PLEASE READ AND SIGN

My signature below certifies that I completed this application and that all entries made, and information contained in it is true, correct, and complete to the best of my knowledge. As required by Blue & Yellow Trucking LLC policy and by the Federal Motor Carrier Safety Regulations (FMCSRs) 391.23, my signature further authorizes Blue & Yellow Trucking LLC and its representatives, employees or agents to make such investigations and inquiries of my professional and private information including, but not limited to, employment history, financial information, medical history, driving record, criminal background, and other related matters as may be necessary to arrive at a decision regarding this Driver Application. I hereby release employers, schools, healthcare providers, and other entities from all liability in responding to inquiries and releasing information in connection with my application. I understand that false or misleading information given in my application or interview(s) may result in decline of my application and/or deactivation of my status. Also, I understand that I am required to abide by all rules and regulations of Blue & Yellow Trucking LLC, client requirements, the DOT, TSA, and any other government entity.

My signature further certifies and acknowledges my understanding that in accordance with Part 391.23 regarding information provided by a DOT regulated employers/motor carrier that I have the following rights regarding any information provided to Blue & Yellow Trucking LLC as a result of these inquiries:

1. The right to review the information provided by previous employers/motor carriers.

2. The right to have errors in the information corrected by the previous employer/motor carrier and for that previous employer/motor carrier to re-send the corrected information to Blue & Yellow Trucking LLC. 

3. The right to have a rebuttal statement attached to the alleged erroneous information if I and my previous employer/motor carrier cannot agree upon the accuracy of the information that my previous employer/motor carrier submits. 

 

For a full understanding of your rights as a driver applicant, employee or contractor, under FMCSR Part 391 you should refer directly to the FMCSRs.

Please provide information on all companies for whom you have worked and/or contracted with during the past three years. List all your previous employers/motor carriers including those that you worked or were contracted to, driving schools, other training programs, periods of military service, self-employment, and period(s) of unemployment. Use additional paper if necessary.

Please begin with the current company or most recent company for whom you have worked and/or contracted. Account for all time of employment or contract work. Also, explain all gaps in employment or work history. Please list complete mailing addresses, phone numbers, supervisor’s name, or company contact name(s). We are specifically looking for all driving positions held and driving experience.

I hereby authorize the above-listed companies (SEE FORM 2) to release all records of employment, contract, and work history including assessments of my job performance, ability, and fitness to each company (or their authorized agents) who may request such information in connection with my Request for Qualification as a driver for Blue & Yellow Trucking LLC. I also authorize this company to release to Blue & Yellow Trucking LLC for the purpose of investigation and as required by 49 CFR Part 40, § 40.25, §40.331, 49 CFR Part 382, § 382.405 and 49 CFR Part 391, §391.23 of the Federal Motor Carrier Safety Regulations (“FMCSR”) all information pertaining to any and all information regarding my safety-sensitive position with your company. I hereby release your company from all liability of any type that may result from furnishing such information.

I understand that it is my right to review information provided by previous employers; to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information; as well as the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot agree on the accuracy of the information. I understand that if I wish to review previous employer-provided investigative information, I must submit a written request, 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. I understand that if I have not arranged to pick up or receive the requested records within thirty (30) days of them becoming available, it may be considered that I have waived my request to review the record(s).

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS 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 Blue and Yellow Trucking LLC (“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 for adjudication.

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 Blue and Yellow Trucking LLC (“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. Department of Transportation, 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 other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of "employee" contained at 49 C.F.R. 383.5.

49 CFR Part 40.25(j) states, as the employer, you must ask the employee whether he or 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 to test, 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 required in 49 CFR Subpart O.

I hereby provide consent to Blue and Yellow Trucking LLC to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.

I am consenting to multiple unlimited queries and for the duration of employment with Blue and Yellow Trucking LLC.

I understand that if the limited query conducted by Blue and Yellow Trucking LLC indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Blue and Yellow Trucking LLC without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for Blue and Yellow Trucking LLC to conduct a limited query of the Clearinghouse, Blue and Yellow Trucking LLC must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates a vehicle weighing 10,001 pounds or more in intrastate, interstate, or foreign commerce, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that as a driver you must comply. These requirements are as follows:

(1) POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess 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, stolen, or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed by that state.

(2)  NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 392.42 and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employing or contracting motor carrier by the NEXT BUSINESS DAY of any revocation, cancellation, 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), you must report it within 30 days to: 1) your employing or contracting motor carrier; and 2) the state that issued your license (if the violation occurs in a state other than the one that issued your license). The notification to both the company and state must be in writing.

(3) Violation of the above mandate can and will result in the termination of your employment or contract, whichever applies. Blue & Yellow Trucking LLC policy requires immediate notification of any incident that affects your driver license status. Written notice is required within 24 hours following an incident (refer to Incident Policy for more details).

The following license is the only license I will possess, and should I update and/or change this license I will immediately notify Blue & Yellow Trucking LLC:

 

DRIVER CERTIFICATION: I certify that I have read, understand, and will comply with the above requirements.