MOTOR VEHICLE DRIVER APPLICATION FOR EMPLOYMENT

Dreamliner Transportation Services Inc. 533 Hickory Hills Blvd. Whites Creek, TN 37189

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, gender, national origin, age, marital status, union affiliation, sexual orientation, the presence of a non-job-related medical condition or handicap, or any other category protected by law.

ADDRESSES FOR THE PAST THREE YEARS (Prior to date of application) State City

2. Have you worked here before?

YESIf not, how long since leaving last employment? NO

6. Are you legally qualified to work in this country?

 

7. Have you ever been convicted of a felony?

If yes, please attach explanation statement

 

DRIVING LICENSES FOR PAST (3) YEARS PRIOR TO APPLICATION DATE: (complete for each license/permit) Type or Class of License Expiration Date

DRIVING EXPERIENCE IN THE OPERATION OF MOTOR VEHICLES

Equipment Type (please specify)

Approximate Number of Miles Driven (Total)

ACCIDENT RECORD FOR THE PAST (3) YEARS PRIOR TO APPLICATION DATE: (use extra sheet if more space needed) Comments Injuries/Fatalities Nature of Accident

(passenger vehicle, head-on, rear end, etc

TRAFFIC CONVICTIONS & FORFIETURES IN THE PAST (3) YEARS PRIOR TO APPLICATION DATE: (other than parking)

Have you ever been denied a license, permit, or privilege to operate a motor vehicle? Have you ever had any license, permit, or privilege to operate ever suspended or revoked?

All driver applicants to drive interstate commerce must provide the following information on all work references during the preceding three (3) years from the date the application is submitted. Those drivers applying to operate a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional seven (7) years information preceding the three (3) years.

NOTE: Please list companies in reverse order starting with the most recent, add additional sheets if needed.

Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? Was this job designated as a safety sensitive function in any D.O.T. regulated mode subject to alcohol and controlled substance testing requirements as required by 49 CFR Part 40?

Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?

Was this job designated as a safety sensitive function in any D.O.T. regulated mode subject to alcohol and controlled substance testing requirements as required by 49 CFR Part 40? Lay OffOther (please describe) Resignation

Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? Was this job designated as a safety sensitive function in any D.O.T. regulated mode subject to alcohol and controlled substance testing requirements as required by 49 CFR Part 40? Resignation Other (please describe) Lay Off

Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? Was this job designated as a safety sensitive function in any D.O.T. regulated mode subject to alcohol and controlled substance testing requirements as required by 49 CFR Part 40?

NOWere you subject to the Federal Motor Carrier Safety Regulations while employed by this employer?

Was this job designated as a safety sensitive function in any D.O.T. regulated mode subject to alcohol and controlled substance testing requirements as required by 49 CFR Part 40?

Were you subject to the Federal Motor Carrier Safety Regulations while employed by this employer? Was this job designated as a safety sensitive function in any D.O.T. regulated mode subject to alcohol and controlled substance testing requirements as required by 49 CFR Part 40? Resignation Other (please describe) Lay Off

I hereby authorize you to release the following information to Dreamliner Transportation Services Inc, for the purposes of investigation as required by 391.23 and 40.321(b) of the Federal Motor Carrier Safety Regulations. You are hereby released from any and all liability which may result from furnishing such information.

has submitted an application to this company for the position of

Dreamliner Transportation Services Inc. 533 Hickory Hills Blvd. Whites Creek, TN 37189

1. Are the dates of employment correct as stated above?

2. Did the applicant drive commercial motor vehicles for your company? 3. Was the applicant a safe and efficient driver? 4. Was the applicant involved in any vehicle accidents while employed with your company?

5. Reason for leaving your employment: 6. Has the applicant tested positive for a controlled substance in the last two (2) years? 7. Has the applicant had an alcohol test with a B.A.C. of 0.04 or greater in the last two (2) years? 8. Has the applicant refused a required test for drugs or alcohol in the last two (2) years?

