Clone of Driver Application

APPLICATION FOR EMPLOYMENT

Applicants for all positions will be considered without regard to race, color, religion, sex, national origin, age, marital status, disability, veteran or other protected status. This application is effective for sixty (60) days after application date. If you wish to be considered for employment after this time, you must reapply.
Full Name

First NameMiddle NameLast Name
Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date

MonthDayYear
Social Security Number
Phone Number
Format: (000) 000-0000.
Alternate Phone Number
Format: (000) 000-0000.

Experience and Qualifications
Drivers License 1 (Please list the state, License Number, and Type of License)
Drivers License 2 (Please list the state, License Number, and Type of License)
Driving Experience - Straight Truck
List the type of equipment hauled, date started and date ended, and approximate number of miles driven
Driving Experience - Tractor and Semi Trailer
List the type of equipment hauled, date started and date ended, and approximate number of miles driven
Driving Experience - Tractor - Two Trailers
List the type of equipment hauled, date started and date ended, and approximate number of miles driven
Have you held a driver’s license in any state other than your current one in the past 5 years? If Yes: “List the state(s) and license number(s).”
Traffic Convictions & Forfeitures (Past 3 Years)Include: Location, Date, Charge, and Penalty
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? or Has any license, permit, or privilege ever been suspended or revoked? If yes, please explain.
Are you authorized to work in the United States? As a condition of employment, you are required to submit proof of employment eligibility and identity in compliance with the Immigration Reform and Control Act of 1986.
Have you ever been convicted of a crime, or have you ever pleaded no contest or had adjudication withheld in a criminal matter? If "Yes", please give date, place, and nature of crime. Each case is considered individually and will not necessarily disqualify the applicant.

Employment Experience

Report your entire work history, starting with your present or last job. Include any job related military assignments and voluntary activities and gaps in employment. ar assignments and voluntary activities and gaps in employment. Excludeorganizations that indicate race, color, religion, sex, age, national origin, marital status, disability, veteran, or other protected status.
Employer 1
Employer Name
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed From

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Salary/Wage
Job Title
Supervisor Name

First NameLast Name
Work Preformed:
Reason For Leaving
Employer 2
Employer Name
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed From

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Salary/Wage
Job Title
Supervisor Name

First NameLast Name
Work Preformed:
Reason For Leaving
Employer 3
Employer Name
Telephone Number
Please enter a valid phone number.Format: (000) 000-0000.
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Employed From

MonthDayYear
Date
Date Employed To

MonthDayYear
Date
Salary/Wage
Job Title
Supervisor Name

First NameLast Name
Work Preformed:
Reason For Leaving

Motor Vehicle Report
Name

First NameLast Name
Birth Date

MonthDayYear
State
Licence Number
Original CDL Date

MonthDayYear
Date
# of Years Driving
Number of Years Hauling Logs, If no log hauling, what have you hauled in the last 3 years with a tractor/trailer
I understand that Motor Vehicle Reports may be obtained as a part of my employment. By checking yes on this disclosure, I hereby authorizethe Company to procure such reports and additional reports about me from time to time, as it deems appropriate, to evaluate my insurability.

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse.

I authorize BURGUNDY TIMBER, INC 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 understand and agree that BURGUNDY TIMBER, INC may conduct unlimited limited queries, as needed or required, for the entire duration of my employment.

If a limited query shows that drug or alcohol violation information exists in the Clearinghouse, the FMCSA will not disclose the details to BURGUNDY TIMBER, INC without first obtaining additional, specific consent from me.

I understand that if I refuse to provide consent for limited queries, BURGUNDY TIMBER, INC must prohibit me from performing any safety-sensitive functions, including operating a commercial motor vehicle, as required by FMCSA drug and alcohol regulations.
I have read and understand the FMCSA Clearinghouse Limited Query Consent.

