - Endorsements / Restrictions
Have you EVER been arrested or convicted of a Felony?*
If convicted, what where you convicted for?

Driving Experience

Fletcher's Towing Inc - Prelim App
Have you EVER failed or refused a drug test, including a pre-employment test?*
Have you EVER been arrested or convicted of a DUI?*
Have you EVER refused a breath alcohol test?*
Has your license EVER suspended, withdrawn or revoked?*
Were you EVER involved ANY rear-end accidents or roll-overs?*
In the past 3 years were you involved in ANY crashes, incidents, or Roadside inspections w/ violations? Any careless or reckless driving?*
Do you have ANY Points on your driving record?*
If you have point, how many?
Are you currently employed? *
If no, provide the date of when you last worked.
Name of current or last employer:*
Address of current or last employer:

Street Address

Street Address Line 2

CityState

Zip Code
Position held at current or last employer:*
Dates of Employment at current or last employer: (mo/yr - mo/yr)*
Contact name and phone number at current or last employer:*
Reason for leaving current or last employer:*

Additional Employers

Fletcher's Towing Inc. - Prelim App
Name of employer:
Position held:
Dates of Employment: (mo/yr - mo/yr)
Contact name and phone number:
Reason for leaving:
Additional Employers

Fletcher's Towing Inc. - Prelim App
Name of employer:
Position held:
Dates of Employment: (mo/yr - mo/yr)
Contact name and phone number:
Reason for leaving:

CDL Holders Only

Fletcher's Towing Inc. - Prelim App
**DO NOT FILL THIS OUT UNLESS YOU HOLD A CDL**

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration

(FMCSA) Drug and Alcohol Clearinghouse

The Clearinghouse Rule:

The Clearinghouse rule requires FMCSA-regulated employers, medical review officers (MROs), substance abuse professionals (SAPs), consortia/third-party administrators (C/TPAs), and other service agents to report to the Clearinghouse information related to violations of the drug and alcohol regulations in 49 Code of Federal Regulations, Parts 40 and 382 by current and prospective employees.

• Employers are required to query the Clearinghouse for current and prospective employees' drug and alcohol violations before permitting those employees to operate a CMV on public roads.

• Employers are required to annually query the Clearinghouse for each driver they currently employ.

I hereby provide consent to Fletcher's Towing Inc (the company), to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. This consent is for the duration of my employment and will remain in effect unless I am no longer employed. This consent will be used for an unlimited number of queries at the employer’s request. I understand that if the limited query conducted by the company indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to the company without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for the company to conduct a limited query of the Clearinghouse, the company MUST prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
Name

First NameMiddle NameLast Name
Signature

Clear
Date

MonthDayYear
Date
Social Security Number

Please submit the form above. On the next page, please follow the link to submit our MVR Authorization specific to the insurance company for approval. Thank you
Should be Empty:

Disclosures and Authorization

Fletcher's Towing Inc - Pensacola, FL

Driving Experience

Additional Employers

Additional Employers

CDL Holders Only