9.Did the applicant complete a substance abuse rehabilitation program, if required?

If yes, please provide documentation of the employee's successful completion of DOT return to duty requirements. 10. Has this person ever violated any other DOT agency drug and alcohol testing regulations?

NOTIFICATION OF DRIVER APPLICANT'S RIGHTS

According to 391.21(d) and 391.23(I) the prospective employer must expressly notify drivers with Department of Transportation regulated employment during the preceding three years that he or she has the following rights regarding the investigative information that will be provided to the prospective employer.

The right to review information provided by previous employers; The right to have errors in the information corrected by the previous employer and for that previous employer to re-send information to the prospective employer; The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer- provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business days deadline will begin when the prospective employer received the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records. For the requirements of drivers and employers regarding these request, see 391.23(j

The following question is made necessary for employment with Dreamliner Transportation Services Inc. by the Federal Motor Carrier Regulations, Section

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two (2) years?

If yes, please provide the name of the Substance Abuse Professional (SAP) that evaluated you below, along with the name of the agency that performed your return to duty test.

If you answered yes to the above question please request Consent for Release of Information regarding Previous Pre-Employment Controlled Substances or Alcohol Testing form.

CONTROLLED SUBSTANCES & ALCOHOL TESTING CONSENT FORM

By my signature I knowledge that I have read, understand, and agree to comply with the drug and alcohol testing program of Dreamliner Transportation Services, as well as the U.S. Department of Transportation Regulations as contained in 49 CFR Part 382.

I also understand that it is a condition of being considered for employment, and continued employment by the company that I agree to abide by the company policy. By my signature I consent to urine and/or breathe/saliva testing for controlled substances and/or alcohol prior to and at any time during my employment when requested by my employer on a random or event triggered basis. I hereby specifically authorize the company to have all and immediate access to any and all of my urine and/or breath custody and control forms and the results thereof.

I understand and agree that I may not be under any degree of influence of alcohol or controlled substance at any time during my employment. Shouldany level of alcohol or controlled substance be detected in any of my breath, saliva, or urine at any time while employed, the company shall have grounds for immediate termination of my employment. This authorization specifically covers any random or event triggered resting as may be required by U.S. Department of Regulations or company policy.

CONTROLLED SUBSTANCES & ALCOHOL TESTING POLICY RECEIPT

have received a copy of the Controlled Substance and Alcohol I, (Applicant) Testing Policy for Dreamliner Transportation Services Inc. By my signature, I acknowledge that I have read, understand, and consent to this Policy.

I request Dreamliner Transportation Services Inc., to order a copy of my motor vehicle report from the state or through the insurance company. I understand this record will be a part of my personnel file and will be available to insuring companies for review. I further understand that this information will be considered for employment purposes and that a copy of the report

will be made available to me upon written request.

Motor carriers using a driver for the first time shall obtain from the driver a signed statement giving the total on-duty during the immediately preceding 7 days and time at which such driver was last relived from duty prior to beginning work for this carrier (Rule 395(j2) of the Federal Motor Carrier Safety Regulations NOTE: Hours for any compensated work during the preceding 7 days, including work for non-motor carrier entity, must be recorded on this form.

I hereby certify that the information given is correct to the best of my knowledge and belief, and that 1 was last relieved from work at:

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 395.2 paragraphs 8 and 9 of the Federal Motor Carrier Safety Regulations includes time performing and other work in the capacity of, or in the employment or service of, a common contract or private motor carrier, also performing and compensated work for any non-motor carrier entity.

Are you currently working for another employer? At this time, do you intend to work for another employer while still employed by this company?

I hereby certify that the information given above is accurate 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.