PSP DISCLOSURE AND AUTHORIZATION
IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with BURGUNDY TIMBER, INC., the Company may obtain one or more reports regarding your driving, safety, and inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

The FMCSA Pre-Employment Screening Program (PSP) provides motor carriers and other authorized entities with access to the following information:

What May Be Included in a PSP Report
Your PSP report may include the following FMCSA-maintained data:
- Five (5) years of crash history
- Three (3) years of roadside inspection history
- Crash reports containing:
  - Date of crash
  - Location
  - Fatalities or injuries
  - Tow-aways
- Roadside inspection reports showing:
  - Violations
  - Out-of-service orders
  - Safety-related defects
- Additional safety performance information as collected by FMCSA
This information is provided directly from FMCSA records and is not influenced or changed by BURGUNDY TIMBER, INC.

Your Rights Regarding PSP Reports

Under the Fair Credit Reporting Act (FCRA), you have the right to:
1. Be notified if information in your PSP report is used to make an employment decision.
2. Receive a copy of your PSP report if the employer relies on it.
3. Dispute inaccurate or incomplete information with FMCSA.
4. Obtain a free copy of your PSP report once every 12 months by visiting:
  https://www.psp.fmcsa.dot.gov
Employer Use of the PSP Report
BURGUNDY TIMBER, INC. may use the PSP report for purposes such as:
- Evaluating your safety performance history
- Verifying crash or inspection history
- Making decisions about your suitability for a safety-sensitive driving position
The Company may obtain this information at any time during the hiring process but will not share it outside of normal employment procedures.

Authorization
By checking below, you authorize:
- BURGUNDY TIMBER, INC. to obtain your PSP crash and inspection history from FMCSA
- FMCSA to release to BURGUNDY TIMBER, INC. all information concerning your safety performance history contained in the PSP system
You also release FMCSA, all providers of such information, and BURGUNDY TIMBER, INC. from any liability arising from the authorized use of this information—consistent with applicable laws and regulations.

This authorization is valid for the duration of the application process only and does not permit ongoing access without additional written consent.
I have read, understand, and authorize the release of my PSP report and FMCSA background information as stated above.

DRUG & ALCOHOL POLICY — FMCSA & COMPANY COMPLIANCE

This policy applies to all drivers performing safety-sensitive functions for Burgundy Timber, Inc. in accordance with Federal Motor Carrier Safety Regulations (FMCSR) Part 382 and the company’s internal drug and alcohol policies.

The following rules, prohibitions, and procedures apply to all applicants and employees who operate commercial motor vehicles (CMVs).

Prohibited Conduct
Drivers are prohibited from:
- Reporting for duty or performing safety-sensitive functions while using alcohol.
- Using alcohol within four (4) hours of performing safety-sensitive functions.
- Possessing alcohol while on duty (unless it is sealed and part of a shipment).
- Performing any safety-sensitive function with an alcohol concentration of 0.04 or higher.
- Using or being under the influence of illegal drugs, including controlled substances not prescribed to the employee.
- Misusing prescription drugs or over-the-counter medications if it impairs safe operation.
- Performing safety-sensitive duties if using marijuana, even if medically prescribed (FMCSA does not recognize medical marijuana exemptions).
- Refusing a required drug or alcohol test.
  Tampering with, adulterating, or substituting test specimens.
Any violation of these conditions will result in immediate removal from safety-sensitive duties and may result in termination of employment.

Safety-Sensitive Functions

Safety-sensitive functions include, but are not limited to:
- Driving a commercial motor vehicle
- Waiting to load or unload a CMV
- Inspecting equipment
- Attending to a disabled CMV
- Loading or unloading freight
- Repairing a CMV
- Any function directly affecting the safe operation of a CMV
Employees must be fit for duty at all times while performing these activities.

