JLS Consortium Application

Company Information
Company Name*
DBA (If applicable)
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone*
Please enter a valid phone number.
Website (if applicable)
Company Structure*

Owner/Operator (Single Driver)Fleet Operator (Multiple Drivers)
Primary Contact

Note: This individual will receive all test notifications, compliance updates, and random selection notices.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Title/Position*
Email*
example@example.com
Business Information
Industry Type*

Trucking/TransportationConstructionStaffing/EmploymentOil & GasAviationSchool/ChildcareOther
Is the company DOT-Regulated?*
If Yes, check applicable agencies:

FMCSA (Trucking)FAA (Aviation)PHMSA (Pipeline)FRA (Railroad)FTA (Transit)USCG (Coast Guard)
Number of Safety-Sensitive Employees:*
Services Requested*

DOT Consortium EnrollmentNon-DOT Consortium EnrollmentDriver Qualification FileDOT-Compliant Drug & Alcohol Testing Policy (customized for your business)Supervisor Reasonable Suspicion TrainingBackground Check/MVR ReportELD ManagementSAP Referral & Case Monitoring Services
Documents Required to Submit with Application
✅ Completed Consortium Enrollment Application
✅ Driver Roster (attached)
✅ Copy of front and back of each driver's CDL
✅ Copy of each driver’s Medical Card
✅ If applicable: Copy of recent (within last 30 days) Negative Drug Test Result
✅ Copy of Company’s Drug Testing Policy (if existing)
✅ DOT Number (if DOT-regulated)
File Upload*

Cancelof
Driver Roster (click ADD ROW for each additional driver)*
By signing below, you certify that the information provided is accurate. You authorize JLS Testing Solutions to enroll your company and drivers into the selected consortium services. You also agree to comply with all applicable DOT and/or company drug and alcohol testing regulations.*

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Company Information

Primary Contact

Business Information