Source: http://www.randstrucking.com/employment/application.php
Timestamp: 2017-12-14 22:27:52
Document Index: 227882000

Matched Legal Cases: ['§383', '§391', '§391', '§382', '§382', '§40', '§391', '§391']

Current Address: 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 Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Previous Address: 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 Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
IN CASE OF EMERGENCY NOTIFY: AT PHONE No.:
Position Applying For: Desired Salary:
Have you ever worked for this company? Yes No IF YES, FROM: TO:
Are you employed? Yes No When will you be Available?
ARE YOU PREVENTED FROM LAWFUL EMPLOYMENT IN THIS COUNTRY BECAUSE OF IMMIGRATION STATUS? Yes No
HAVE YOU EVER BEEN CONVICTED OF A FELONY, MISDEMEANOR, OR CRIMINAL VIOLATION? Yes No
Driver's License Information (This info will be verified)
VALID DRIVER'S LICENSE NUMBER: 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 Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Expiration:
License Type (i.e. cdl class a): CDL Endorsements:
HAS YOUR LICENSE, PERMIT, OR PRIVILEGE TO OPERATE A MOTOR VEHICLE EVER BEEN DENIED, REVOKED, OR SUSPENDED? Yes No
HAVE YOU EVER BEEN DISQUALIFIED UNDER §383 OR §391 OF THE FEDERAL MOTOR CARRIER SAFETY REGULATIONS? Yes No
I CERTIFY I DO NOT HAVE MORE THAN ONE DRIVER'S LICENSE.
Truck: Years: States you've driven in: None
Trailer/Tank: Years: States you've driven in: None
Straight Truck: Years: States you've driven in: None
Bus: Years: States you've driven in: None
Other: Years: States you've driven in: None
accident record last three years (this info will be verified)
Date: Nature of the Accident: No. of fatalities: No. of injuries: Commercial or
Traffic convictions and forfeitures (other than parking) last three years (this info will be verified)
State: 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 Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Date: Charge: Penalty: Commercial or
Non-CDL driver applicants must provide 3 years employment history. CDL driver applicants must provide 10 years. We are required under §391.23 to investigate your safety performance history of all Federal Motor Carrier Safety Administration regulated employers that you worked for in the preceding 3 years. We are required to investigate your participation in a U.S. DOT mandated drug and alcohol testing program, whether you violated and probations under §382 subpart B, and whether you failed to undertake or complete rehabilitation as required under §382.605 or subpart O §40 of all U.S. DOT regulated employers that you worked for in the preceding 3 years. You must give written consent for these investigations in order to be considered for employment as a driver. You have due process rights regarding the information received from the investigations under §391.23(i).
All information obtained from previous employers will be kept confidential.
Address: 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 Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Supervisor's Name: Employed From: To:
Positon: Reason for Leaving:
did you perform "safety sensitive functions" while employed? Yes No did you operate a cdl vehicle? Yes No
were you required to participate in a u.s. dot mandated drug and alcohol testing program? Yes No
Applicant - If employer has not explained or given a job description, make sure one is given to you and that you fully understand what is expected of you prior to answering the following two questions.
I agree and understand that any misrepresentations or omissions of information or facts given on this form shall be considered an act of falsification.
I agree and understand that the carrier or its agents may investigate any and all information given on this form to determine its validity.
I understand that all employment history information from previous employers will be used by the carrier only as part of deciding whether to hire me.
I understand that under U.S. DOT regulation §391.23(i), I cannot bring an action or proceeding for defamation, invasion of privacy, or interference with a contract against this carrier or any previous employer base on furnishing or using employment history information.
I agree to furnish such additional information and complete such examinations as may be required to complete my driver qualification and employment files.
If hired, I agree to abide by all the rules and policies of this carrier.
Date Signature of Company Representative Date of Hire
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