You must meet the following qualifications in order to be eligible for enrollment.

• Pass pre-employment hair and DOT urine drug screen
• No DUI or DWI violations less than 10 years old
• Must be an Ohio resident with a valid Ohio license
• Must pass a background check
• No more than 1 moving violation or preventable accident in the previous year
• No more than 2 instances of moving violations or preventable accidents in 3 years

Inquiry to Past Employer

You are hereby authorized to give Mast Trucking, Inc. (MTI) all information regarding my services, character, and conduct while in your employ, and you are released from liability that may result from giving such information. In order to enable MTI to comply with the requirements of 49 CFR, 382.413 & 391.23, I hereby consent to MTI obtaining from my prior employers the information pertaining to me which they are required to maintain by 49 CFR 382.401 (b) (I) (I) through (III) regarding alcohol tests with a concentration result of 0.04 or greater, positive controlled substance test results and refusal to be tested within the three (3) years preceding the date of this application and 49 CFR 391.23(a)2 investigation of my past employment record. I hereby authorize and direct my prior employers to release such information to MTI in personal interviews, telephone interviews, letters or any other method that ensures confidentiality. I hereby authorize MTI to release such information to any of its personnel whose duties require them to access this application or to make any recommendations or decisions with respect to it.

Your signature indicates consent to inquire of previous employers previously listed.

In addition to any past employers above that you’ve allowed us to contact, are there any additional references you’d like us to contact? List up to 3 other references below. No friends or family members, please.

Criminal convictions are not an automatic bar to employment, and all relevant circumstances will be considered, including (a) the nature and gravity of the offense, (b) the time that has passed, (c) the relevance to the job, (d) evidence of rehabilitation, and (e) truthful disclosure of offense. You will be offered a chance to explain or challenge any convictions disclosed or discovered through a background check. You are not required to disclose any convictions which have been sealed, expunged, annulled, or pardoned. You are not required to disclose juvenile court convictions or delinquency. You may not be required to answer this question if you are applying in certain states or cities, such as the following:

You are not required to answer this question and you may skip this page, if you reside in, or are applying for a position in one of the following locations: Hawaii; Maryland; Massachusetts, Minnesota; New Jersey; Utah

You are not required to answer this question and you may skip this page, until after you have been interviewed and been identified as an otherwise qualified applicant, if you reside in, or are applying for employment in, one of the following cities or states: Oregon; Illinois; Connecticut; Vermont; Memphis, TN; San Francisco, CA; Baltimore, MD; Columbia, MO; Buffalo, NY; New York, NY; Rochester, NY; Philadelphia, PA; Rhode Island; Austin, TX; Seattle, WA;

You are only required to disclose convictions which occurred, or for which you have released from incarceration, during the applicable period of time: District of Columbia (10 years), Washington (10 years), San Francisco (7 years).

If you reside in, or are applying for a position in Colorado, Pennsylvania, Wisconsin, Washington, you are only required to disclose convictions for crimes related to the job for which you are applying.

Please list all felony and misdemeanor convictions with date, unless excepted from such disclosure by law or as described above, and state any relevant circumstances:

PRE-EMPLOYMENT DRUG TESTING NOTIFICATION AND CONSENT

I understand that, as required by the Federal Motor Carrier Safety Regulations 49 CFR Part 382 and company policy, all prospective drivers must submit to a controlled substance test for the following: marijuana, cocaine, opiates, amphetamines, and phencyclidine (PCP).

I understand that if I test positive for use of a controlled substance, I am not medically qualified to operate a commercial motor vehicle. I also understand I will be given a reasonable opportunity to confer with the company’s medical review officer before any positive drug test is reported to the company.

The results of the drug test will be maintained by the medical reviews officer of the company, who will report to the company whether the test result was negative or positive. The results of any tests will not be released to any additional parties, except as provided in 40.37 without my written authorization.

I hereby agree to submit to a urine drug test and hair drug test.

EMPLOYER VERIFICATION DISCLOSURE STATEMENT

By applying my signature, I the applicant, hereby authorize the companies listed in my information sheet all records of employment, including assessments of my job performance, ability and fitness level, accident history, as well as alcohol & drug testing information to Mast Trucking, Inc. I hereby release this company from any and all liability of any type as a result of providing the information requested to Mast Trucking, Inc.

I have carefully read and understand all contents in the above application. By signing below, I certify that all information
contained in this application is true.

This information will be used only for background screening purposes and will not be taken into consideration in any employment decisions.

 

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