Truckers411.com, Trucking jobs

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COMMERCIAL DRIVER APPLICATION

APPLICANT INFORMATION

Position applying for:
PREVIOUS THREE YEARS ADDRESSES
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HAVE YOU WORKED FOR THIS COMPANY BEFORE?
If yes, give dates

EDUCATION HISTORY

Please circle the highest grade completed:
Grade school:
College:
Post Graduate:

EMPLOYMENT HISTORY

Give a COMPLETE RECORD of all employment in the past ten (10) years, including the name, dates of employment/contract, reason for leaving, and address of the employers/contractors for which you worked, as well as any periods of unemployment and self-employment, starting with your current or most recent job first.

Present or Last Employer

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Were you subject to the FMCSRs while employed here?

Was your job designated as a safety-sensitive function in any DOT- regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40?

DRIVING EXPERIENCE

Class of Equipment From To Approximate Number of Miles Remove
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Accident Record for past three (3) years

Date of Accident Nature of Accidents
(Head on, rear end, etc)
Location of Accident No. of Fatalities No. of People Injured Remove
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Traffic Convictions and Forfeitures for the last three (3) years
(other than parking violations)

Date Location Charge Penalty Remove
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Driver's License (list each driver's license held in the past three (3) years:

State License Type Endorsements Expiration Date Remove
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Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Has any license, permit or privilege ever been suspended or revoked?

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)?

Job References

List three (3) persons for references, other than family members, who have knowledge of your safety habits.

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To Be Read and Signed by Applicant:

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

 

Applicant Signature

Truckers411.com does not discriminate in any employment practices on the basis of race, color, religion, gender, national origin, age, disability, or other characteristics protected by law. Decisions at Truckers411.com are made solely on the basis of merit, ability, qualifications, and character. Reasonable accommodation will be made for qualified individuals with known disabilities so long as it does not impose undue hardship on the company. In the event an employee believes there has been unlawful discrimination or harassment, the employee should contact Aaron Robertson or Zachary Elsts to report the complaint.

SECTION 1: PREVIOUS EMPLOYEE INFORMATION AND RELEASE

I hereby authorize

to release the below information to Truckers411.com, LLC.

For the purposes of investigation and qualifying me to drive a commercial motor vehicle, including to employment drug tests results. You are now required by the U.S. DOT and Federal Motor Carrier Safety Regulations 49 CFR Parts 40, 382, 391 to furnish this information. You are hereby released from and all liability that may result from furnishing such information. Your quick response to this request will be greatly appreciated.

 

Applicant Signature
Requested by prospective employer: Truckers411.com LLC.

SECTION 2: PREVIOUS EMPLOYEE WORK HISTORY (to be completed by past employer)

Did the employee drive a motor vehicle?

Reason for leaving:

SECTION 3: SAFETY PERFORMANCE HISTORY PER 49 C.F.R. 391.23 (2)

Was the employee a safe and efficient driver?

Was the employee involved in accidents in the past three years?

If yes, were any accidents preventable:

If yes, please provide details, including dates:

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SECTION 4: PREVIOUS DRUG AND ALCHOL RESULTS PER 48 C.F.R. 40.25

Was this applicant in a DOT controlled substance testing program with your company?

1. Did the employee have a verified positive drug test result?

2. Did the employee refuse to be tested? ..

3. Did the employee have other violations of DOT agency drug and alcohol testing regulations?

4. Did any previous employers report any drug or alcohol rule violations to you?

5. Did any previous employers report any drug or alcohol rule violations to you?

Drug Screen Authorization and Consent

I hereby authorize and give full permission to have Truckers411.com,LLC.and/or there medical company physician send a specimen of my urine and/or blood to a laboratory for screening test using S.A.M.H.S.A standards for the presence of illegal drugs.

I will hold all parties concerned harmless, meaning it will not sue or hold resposible for any alleged harm to me or interfering with my obtaining a job or continuing my employment due to not submiting to the tests or as a result of the tests.This includes, but is not limited to, possible clerical or laboratory error.