CERTIFICATE OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS MOTOR CARRIER REQUIREMENTS

The requirements of Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle with a GVWR of 26,001 lbs. or more, can transport (16) or more people, or transports hazardous materials that require placarding. The requirements of Part 391 apply to every driver who operates in interstate commerce and operates a vehicle with a GVWR of 10,001 lbs. or more, can transport (9) or more people, or transports hazardous materials that require placarding.

Parts383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:

1Must Posses Only One License:

You, as a commercial motor vehicle driver, may not posses more than one motor vehicle operator's license.

If you have more than one license, keep the license from your state of residence and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stole, or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed by the state.

2Notification of License Suspension, Revocation, or Cancellation:

Section 391.15(b2) and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the next business day of any revocation or suspension of your driver's license. In addition Section 383.31 requires that any time you violate a state or local traffic law (other than parking violation), you must report it within 30 days to: 1. Your employing motor carrier, and 2. The state that issued your license (if the violation occurs in a state other than the one which issued your license The notification to both the employer

The following license is the only one I will possess:

Ihereby certify that I have read and agree to the above stated requirements.

DRUG AND ALCOHOL CLEARINGHOUSE NOTICE TO REGISTER & CONSENT TO PRE-EMPLOYMENT QUERY ACKNOWLEDGEMENT

NOTICE TO DRIVER: The DOT Drug & Alcohol Clearinghouse is a federal database containing information about CDL drivers who have violated the Federal Motor Carrier Safety Administration's (FMCSA's) drug or alcohol regulations in 49 CFR Part 382. Whether you have committed such a violation or not, each motor carrier for whom you drive is required to check whether the Clearinghouse has any information about you, both before employment and annually.

hereby understand that Dreamliner Transportation Services Inc. is required to conduct a full detailed query of prospective driver's FMCSA's Drug & Alcohol Clearinghouse record, to ensure he or she is eligible to perform safety-sensitive

Dreamliner Transportation Services Inc. must ensure there is no violation on the prospective driver's record. If there is, the record must also show that the driver has successfully completed the evaluation,

referral, treatment, and return-to-duty testing process.

I agree to go to the DOT Drug & Alcohol Clearinghouse (www.clearinghouse.fmcsa.dot.gov) to register and grant electronic consent to Dreamliner Transportation Services within 24 hours of signing this acknowledgement form. Dreamliner Transportation Services will obtain my full Clearinghouse record. Refusal to provide such consent will result in my removalfrom consideration in the recruitment process.

DRUG AND ALCOHOL CLEARINGHOUSE

NOTICE TO DRIVER: The DOT Drug & Alcohol Clearinghouse is a federal database containing information about CDL drivers who have violated the Federal Motor Carrier Safety Administration's (FMCSA's) drug or alcohol regulations in 49 CFR Part 382. Whether you have committed such a violation or not, each motor carrier for whom you drive is required to check whether the Clearinghouse has any information about you, both before employment and annually. When conducting an annual inquiry, the motor carrier has the option to request a "limited" report that only indicates whether the Clearinghouse has any information about you; it does not release any violation or testing information. Before a motor carrier may request a limited report, they must have your written authorization, per $382.701(b This authorization may be valid for more than one year. If a limited query ever reveals that the Clearinghouse has information about you, you will be required to log in to the Clearinghouse website within 24 hours to grant electronic consent for the motor carrier to obtain a full Clearinghouse record.

NOTICE TO MOTOR CARRIER: This consent form authorizes you to run a "limited" query to check whether the Clearinghouse has information about the driver identified below. If it does, then you must obtain a "full" Clearinghouse record within 24 hours, per $382.701(b This consent form must be retained until 3 years after the date of the last limited query you perform for this driver, based on the authorization below.

hereby authorize Dreamliner Transportation Services , INC., to conduct limited annual reports of the FMCSA's Drug & Alcohol Clearinghouse, to determine if a Clearinghouse record exists for me. This consent is valid from the date shown below until my employment with the Dreamliner Transportation Services Inc. ceases or until I am no longer subject to the drug and

alcohol testing rules 49 CFR Part 382 for Dreamliner Transportation Services Inc.

