155 Enterprise Drive I Wentzville, MO 63385
Telephone: (636) 875-5057 I FAX: (314) 627-0622 I Toll Free: (888)868-2911
www. rapid responsestl .com

Company Driver
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, or non-job-related disability.

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All applicants to a drive Commercial Motor Vehicle in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code. Applicants to drive a Commercial Motor Vehicle in intrastate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent. Add additional sheets as necessary.)

†The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding

Disclosures (Please initial the right column on the line next to each disclosure)

Multiple Employers
I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.

Check of Driving Record
The Applicant is hereby informed that the MVR will be obtained for the purpose of
investigation as required by Sections 391.23 and 391.25 of the FMCSRs. The furnished is released from any and all liability, which may result from furnishing such information

Fair Credit Reporting Act Disclosure Statement
In accordance with the provisions of Section 604 (B)(2)(A) 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 FMCSRs

TO BE READ AND SIGNED BY THE APPLICANT
This certifies that I have completed this application, and that all entries on it and information in it are trueand complete to the best of my knowledge.

 I authorize you to make such investigation and inquire of my personal, employment, medical history, and/ or motor vehicle reports containing driving 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.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquire 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.

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 transport 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 possess more than one motor vehicle operator's license.
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 revocations, suspensions, cancellation, or disqualification of your driver's license or driving privilege. In addition, Section 383.31 requires that any time you are convicted of violating a state or local traffic law (other than Parking), you must report it within 30 days to your_ employing motor carrier. The notification must 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, when you have your true, fixed, and permanent home and principal resident and to which you have 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 day

The following license is the only one I possess:

DRIVER CERTIFICATION: I certify that I have read and understood the above requirements.

I. CERTIFICATION OF VIOLATIONS:
I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months.

(MOTOR CARRIER'S NAME):RAPID RESPONSE

(MOTOR CARRIER'S ADDRESS): 155 ENTERPRISE DR WENTZVILLE MO 63385

 

II. REVIEW AND EVALUATION OF DRIVER'S RECORD:

In accordance with Section 391.25, Federal Motor Carrier Safety Regulation, all information pertinent to the above driver's safety of operations, including the list of violations furnished by him in accordance with Section 391.27, has been reviewed for the past 12 months. 

(MOTOR CARRIER'S NAME):RAPID RESPONSE

(MOTOR CARRIER'S ADDRESS): 155 ENTERPRISE DR WENTZVILLE MO 63385

 

INSTRUCTION: Motor carriers when using a driver for the first time shall obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395.80)(2) Federal Motor Carrier Safety Regulations. NOTE: Hours for any compensated work during the preceding 7 days, including work for a non-motor carrier entity, must be recorded on this form.

I hereby certify that the infonnation given above is correct to the best of my knowledge and belief, and that I was last relieved from work at

I hereby certify that the infonnation given above is correct to the best of my knowledge and belief, and that I was last relieved from work at

DRIVER CERTIFICATION FOR OTHER COMPENSATED WORK

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, also performing any compensated work for any nonmotor carrier entity.

l hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.

*THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE JS 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 RAPID RESPONSE, INC. ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from 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 FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the
Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse
action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State foradjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver
and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will 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 RAPID RESPONSE, 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. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective 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 has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change 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 crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization,
Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Deparlment of Transporlation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any otherlanguage.

Disclosure

RAPID RESPONSE, INC. {the "Company") may request from a consumer reporting agency and for employment-related purposes, a "consumer report(s)" (commonly known as "background reports") containing background information about you in connection with your employment or application for employment (including independent contractor or volunteer assignments, as applicable).

The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited
to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.

Authorization

I hereby authorize Company to obtain the consumer reports described above about me.

General Consent for Queries of The Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

These receipts are to be read and signed by both the applicant and Carrier Representative. This form must be sent to Driver Qualifications and placed in the appropriate Safety file.

I hereby acknowledge receipt of the following:
Drug Abuse & Alcohol Misuse Driver Information Policy

I have read the Drug Abuse & Alcohol Misuse Driver Information Policy of Rapid Response, Inc. and understand the negative effects and serious consequences of drug and alcohol abuse on my personal health and safety. I understand the safety regulations and procedures regarding the testing of drugs and alcohol and agree to abide by these procedures.

Safety Policies & Guideline

I have read the Safety Policies including: the Accident Reporting Policy, Safety Tips, Jackknife Avoidance Policy, Roadside Inspections, and Safety Practices. As a company and/or Independent Contractor, I understand my responsibilities for compliance with the Rapid Response, Inc. Safety Policies and Guidelines and agree to abide to these policies. Log Compliance Information I have read and understand the Hours of Service and Log Compliance procedures set forth by the Department of Transportation and Rapid Response, Inc. I agree to abide by them as long as
I am a qualified Company and/or Independent Contractor with Rapid Response, Inc. I further understand that if I do not comply with these rules, I will be assessed training points and may be required to attend retraining or my qualification with Rapid Response, Inc. could be terminated.

Sec. 40.250) As the employer, you must also ask the employee whether he of 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, 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)(S) and (e) )

The prospective employee is required by SEC. 40.25(j) to respond to the following questions.

I certify that the information provided on the document is true and correct.

Company/Department :Rapid Response, Inc.

11. Information on:
The effects of alcohol and controlled substances use on an individual's health, work or personal life Signs and symptoms of a problem

Available methods of intervening when a problem is suspected (confrontation, referral, etc.)