Required Testing
Under FMCSA Part 382 and Company Policy, testing may occur under the following circumstances:

Pre-Employment Testing:
- Required before performing any safety-sensitive duties.
- A verified negative drug test result must be received prior to driving.
Random Testing:
- Conducted throughout the year without notice.
- Includes both drug and alcohol testing.
- Random testing is administered under DOT random selection rules.
Reasonable Suspicion Testing
- Required when a supervisor observes behavior, appearance, speech, or smell that indicates drug or alcohol use.
- Behavior such as slurred speech, unsteadiness, erratic behavior, aggression, or visible impairment can trigger testing.
Post-Accident Testing
Conducted when:
- A DOT-recordable accident results in a fatality,
- The driver receives a citation for a moving violation and there is injury requiring medical treatment away from the scene, or
- A vehicle is towed from the scene.
Return-to-Duty and Follow-Up Testing
- Required after a violation of FMCSA Part 382 or a positive drug/alcohol test.
- Conducted under the direction of a DOT-qualified Substance Abuse Professional (SAP).
- Follow-up testing can continue for up to 5 years.
Consequences of Violations
Failure or refusal to comply with this policy will result in:
- Immediate removal from safety-sensitive functions
  Possible termination of employment
- Mandatory referral to a Substance Abuse Professional (if return-to-duty is pursued)
- Possible denial of workers’ compensation benefits in post-accident cases
Refusal to test is treated the same as a positive test result.

Confidentiality
All drug and alcohol test records are:
- Confidential
- Released only to individuals with a legitimate need to know
- Maintained in secure files
- Never shared without written consent (except as required by DOT or other legal authority)
Results may be discussed only between:
- The employee
- The Medical Review Officer (MRO)
- Authorized Company officials
Employee Responsibility
Employees must:
- Report any medication that may impair safe operation
- Comply fully with all testing procedures
- Notify the Company of any drug or alcohol-related legal violations involving CMV operation
- Remain free from any prohibited substance use while performing FMCSA safety-sensitive duties
By checking below, I certify that I have read and understand the Drug & Alcohol Policy, including FMCSA Part 382 requirements, prohibited conduct, testing procedures, and consequences of violations.

Substance Abuse, Drug & Alcohol, and Workplace Compliance Policy

This policy applies to all applicants and employees performing safety-sensitive functions as defined by the Federal Motor Carrier Safety Administration (FMCSA) and Burgundy Timber, Inc. It incorporates all Company and DOT-required rules regarding drug and alcohol use, testing, workplace conduct, and compliance.

Burgundy Timber, Inc. maintains a drug-free and alcohol-free workplace. The use, possession, sale, distribution, or being under the influence of illegal drugs, controlled substances (without a valid prescription), or alcohol while performing safety-sensitive duties is strictly prohibited. Employees may not perform any safety-sensitive functions if using marijuana, even if medically prescribed, as FMCSA regulations do not recognize medical marijuana exemptions.

Safety-sensitive functions include, but are not limited to, operating a commercial motor vehicle (CMV), inspecting equipment, waiting to load or unload, attending to a disabled vehicle, loading or unloading freight, repairing a CMV, or any activity that directly affects CMV safety.

Employees are prohibited from:
- Using alcohol while performing safety-sensitive functions, or within four (4) hours of performing such duties.
- Performing safety-sensitive duties with an alcohol concentration of 0.04 or greater.
- Possessing alcohol while on duty unless sealed and part of a shipment.
  Using or being under the influence of illegal drugs, misusing prescription medication, or using any substance that impairs safe operation.
- Refusing a required drug or alcohol test, or tampering with, substituting, or adulterating a specimen.
Burgundy Timber conducts Pre-Employment, Random, Reasonable Suspicion, Post-Accident, Return-to-Duty, and Follow-Up testing as required by FMCSA regulations and company policy. All pre-employment applicants must complete a drug test and receive a verified negative result before beginning safety-sensitive work. Employees selected for random tests must submit immediately when notified. Employees exhibiting signs of impairment—including slurred speech, unsteady movement, erratic behavior, or the smell of alcohol or drugs—are subject to Reasonable Suspicion testing.

