• DRIVER EMPLOYMENT APPLICATION

    FMCSA Standards FMCSA Driver Employment Application.49 CFR 391.21
  •  Driver Candidate

    You will be required to upload the following.

    1. CDL License Front and Back 

    2. Medical Card 

    3. Any other licenses and endorsements

     Click NEXT to start the driver application.

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    APPLICANT INFORMATION

     

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    PREVIOUS THREE YEARS RESIDENCY

     

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  • PAST THREE YEARS RESIDENCY
  • PREVIOUS ADDRESS IN THE LAST 3 YEARS IF DIFFERENT THAN THE PHYSICAL ADDRESS
  • DRIVER LICENSE INFORMATION

    No person who operates a commercial motor vehicle shall at any time have more than one driver’s license (49 CFR 383.21). I certify that I do not have more than one motor vehicle license, the information for which is listed below. Include all licenses held for the past three years; attach additional sheets if needed.

     

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  • LICENSE INFORMATION
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  • PREVIOUSLY HELD LICENSE

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    DRIVING EXPERIENCE

  • STRAIGHT TRUCK
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  • TRACTOR & SEMI-TRAILER
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  • TRACTOR & 2 TRAILER
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  • TRACTOR & TANKER
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  • OTHER
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    ACCIDENT RECORD FOR THE PAST 3 YEARS

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  • ACCIDENT RECORD FOR PAST 3 YEARS
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  • VIOLATIONS

    TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

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  • VIOLATIONS

    TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST THREE YEARS

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    EMPLOYMENT HISTORY

    The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained. Start with the last or current position, including any military experience, and work backward (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information. 

  •  CURRENT (MOST RECENT) EMPLOYER
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  •  SECOND (MOST RECENT) EMPLOYER
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  •  THIRD (MOST RECENT) EMPLOYER
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  •  EDUCATION
  • HIGH SCHOOL
  • COLLEGE
  • OTHER
  •  OTHER QUALIFICATIONS
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  • FOR EMPLOYMENT

    TO BE READ AND SIGNED BY APPLICANT

  • I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary for arriving at an employment decision. 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.

    In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company.
    I understand that the information I provide regarding my current and/or prior 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. I understand that I have the right to:

    • Review information provided by current/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.

    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. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

     

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    DRUG & ALCOHOL ABUSE TESTING POLICY

    49 CFR Part 382 & 49 CFR part 40
    Effective Oct 2023

    DOWNLOAD POLICY CLICK HERE 

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  •  ATTENTION CDL DRIVERS

    The Dot Drug & Alcohol Clearinghouse is live as of Jan. 6th, 2020 Access the Clearinghouse https://clearinghouse.fmcsa.dot.gov/Learn

    「✔」You will need to register on the Clearinghouse website.
    Registration will give you free access to your own Clearinghouse record and you will need to register if you switch emp/orders or haVe a DOT drug or a/coho/ vio/action.

    「✔」You will need to grant electronic consent whenever your employer is required to purchase a full Clearinghouse report on you.
    If you refuse to grant consent (382.703(c)) you are not allowed to continue to operate a commercial/ITIOtOF VE'hic/e (CMV) or perform other safety-sensitiVe duties.

    「✔」You will need to sign a separate consent form ( annually or one-time) to allow your employer to obtain a "limited" Query.
    If that/limited query indicates there is information on you in the Clearinghouse then a fu// report  is required. (382.701 (b)).


    WHAT WILL BE REPORTING TO THE CLEARINGHOUSE?

    • Any verified positive, adulterated, or substituted drug test.
    • Any confirmed alcohol test results of 0.04 or higher.
    • Any refusal to submit a DOT required test.
    • Successful completion of the SAP program / return-to-duty process.
    • Any Negative return to duty test*
    • Successful completion of the follow-up testing.
    • Any verified and documented "actual knowledge" that you violated the drug/alcohol rules
    • Any on-duty alcohol use, including any citation for DUI/DWI while driving a CMV.
    • Any alcohol use within 4 hours before going on duty.
    • Any alcohol use within 8 hours of an accident or before a post-accident test is complete.
    • Any prohibited use while on duty.

