Venky Perfect Passage Commercial Driver Application Form

In compliance with Federal and State equal opportunity laws, qualified applicants are considered for all positions without regard to race, religion, sex, national origin, age, marital status, or non-job related disability. Please answer all questions.

List each driver’s license held in the past 3 years. List the issuing state, number and expiration date of each unexpired commercial motor vehicle operator’s license or permit that has been issued to you.

In accordance with FMCSR 391.21 & .23, an applicant must list all previous work experience for the three (3) years prior to the date of the application shown on page one, as well as all commercial driving experience for the seven (7) year period prior to those three years, for a total of 10 years. Include your job description, date of employment, reason for leaving and whether you were subject to FMCSA & U.S. DOT alcohol and controlled substance testing requirements for each job listed. Please provide the last 3 years of residence history. Please start with the most recent employer. Include self-employment or time leased to another carrier. Use an additional sheet if needed. Any gaps in employment (including unemployment or retirement) must be explained. We may investigate your safety performance history with previous DOT-regulated employers. This includes information regarding your employment dates, work history, accident history, and drug/alcohol testing results.

This notice is to inform you of the existence of the Venky Perfect Passage Drug Abuse Policy (the “Policy”). As a condition of providing services to or becoming employed by Venky Perfect Passage, all driver applicants—whether seeking employment or independent contractor status—must submit to a pre-engagement controlled substances test, as required by FMCSR Section 382.301. A motor carrier must receive verified negative test results for any applicant to be eligible to perform safety-sensitive functions.I understand and agree that I must not use, buy, sell, accept as a gift, experiment with, traffic in, or otherwise be involved with illicit or inappropriate drugs when it could affect the safe performance of my duties. I also understand that this Policy does not apply to medication properly taken as prescribed by a licensed physician, except as otherwise provided by the Policy.I further understand and agree that, if I become engaged with Venky Perfect Passage—whether as an employee or independent contractor—I may be required to submit to urinalysis for the detection of prohibited substances, and to saliva or breath alcohol testing (collectively, “testing”), under the following circumstances:Based upon reasonable suspicion (382.307),Following a reportable or on-the-job accident (382.303),When returning from a leave of absence (382.309), orOn a random basis (382.305).I further understand that, in the event any test result is positive, I will have the opportunity to discuss with the Company’s Medical Review Officer (MRO) my medical history and any other relevant biomedical factors that may explain the result. To assist in this process, I hereby authorize any hospital, physician, dentist, or pharmacist to release medical records and to discuss with the MRO any treatment or prescriptions that may relate to a positive test result.I understand that refusal to submit to testing when requested by a representative of Venky Perfect Passage will be considered a positive result and may lead to disqualification from performing services, termination of employment or contract, or other disciplinary action as appropriate.If I am confirmed to have a positive test result for controlled substances and/or alcohol, I will be immediately removed from any safety-sensitive functions as required by FMCSR Part 382 and may be subject to further action, up to and including termination of employment or termination of contract.My signature below indicates that I understand and agree to comply with this Policy, consent to the required testing, and authorize the release of information necessary for implementation of the Policy by Venky Perfect Passage, collection site personnel, and the Medical Review Officer.

By signing this application, you authorize Venky Perfect Passage to obtain consumer reports, including Motor Vehicle Reports (MVR), employment and criminal background history, and other data under the Fair Credit Reporting Act (FCRA), for evaluating your eligibility and qualifications, both initially and throughout your service as an employee or independent contractor.

Pursuant to 49 CFR Parts 40 and 382, all individuals selected for safety-sensitive roles—whether as employees or independent contractors—must complete pre-engagement drug and alcohol testing. A verified negative result is required for consideration. A refusal to test or a positive result will disqualify the applicant from employment or contract opportunities with Venky Perfect Passage.

I certify that all information provided is true and complete. I understand that false statements or omissions may disqualify me or lead to termination. I authorize Venky Perfect Passage to investigate all statements, including contact with previous employers, schools, and references, unless otherwise noted, for employment or independent contractor consideration.

I authorize, in accordance with 49 CFR Part 40 and applicable DOT regulations, the release of information from my DOT-regulated drug and alcohol testing records. This authorization is granted for the sole purpose of transmitting such records to the motor carrier or company identified below, Venky Perfect Passage, in consideration of my application to provide services either as an employee or independent contractor.I authorize the release of the following information concerning my drug and alcohol tests conducted under DOT authority within the past three years: (i) alcohol test results of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to test (including verified adulterated or substituted results); (iv) other documented violations of DOT drug and alcohol testing regulations; (v) information provided by previous employers or contracting companies concerning rule violations; and (vi) documentation, if applicable, of successful completion of the return-to-duty process following a violation.I also authorize any carrier or company possessing such information to disclose the dates of any negative drug and/or alcohol tests and/or test results below 0.04 within the same three-year period, as well as the name and contact number of any substance abuse professional who evaluated me.Carrier/Employer: Venky Perfect Passage

In connection with my application for employment and/or review of my driving record, I understand that Venky Perfect Passage, West Palm Beach, FL, may request consumer reports that may contain public record information. These reports may include details such as the names and dates of previous employers, reasons for termination of employment, work experience, accidents, and more. Additionally, these reports may include public record information regarding my driving record, workers' compensation claims, credit history, bankruptcy proceedings, criminal records, etc., obtained from federal, state, and other agencies that maintain such records. This may also include information from DAC regarding previous driving record requests made by other organizations or agencies. I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY VENKY PERFECT PASSAGE OR DAC TO FURNISH THE ABOVE-MENTIONED INFORMATION.I understand that I have the right to request the nature and substance of all information held by Venky Perfect Passage about me upon presentation of proper identification. This includes the sources of information and the recipients of any reports about me that Venky Perfect Passage has previously furnished within the past three years. I hereby consent to Venky Perfect Passage obtaining this information, and I agree that this information may be supplied to other companies requesting it.This authorization covers consumer reports and will remain in effect for the duration of my employment or contract relationship. I also understand that this ongoing authorization allows Venky Perfect Passage to procure such reports at any time during my employment or contract period. If I am hired or contracted, this authorization will remain on file for any necessary future requests.

In connection with your application for employment or independent contractor agreement with Venky Perfect Passage (“Prospective Employer”), Venky Perfect Passage may obtain one or more reports regarding your driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). If the Prospective Employer uses any information obtained from FMCSA in a decision not to hire you or to make any other adverse employment or contracting decision regarding you, Venky Perfect Passage will provide you with a copy of the report upon which its decision was based, as well as 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 based upon your driving history or safety report, Venky Perfect Passage will notify you that the action has been taken and that the decision was based in part or in whole on this report. Venky Perfect Passage cannot obtain background reports from FMCSA unless you consent in writing. If you agree that Venky Perfect Passage may obtain such background reports, please read the following and sign below:I authorize Venky Perfect Passage (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and safety inspection history. I understand that I am consenting to 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 acknowledge that this information may assist Venky Perfect Passage in determining my suitability as an employee or independent contractor.I further understand that neither Venky Perfect Passage nor the FMCSA contractor supplying the crash and safety information has the ability to correct any safety data that appears to be incorrect. I understand that I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a state, FMCSA cannot change or correct this data. My request will be forwarded to the appropriate State for adjudication.I have read the above Notice Regarding Background Reports provided by Venky Perfect Passage, and by signing this consent form, I authorize Venky Perfect Passage and its employees, authorized agents, and/or affiliates to obtain the information described above.