This policy and authorization have been explained to me in a language I understand and I have been told that if I have any question they will be answered about the test.I understand this is legal binding document which is binding because Truckers411.com,LLC. is sending me for the examination and paying for it

I UNDERSTAND Truckers411.com,LLC. WILL REQUIRE A DRUG SCREEN TEST WHENEVER AN ON-THE-JOB ACCIDENT AND INJURY IS REPORTEED IN ACCORDANCE WITH Truckers411.com,LLC. POLICY. MY REFUSAL TO SUBMIT TO DRUG TESTING WILL BE GROUND FOR TERMINATION

 

Applicant Signature

FMCSA Notification of Driver Rights

1) In compliance with 49 CFR Part 40 $391.23 you have certain rights regarding the safety performance history information that will be provided to prospective employers

  • l) You have the right to review information provided by previous employers.
  • ll) You have the right to have errors in the information corrected by the previous employers for that previous employer to resend the corrected information to prospective employers.
  • lll) You have the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

2) Drivers who have previous DOT regulated employment history in the preceding three years and wish to review previous employer provided investigative information must submit a written request to prospective empolyers. This may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. Prospective employers must provide this information within five business days of receiving the written request. If prospective employers have not yet received the requested information from the previous employers, then the five deadline will begin when the requested safety performance history information is received. If you have not arranged to pick up or receive the requested records within 30 days of prospective employers making them available, the prospective employers may consider you to have waived your request to review the record.

 

Applicant Signature

DISCLOSURE & AUTHORIZATION FOR RELEASE OF INFORMATION

As a part of our hiring, a background check and investigation will be conducted. We may ask FleetScreen, a consumer reporting agency, to prepare a consumer report and an investigative consumer report prior to your being qualified in the service of Truckers411.com LLC. The consumer investigative report may consist of contacting all listed prior employers to verify your employment history, job performance and drug/alcohol testing data. It may also include a consumer report to include a check of applicable criminal police or court records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can seek such a report from FleetScreen, we must have your written permission for FleetScreen to obtain the information and to provide the information to us as part of our analysis of your application for employment with our company

Below you will find an authorization and release for FleetScreen to prepare a consumer report, and for our company to receive, a copy of that report. If you do not wish to execute this release, please return all of the application materials to the person from whom you obtained them.

AUTHORIZATION & RELEASE TO OBTAIN CONSUMER REPORT

Under the provision of the Fair Credit Reporting Act, 15 USC, Section 1681 et. Seq., the Americans with Disability Act and all applicable federal, state and local laws, I hereby authorize and permit Truckers411.com LLC. to obtain from FleetScreen, a consumer report and investigative consumer report which may include the following:

  • 1. My employment records.
  • 2. Records concerning any driving, criminal history, credit history, and civil records.
  • 3. For Truck Drivers Only- In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382,413, information concerning alcohol and controlled substances use for the past three (3) years.
  • 4. Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service.

I understand that the above items, which may constitute "investigative consumer reports", may include information as to my character, general reputation, personal characteristics, and mode of living which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information.

I agree that a copy of the authorization has the same effect as an original.

I hereby release and hold harmless any person, firm or entity that discloses matters in accordance with this authorization, as well as Truckers411.com LLC. and FleetScreen from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information

I understand and acknowledge that under provisions of the Fair Credit Reporting Act, I may request a copy of the consumer report or consumer investigative report from FleetScreen, the consumer reporting agency that compiled the report, after I have provided FleetScreen with proper identification. I also understand that before any adverse action is taken based, in whole or in part, on the information in the consumer report, I will be provided a copy of the report, the name, address and telephone number of Fleetscreen, and a summary of my rights under the Fair Credit Reporting Act.

I hereby authorize FleetScreen to obtain and prepare an investigative consumer report as set forth above and to provide that report to Truckers411.com LLC. as part of its investigation of my employment application.

 

Applicant Signature
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