Post-accident testing is required in accordance with DOT rules, including accidents involving fatalities, tow-aways, or injuries requiring medical treatment when the driver receives a citation.

All drug and alcohol test results are confidential and may be discussed only between the employee, the Medical Review Officer (MRO), and authorized company officials. Employees may be disqualified from workers’ compensation benefits under state law if they test positive after an accident.

The Company also complies with FMCSA Clearinghouse requirements. By applying for or accepting employment, employees acknowledge that Burgundy Timber, Inc. may conduct limited queries of the FMCSA Drug & Alcohol Clearinghouse and obtain necessary drug and alcohol violation information, past employer testing history, and return-to-duty status.

Employees must also comply with all drug and alcohol policies of clients for whom Burgundy Timber performs work. Violations of client-mandated testing or substance rules may result in removal from job assignments or termination.

The Company reserves the right to conduct unannounced searches or investigations of company property—including lockers, desks, vehicles, tools, and equipment. Employee vehicles and personal belongings such as bags, lunch boxes, toolboxes, purses, and containers brought onto company property may also be inspected. Refusal to cooperate with any investigation or search will result in disciplinary action, up to and including termination.

Any violation of this policy—including refusal to test, positive test results, impairment while on duty, possession of prohibited substances, or noncompliance with federal or company rules—may result in immediate removal from safety-sensitive duties, disciplinary action, or termination.

By acknowledging this policy, employees confirm they understand their responsibilities, the testing requirements, prohibited conduct, and the consequences of violations under FMCSA regulations and Burgundy Timber, Inc. policy.
I have read, understand, and agree to comply with the Burgundy Timber, Inc. Substance Abuse, Drug & Alcohol, Workplace Search, and FMCSA Compliance Policy.

Antidiscrimination & Anti- Harassment Policy

Burgundy Timber Inc. will not condone, permit or tolerate any form of discrimination and/or harassment by or against any employee, customer, vendor, independent contractor or other individual with whom our employees come in contact with in connection with their employment with Burgundy Timber, Inc. based upon age, race, creed, religion, sex, sexual orientation, national origin, disability or other protected class or characteristic established under applicable federal, state, or local statute or ordinance.

Sexual harassment is a form of illegal sex discrimination. Sexual harassment refers to behavior that is unwelcome, personally offensive, and which interferes with our work effectiveness. Federal law defines unlawful sexual harassment as unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature, whether by male or female, when (1) submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment, (2) submission to or rejection of such conduct by an individual is used as a basis for employment decisions affecting such individual, or (3) such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile or offensive work environment.

Individuals who believe they have been subjected to discrimination or harassment as described above or have questions about whether certain conduct is unlawful should immediately speak to .their supervisor or Clint Beckham. This is particularly important involving sexual harassment where there can be uncertainty about what is unlawful conduct.

Supervisors who receive complaints of discrimination or harassment or who are made aware of conduct that may constitute discrimination or harassment must immediately notify Clint Beckham.
By checking below, I acknowledge my receipt and understanding of the BurgundyTimber, Inc. Anti-Discrimination/Harassment Policy

Employment At-Will Policy

Employment with Burgundy Timber, Inc. is “at-will,” which means that either the employee or the Company may terminate the employment relationship at any time, with or without notice, and with or without cause.

No supervisor, manager, or representative of the Company has the authority to enter into any agreement that changes this at-will employment relationship, except in a written contract signed by the President of the Company.

Nothing in any policy, handbook, or communication should be interpreted as creating a contract of employment or guaranteeing employment for any specific duration.

By signing below, I acknowledge that I have read and understand the above Employment At-Will Policy and that no verbal statements or promises can alter this relationship.
I have read and understand the Employment At-Will Policy.
Should be Empty:

APPLICATION FOR EMPLOYMENT

Experience and Qualifications

Employment Experience

Employer 1

Employer 2

Employer 3

Motor Vehicle Report