Join Prime Logistics

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Name* This field is required.
First Name
Middle Name or Initial (optional)
Last Name
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Phone number* This field is required.Enter the best phone number to reach you
Area Code
Phone Number
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Email* This field is required.
example@example.com
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Current address* This field is required.
Street Address
Street Address Line 2
City
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Other
Country
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Have you been at that address for 3+ years?* This field is required.
Yes
No
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Enter any previous addresses where you have lived in the last 3 years
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Date of birth* This field is required.mm/dd/yyyy
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Place of birth* This field is required.City, State or Country
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Social security number* This field is required.
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Driver's license number* This field is required.
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Driver's license state of issue
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Ohio
Oklahoma
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Pennsylvania
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South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
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Add picture of current Driver's LicenseSENDING A PICTURE NOW WILL SPEED UP YOUR APPLICATION, but you can send it later if you like.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Add picture of SSN cardSENDING A PICTURE NOW WILL SPEED UP YOUR APPLICATION, but you can send it later if you like.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Add picture of Medical cardSENDING A PICTURE NOW WILL SPEED UP YOUR APPLICATION, but you can send it later if you like.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Driving Experience
Equipmt. type
Date from
Date to
Total miles
Straight Truck
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Row 0, Column 1
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Semi-Trailer
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
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Straight Truck
Semi-Trailer
Equipmt. type
Row 0, Column 0
Date from
Row 0, Column 1
Date to
Row 0, Column 2
Total miles
Row 0, Column 3
Equipmt. type
Row 1, Column 0
Date from
Row 1, Column 1
Date to
Row 1, Column 2
Total miles
Row 1, Column 3
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Have you had any traffic accidents in the last 3 years?* This field is required.
No
Yes, I'll explain
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Traffic accidents for past 3 yearsIf YES, please give date, location, injuries and fatalities (if any):
18
Have you had any traffic convictions in the last 3 years?* This field is required.Parking violations need not be disclosed
No
Yes, I'll explain
19
Traffic convictions for past 3 yearsIf YES, please give date, location, charges and penalties:
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Have you ever been convicted of a Felony, DUI, or DWI?* This field is required.
No
Yes, I'll explain
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Felony convictionsIf YES, please list date of offense, any fines or time served:
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Has any license, permit, or privilege been suspended or revoked?* This field is required.
No
Yes, I'll explain
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License suspensionsIf YES, please give reasons, dates and lengths of suspensions:
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Past employers and qualificationsList all employers and qualifications for the last 3 years (most recent first)
Company name
Date from
Date to
Phone number
Employer 1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Employer 2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Employer 3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Employer 1
Employer 2
Employer 3
Company name
Row 0, Column 0
Date from
Row 0, Column 1
Date to
Row 0, Column 2
Phone number
Row 0, Column 3
Company name
Row 1, Column 0
Date from
Row 1, Column 1
Date to
Row 1, Column 2
Phone number
Row 1, Column 3
Company name
Row 2, Column 0
Date from
Row 2, Column 1
Date to
Row 2, Column 2
Phone number
Row 2, Column 3
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Will you email us pictures of your ID documents?We will need a picture of your driver's license, SSN card, and medical card to fully process your application. One or more of those might be missing. Will you please email us those pictures at safety@primelogisticscorp.com after you submit your application?
YESNO
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Disclosures and AuthorizationsI authorize PRIME to perform the driving history and background checks described here.
I understand and agree that: The information supplied, was submitted by myself, and all information is true and correct, to the best of my knowledge. I understand that false or misleading information given in my application and/or interview(s) will be considered as cause for possible dismissal and/or discharge. I also understand that I am to abide by all rules and regulations of the company. 

MOTOR VEHICLE AUTHORIZATION 

The company has my authorization to thoroughly investigate my work and personal history. I understand that the information supplied by me, regarding my Motor Vehicle Record(s) will be utilized as part of the processing procedures. A background check will be conducted to verify the veracity of the information submitted and will be utilized to develop information concerning my character, general reputation, personal characteristics, and mode of living. I will hold no person liable for giving or receiving information in this investigation. I hereby authorize: 

HireRight Solutions Inc an agent of PRIME may be asked to make a thorough check of my driving history. I release from liability all persons, companies, and corporations supplying that information. I release and indemnify PRIME and HireRight Solutions Inc against any liability that might result from making such background checks. A copy of this form is as valid as the original. 

CRIMINAL BACKGROUND CHECK 

I understand that PRIME, as part of driver background investigations, will run a Criminal Background Check on all potential driver's as of 10/01/2015. As per the Fair Credit Reporting Act, by my signature, I am allowing PRIME the authority to obtain this report. By not allowing PRIME the authority to run this report, this could result in me not being employed or leased by PRIME as a driver. Information found on this report that is not marked properly on my application will result in an automatic termination of my employment or lease for a falsification on the driver's application.
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Disclosures and AuthorizationsI authorize PRIME to access my FMCSA Pre-Employment Screening report.
IMPORTANT DISCLOSURE 
BACKGROUND REPORTS FROM THE PSP Online Service 

In connection with your application for employment with PRIME ("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.fi.ncsa.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 in the box provided. 

I authorize PRIME ("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://clataqs.fi.ncsa.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, wit11or 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. LAST UPDATED 2/11/2016
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