Name
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First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
FEIN/SS#
DOB
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Month
-
Day
Year
Date
Drivers License #/ State
DL #
State
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Email
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example@example.com
Which contract position are you interested in?
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Owner Operator
Shipper
HAVE YOU TESTED POSITIVE, OR REFUSED TO TEST, ON ANY PRE-EMPLOYMENT DRUG OR ALCOHOL TESTADMINISTERED BY AN EMPLOYER TO WHICH YOU APPLIED FOR, BUT DID NOT OBTAIN, SAFETY-SENSITIVETRANSORTATION WORK COVERED BY DOT DRUG AND ALCOHOL RULES DURING THE PAST 2 YEARS?
*
Yes
No
IF YOU ANSWERED “YES” TO THE ABOVE QUESTION, CAN YOU PROVIDE DOCUMENTATION OF SUCCESSFULCOMPLETION OF DOT RETURN TO DUTY REQUIREMENTS (INCLUDING FOLLOW-UP TESTS)?
Yes
No
HAVE YOU EVER BEEN CONVICTED OF A FELONY OR MISDEMEANOR WHICH RESULTED IN IMPRISONMENTWITHIN THE LAST 7 YEARS? (NOTE: SUCH CONVICTIONS ARE NOT AN AUTOMATIC BAR TO EMPLOYMENT.ALL CIRCUMSTANCES WILL BE CONSIDERED)
*
Yes
No
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Download & Complete Drug Screen
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Drug Screen File Upload
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I HEARBY AUTHORIZE YOU TO RELEASE THE FOLLOWING INFORMATION TO Brotherz Tranzport Logistics FOR THE PURPOSE OF INVESTIGATION AS REQUIRED BY SECTION 391.23 OF THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS. YOU ARE HEREBY RELEASED FROM ANY ANDALL LIABILITY WHICH MAY RESULT FROM FURNISHING SUCH INFORMATION.
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