    I hereby acknowledge receiving educational information about the CDL Drug & Alcohol Clearinghouse as required under 382.601 (b) (12).

     

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  •  Consent For Full Pre Employment Queries Of The Federal Motor Carrier Safety Administration (FMCSA) Drug And Alcohol Clearinghouse

    NOTICE TO DRIVER:

    Consent Form for CDL Drivers - Full Pre-Employment Query Pull through Clearinghouse

     

    Purpose: The purpose of the full pre-employment query pull through the Clearinghouse is to obtain a comprehensive report of my drug and alcohol violation history, including any positive tests, refusals, or other violations, as required for the evaluation of my qualifications as a CDL driver.

    Information Collection: I understand that the full pre-employment query pull will involve accessing my records from the FMCSA Drug and Alcohol Clearinghouse. This will include information such as any past violations, return-to-duty processes, and the status of my CDL driving privileges related to drug and alcohol testing.
    Consent for Release of Information:


    Confidentiality: I understand that the information obtained through the full pre-employment query pull through the Clearinghouse will be treated as confidential and will only be used for employment-related purposes. Any unauthorized disclosure of this information is strictly prohibited.
    Compliance with Regulations: I acknowledge that the full pre-employment query pull will be conducted in compliance with all applicable DOT and FMCSA regulations, including the Privacy Act of 1974 and the regulations governing the FMCSA Drug and Alcohol Clearinghouse.

     


    NOTICE TO MOTOR CARRIER: This consent form authorizes you to run a "full pre employment query" to check whether the Clearinghouse.

  • I,   *   hereby authorize to conduct a full pre employment query pull of the FMCSA's Drug and Alcohol Clearinghouse, to determine if a Clearinghouse record exists for me.

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  • https://clearinghouse.fmcsa.dot.gov/Learn

  •  FCRA Summary of Rights and State Disclosures

     

     
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    Click HERE to download a copy of the FCRA Summary of Rights and State Disclosures.

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     FAIR CREDIT REPORTING ACT DISCLOSURE

     

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    Disclosure Regarding Background Investigation

     

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  • BrightStar Care - Cuyahoga West, the "Company," may obtain information about you from a third party consumer reporting agency for to work purposes. Thus, you may be the subject of a "consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living. 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 (including income), or other background checks.

    You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by Verified First, Phone: 888-670-9564, Fax: 208-266-2310, Mailing Address:, 1120 S Rackham Way, Suite 300, Meridian, ID 83642. To the extent permitted by law, the Company may obtain consumer reports from any outside organization throughout the course of your to work.

    I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and certify that I have read and understand this document.

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    Acknowledgment and Authorization For Background Check

     

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  • I acknowledge receipt of the separate documents entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION, A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and the DISCLOSURE FOR INVESTIGATIVE CONSUMER REPORT and certify that I have read and understand those documents. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" by the Company 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, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Verified First, Phone: 844-709-2708 / 844- 709-2708, Fax: 208-848-3204, 1120 S Rackham Way, Suite 300, Meridian, ID 83642, https://www.verifiedfirst.com and/or Company itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.

    I understand that by checking the "I AGREE" box, typing my name and the last four digits of my Social Security Number or User ID, and clicking on the "SIGN ACKNOWLEDGMENT" button below, constitutes my electronic signature, dated as of when I click on the "SIGN ACKNOWLEDGMENT" button, and that by doing so:

    I am authorizing Verified First to conduct the background check(s) described above
    I am consenting to use electronic means to sign this form and have read and understand the above disclosure
    I acknowledge I may request a hard copy of this Disclosure and Authorization form after agreeing to the background check electronically by calling Verified First at Phone: 844-709-2708 / 844-709-2708, Fax: 208-848-3204

     

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  • UPLOAD REQUIRED DOCUMENTS

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    Thank you for completing your FMCSA Pre-Employment Application 

     

    A copy of your application will be available after you submit. 

     

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