I understand that if any limited query reveals that the Clearinghouse contains information about me, I must grant electronic consent within 24 hours, via the Clearinghouse website, for Dreamliner Transportation Services Inc. to obtain my full Clearinghouse record. Refusal to provide such consent will

result in my removal from safety-sensitive duties.

Employment Eligibility Verification

Department of Homeland Security U.S. Citizenship and Immigration Services

START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable for failing to comply with the requirements for completing this form. See below and the Instructions. ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal. Section 1. Employee Information and Attestation: Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer. Other Last Names Used (if any) Middle Initial (if any)

City or Town Apt. Number (if any)

I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.

Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions:

If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3.

Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employment, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions. List C List B List A

Check here if you used an alternative procedure authorized by DHS to examine documents.

Certification: I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-named employee, (2) the above-listed documentation appears to be genuine and to relate to the employee named, and (3) to the best of my knowledge, the employee is authorized to work in the United States.

For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4.

All documents containing an expiration date must be unexpired. * Documents extended by the issuing authority are considered unexpired. Employees may present one selection from List A or a combination of one selection from List B and one selection from List C. Examples of many of these documents appear in the Handbook for Employers (M-274

Documents that Establish Both Identity and Employment Authorization

ORDocuments that Establish Identity

1. U.S. Passport or U.S. Passport Card 2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551) 3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machine- readable immigrant visa 4. Employment Authorization Document that contains a photograph (Form I-766) 5. For an individual temporarily authorized to work for a specific employer because of his or her status or parole: a. Foreign passport; and b. Form I-94 or Form I-94A that has the following: (1) The same name as the passport; and (2) An endorsement of the individual's status or parole as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form. 6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI

1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 3. School ID card with a photograph 4. Voter's registration card 5. U.S. Military card or draft record 6. Military dependent's ID card

Documents that Establish Employment Authorization 1. A Social Security Account Number card, unless the card includes one of the following restrictions:

(1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION

2. Certification of report of birth issued by the Department of State (Forms DS-1350,

3. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal

7. U.S. Coast Guard Merchant Mariner Card 8. Native American tribal document

4. Native American tribal document

9. Driver's license issued by a Canadian government authority For persons under age 18 who are unable to present a document listed above: 10. School record or report card 11. Clinic, doctor, or hospital record 12. Day-care or nursery school record

5. U.S. Citizen ID Card (Form I-197) 6. Identification Card for Use of Resident Citizen in the United States (Form I-179) 7. Employment authorization document issued by the Department of Homeland Security For examples, see Section 7 and Section 13 of the M-274 on auscis.gov/i-9-central. The Form I-766, Employment Authorization Document, is a List A, Item Number 4. document, not a List C document.

Acceptable Receipts May be presented in lieu of a document listed above for a temporary period. For receipt validity dates, see the M-274.

Receipt for a replacement of a lost, stolen, or damaged List A document.

Form I-94 issued to a lawful permanent resident that contains an I-551 stamp and a photograph of the individual.

Form I-94 with "RE" notation or refugee stamp issued to a refugee.

*Refer to the Employment Authorization Extensions page on I-9 Central for more information.

Dreamliner Driver General Information

Social Security Number: Date of Birth: Birthplace (city, state):

Expiration Date: Country of Issue: Can you get into Canada?

APPLICATION CERTIFICATION STATEMENT

By signing this statement, I certify that this application has been completed by me, and all of the entries provided are true, complete, and accurate, to the best of my knowledge. By signing below I authorize this company or their assigned agent to make such inquires into my employment, financial, personal, or medical history as might be needed to make an employment decision. I understand that inquires into my medical history are generally made after a job offer has been made.

I hereby release my former employers, healthcare providers, schools, and insurance Agents from any and all liability in making response to inquiries and from releasing the requested information.