• EMPLOYMENT APPLICATION

  • Please note that in order to complete this application, you must upload copies or pictures of the following DOT and OSHA required documents

    • Driver's License
    • DOT Medical Card  
    • Social Security Card, Birth Certificate or US Passport
    • OSHA 10 or higher
    • OSHA Confined Space Certification

     

    All applicants will be subject to a pre-employment drug test to be conducted at

    Occupational Health 52 Crest Ave #7a, Winthrop, MA 617-846-0845

    *DOT cards can be obtained from this location as well

     

    Need OSHA Certifications?

     

     

    • To take the OSHA courses and recieve your required certifications if you have not done so already click here

     

    • If you have completed OSHA requirements and lost your physical certification proof, request a free copy at any time here

     

  • I. CONTACT INFORMATION

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  • Dates Resided
  • Dates Resided
  • Dates Resided
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  • II. DRIVING EXPERIENCE

  • Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license." I certify that I do not have more than one motor vehicle license, the information for which is listed below.

  • DRIVER'S LICENSE INFO*
    Rows

  • PLEASE FILL OUT THE TABLES TO THE BEST OF YOUR ABILITY, FOR FIELDS THAT DO NOT APPLY TO YOUR EXPIRIENCE PLEASE PUT "NA" 

  • DRIVING EXPERIENCE*
    Rows
  • ACCIDENT RECORD PAST 3 YEARS*
    Rows
  • TRAFFIC CONVICTIONS AND FORFEITURES IN PAST 3 YEARS*
    Rows
  • A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
  • B. Has any license, permit or privilege ever been suspended or revoked?*

  • III. EMPLOYMENT HISTORY

  • Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record)

  • MUST LIST THE COMPLETE MAILING ADDRESS: STREET NUMBER AND NAME, CITY, STATE AND ZIP CODE

  •  -
  •  -
  • when*
  • Were you subject to the Federal Motor Carrier Safety Regulations (FMCRs) while employed by the previous employer?
  • Was the previous job position designated as a safety sensitive function is any DOT regulated mode, subject to alcohol and controlled substances testing as requirements required by 49 CFR Part 40?
  •  -
  •  -
  • when
  • Were you subject to the Federal Motor Carrier Safety Regulations (FMCRs) while employed by the previous employer?
  • Was the previous job position designated as a safety sensitive function is any DOT regulated mode, subject to alcohol and controlled substances testing as requirements required by 49 CFR Part 40?
  •  -
  •  -
  • when
  • Were you subject to the Federal Motor Carrier Safety Regulations (FMCRs) while employed by the previous employer?
  • Was the previous job position designated as a safety sensitive function is any DOT regulated mode, subject to alcohol and controlled substances testing as requirements required by 49 CFR Part 40?

  • The Federal Motor Carrier Safety Regulations (FMCSR) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 pounds or more, (2) is designed or used to transport nine or more passengers, or, (3) is of any size, used to transport hazardous materials in a quantity requiring placarding. 

  • TO BE READ AND SIGNED BY APPLICANT

    I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision.(Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended). I here by release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

    In the event of employment, I understand that false or misleading information given in my application or interview(s), may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. I understand that information I provide regarding current and/or previous employers may be used and those employer(s)will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e).

    I understand that I have the right to:

    • Review information provided by previous employers;
    • Have errors in the information corrected by previous employers and for  those previous employers to re-send the corrected information to the prospective employer; and
    • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.
  • Signature*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

  • Signature*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations

  • IV. DRIVER RECORD SCREENING DISCLOSURE

  •  I hereby authorize Embark Safety LLC and its designated agents and representatives to conduct a comprehensive review of my driver record background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include information about my names, motor vehicle records, license verification. Upon Request, Embark Safety LLC will supply a copy of the completed consumer report along with a copy of an individual’s rights under the Fair Credit Reporting Act.

    Authorization and Release

    I  authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may have. I authorize the full release of the information described above, without any reservation, throughout any duration of my employment at Rapid Flow Inc. I certify that all information provided below is correct to the best of my knowledge. This authorization and consent shall be valid in original, fax, or copy form. The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose.

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year

  •  Notice to California Applicants: Under section 1786.22 of California Civil Code, you have the right to request from Embark Safety LLC, upon proper identification, the nature and substance of all information in files pertaining to you, including the sources of information, and recipients of any reports on you, which Embark Safety LLC has previously furnished within the two-year period preceding your request. You may view the file maintained on you by Embark Safety LLC during normal business hours. You may also obtain a copy of this file upon submitting proper identification. Upon making a written request, you may receive a summary of your report. Notice to Maine Applicants: Under Chapter 210 Section 1314 of Maine revised Statutes, you have the right, upon request, to be informed within 5 business days of such a request to whether or not an investigative consumer report was requested. If such report was obtained, you may contact the Consumer Reporting Agency and request a copy. Notice to Massachusetts Applicants: Under Mass. Ann. Laws chapter. 93 §§ 50, a Consumer Reporting Agency may furnish a report if intended to be utilized for employment purpose

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Are You Applying for a CDL Position?*

  • V. DRIVER APPLICATION/QUALIFICATION

  • The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations and Rapid Flow Inc.

  • Position applying for*
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  •  -
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • D.O.B.*
     - -
    2 digit month, 2 digit day, 4 digit year

  • *The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are atleast 40 but less than 70 years of age.

  • Dates resided
  • Dates resided
  • Dates resided
  • Physical exam expiration date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • have current DOT medical card?*
  • Have you worked for this company before?
  • If so, When?
  • Highest grade or degree completed*

  • VI. DRIVER HISTORY

  • PLEASE FILL OUT THE TABLES TO THE BEST OF YOUR ABILITY, FOR FIELDS THAT DO NOT APPLY TO YOUR EXPIRIENCE PLEASE PUT "NA" 

  • Equipment Class*
    Rows
  • Accident History (last 3 years)*
    Rows
  • Traffic Convictions and Forefeitures (past 3 years)*
    Rows
  • Driver's License Information (list each driver's license held in the past 3 years)*
    Rows
  • A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
  • B. Has any license, permit or privilege been suspended or revoked?*
  • C. Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?*
  • D. Have you ever been convicted of a felony?*

  • VII. EMPLOYMENT HISTORY

    Give a complete record of all employment
  • Present or Last Employer*
    Rows
  • Employment Duration*
  • Were you subject to the FMCSR while employed here?*
  • Was the previous job position designated as a safety sensitive function is any DOT regulated mode, subject to alcohol and controlled substances testing as requirements required by 49 CFR Part 40?*
  • Present or Last Employer
    Rows
  • Employment Duration
  • Were you subject to the FMCSR while employed here?
  • Was the previous job position designated as a safety sensitive function is any DOT regulated mode, subject to alcohol and controlled substances testing as requirements required by 49 CFR Part 40?
  • Present or Last Employer
    Rows
  • Employment Duration
  • Were you subject to the FMCSR while employed here?
  • Was the previous job position designated as a safety sensitive function is any DOT regulated mode, subject to alcohol and controlled substances testing as requirements required by 49 CFR Part 40?
  • Present or Last Employer
    Rows
  • Employment Duration
  • Were you subject to the FMCSR while employed here?
  • Was the previous job position designated as a safety sensitive function is any DOT regulated mode, subject to alcohol and controlled substances testing as requirements required by 49 CFR Part 40?
  • Please Print Name in blank space*
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  •  -
  • I worked for this company between the dates of:*
  • D.O.B*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Today's date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • VIII. PERSONAL REFERENCES

    List three persons for references, other than family members, who have knowledge of your safety habits
  • Reference 1*
  • Reference 2*
  • Reference 3*

  • It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file. It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be
    disqualified without recourse. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • VIIII. BACKGROUND INFORMATION REQUEST AND WAIVER

  • Personal Data

  • D.O.B.*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Print name in blank space
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • X. COMPANY POLICIES

    Read the policies then sign and date
  • Rapid Flow Inc. Non-Harassment Policy

  • Receipt of the No-Harassment Policy

     I have this day received a copy of the company’s No-Harassment policy. I understand that I am responsible for reading the policy and procedures contained therein.  I understand that the policy’s replaces any and all prior policies and practices of the company.

    I agree to abide by the policy and procedures.  I understand that the policy and procedures may be added to, deleted or changed by the company at any time.

    If I have any questions regarding the content or interpretation of the policy or procedures, I will bring them to the attention of my supervisor or any member of management.

     Please sign below to acknowledge receipt and understanding of this notice.

     

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • VEHICLE INSPECTION POLICY

  • Vehicle Inspection Policy

    To All Employees:

    It is a mandatory requirement for every driver to fill out a vehicle inspection report prior to leaving the shop. A walk around checking fluids is a requirement as well not only for DOT but Company Policy. All vehicle inspection reports are to be put in the basket above FedEx Cabinet completely filled out and notes taken of specific repairs that need to be done.  Failure to follow these procedures will result in a 1 day suspension and multiple occurrences may result in a longer suspension or termination.

    Please sign below to acknowledge receipt and understanding of this notice.

     

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • MSO SECURITY GUIDELINES

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Please Print the following legal tax forms, fill them out and IF you are unable to upload the completed forms to this application, please email, fax or bring to the Rapid Flow Inc. HR office:

    80 Hitchborn st Revere, MA 02151

    fax: 781-289-5661

    email: ameads@rapidflowinc.com

  • W4
  • Please Upload completed W4
  • M4
  • Please Upload completed M4
  • I-9
  • Please Upload completed page 1 of I-9
  • Upload List A Document
  • Upload List B and C Documents
  • Direct Deposit
  • Upload completed Direct Deposit File
  • Blue Cross Blue Shield of Massachusetts Waiver
  • Upload completed BCBS Waiver File
  • Do you anticipate accepting BCBS health care coverage via RapidFlow Inc?

  • Required Certifications and Documentation

  • Upload OSHA 10 (or Higher) File*
  • Upload OSHA Confined Spaces File*
  • Upload DOT Medical Card*
  • Upload Driver's License*
  • Social Security Card*
  • Are you applying for a Catch Basin position?
  • Hoisting License
  • Additional Certifications
  • Legal Citizenship Documents (ex: green card)
  • Should be Empty: