Source: https://www.bcptrans.com/drivers-application-for-employment
Timestamp: 2019-01-23 12:36:11
Document Index: 714309730

Matched Legal Cases: ['art 391', 'art 391', 'art 40', 'art 40', 'art 40', 'art 40', 'art 391', 'art 391', 'art 391']

Truck Driver's Job Application | BCP Transportation
Home / Driver’s Application for Employment
Step 1 of 14 - Applicant’s Statement and Agreement
APPLICANT’S STATEMENT AND AGREEMENT
I authorize BCP Transportation, Inc. (“Company”) and any agent acting on their behalf, to verify all statements contained in this application for employment and 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. I agree to furnish additional information and complete such examinations as may be required to complete my application file. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.)
I hereby release and discharge the Company and any agent acting on their behalf, employers, schools, health care providers and other persons from any and all liability in responding to inquiries and releasing information in connection with my application.
According to the Fair Credit Reporting Act, I am entitled to know if employment is denied because of information obtained by my prospective employer from a consumer reporting agency. If so, I will be so advised and given the name of the agency or source of information.
I understand that any misrepresentation, falsification or willful omission of information contained in this application or in connection with any physical examination shall be sufficient reason for refusal of or dismissal from employment.
I understand that this employment application and any related Company documents are not contracts of employment and that, if I am hired, I may voluntarily leave employment at any time for any reason and, otherwise, the Company may terminate my employment at any time for any reason. Any representations to the contrary in any related Company document or by any representative of the Company shall not be relied upon or be construed as Company policy.
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 FMCSA regulation 49 CFR Part 391.23(d) and (e). I understand that pursuant to FMCSA regulation 49 CFR Part 391.23(i)(1), I have the right to:
I agree to the above "Applicant's Statement"
Owner Operator (contractor)
Owner Operator’s Driver
Mechanic (w/CDL)
Previous Address(es) (if less than 3 years at current):
Conviction of a crime is not an automatic bar to employment-all circumstances will be considered.
All applicants must provide the following information on all employers during the preceding 3 years. List complete mailing address and contact information.
All applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years’ information on those employers for who the applicant operated such vehicle.
*Includes vehicles having a GVWR OF26,001 lbs or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring place carding.
WERE YOU SUBJECT TO THE FMCSRs† WHILE EMPLOYED?
†The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring place carding.
- FOR PAST 3 YEARS OR MORE, IF NONE WRITE "NONE"
HAZARDOUS MATERIALS SPILL (Y/N)
TRAFFIC CONVICTIONS & FORFEITURES
- FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE "NONE"
LIST ALL DRIVER LICENSES OR PERMITS THAT HELD IN THE PAST 3 YEARS*
If the answer to either A or B is YES, give details:
Select Yes or No if you have experience with the below classes of equipment. If you answer ‘Yes’, also indicate the type of equipment operated in the class, number of years of experience and approximate number of miles.
CHECK TYPE OF EQUIPMENT*
TRACTOR AND SEMI-TRAILER*
TRACTOR-TWO TRAILERS*
TRACTOR-THREE TRAILERS*
MOTORCOACH-SCHOOL BUS*
8+ PASSENGERS
LIST OF STATES OPERATED IN FOR LAST FIVE YEARS:
LIST ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE, COURSES AND TRAINING THAT MAY HELP YOU IN YOUR WORK FOR THIS COMPANY:
Grade School 1Grade School 2Grade School 3Grade School 4Grade School 5Grade School 6Grade School 7Grade School 8Grade School 9Grade School 10Grade School 11Grade School 12College 1College 2College 3College 4
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 and any misrepresentation or omission on my part is cause for rejection or termination.
Drug And Alcohol Pre-Employment Statement And Consent
Pre-Employment Drug or Alcohol Test for Previous Employers
49 CFR Part 40.25(j) requires an employer to ask any applicant whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If the applicant admits that he or she had a positive test or a refusal to test, BCP Transportation, Inc. (“Company”) must not use the applicant to perform safety-sensitive functions, until and unless the applicant documents successful completion of the return-to-duty process (see section 49 CFR Part 40.25 (b)(5) and (e)).
As an applicant applying to perform safety-sensitive functions for the Company, you are required by 49 CFR Part 40.25(j) to respond to the following questions:
1. Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?*
2. If you answered “yes” to the above question, can you provide proof that you have successfully completed the DOT return-to-duty requirements?*
PRE-EMPLOYMENT DRUG TESTING NOTIFICATION AND CONSENT
I understand that, if I test positive for use of controlled substances, 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 result is reported to the Company. The results of the drug tests will be maintained by the medical review 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 49 CFR Part 40.37, without my written authorization.
I hereby agree to submit to a urine drug test.*
Previous Employer Drug and Alcohol Testing and Safety
Performance History Consent
In accordance with FMCSA Regulation 49 CFR Part 391.23, I understand that BCP Transportation, Inc. (“Company”) will perform an investigation of my safety performance history with Department of Transportation (“DOT”) regulated employers during the preceding three years from the date shown below. I acknowledge that this information will be used in determining my eligibility to be hired, and that I have the right to review this information and rebut any errors in the statements from previous employers, as described in the FMCSA Regulation 49 CFR Part 391.23(i)(1).
1. I authorize the release of information from my DOT regulated drug and alcohol testing records by the previous employer listed below to the Company, and any agent acting on their behalf, for the sole purpose of transmitting such records to the Company. I authorize release of the following information concerning DOT drug and alcohol testing violations, including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher alcohol concentration; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted drug test results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation, to include SAP information and follow-up tests and/or documentation of non-completion or refusal of SAP referral and all testing violations subsequent to the successful completion of a rehabilitation SAP.
2. I authorize the release of my safety performance history information, as described in 49 CFR Part 391.23(d), by the previous employer listed below to the Company.
3. I authorize the release of employment information as requested by the Company to the previous employer listed below as they pertain to my application for employment, including, but not limited to, names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials, and training courses completed.
4. I hereby release the previous employer listed below, and its employees, officers, directors, and agents from any and all liability of any type as a result of providing information to the Company.
I authorize all previous employers to release and forward in accordance with the above regulation, all known information pertaining to my alcohol and controlled substances testing/training records to BCP Transportation, Inc.
Background Reports Disclosure and Release
In connection with your employment or application for employment (including contract for services) through BCP Transportation, Inc. (“Company”), consumer reports (Investigative Consumer Reports in California) may be requested from HireRight, Inc. (“HireRight”). These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials, and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers’ compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well as information from HireRight concerning previous driving record requests made by others from such state agencies and state provided driving records.
BCP Transportation, Inc., will also obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration (“FMCSA”).
You have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that HireRight has previously furnished within the past two year period preceding your request (3 years in California). HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.com. You may also bring a third party with you to view the information at the HireRight offices if this person provides proper identification. Information about HireRight’s privacy practices is available at www.hireright.com/Privacy-Policy.aspx.
I AUTHROIZE, WTHOUT RESERVATION, HIRERIGHT, FMCSA, AND ANY OTHER PARTY OR AGENCY CONTACTACTED BY HIRERIGHT TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER THE CONSENT FOR PREVIOUS EMPLOYER DRUG AND ALCOHOL TESTING AND SAFETY PERFORMANCE HISTORY.
I hereby consent to the Company obtaining the above information from HireRight, and I agree that such information which HireRight has or obtains in my employment history (not DOT drug and alcohol information without a specific consent by me) with the Company if I am hired, will be supplied by HireRight to other companies which subscribe to HireRight. I hereby authorize procurement of consumer reports as set forth above.
I hereby consent to the Company obtaining the above information from FMCSA. I understand that neither the Company nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. If I challenge the accuracy of the data, a request must be submitted to https://dataqs.fmcsa.dot.gov. If crash or inspection information reported by a State is challenged, FMCSA cannot change or correct this data. Requests 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 Pre-Employment Screening Program (“PSP”) report. Since the PSP report does not report, or assign, or imply fault, I understand it will include all Commercial Motor Vehicle (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, with or without violations, appear on the PSP report and that 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.
I agree to the above disclosure and release statements
In connection with your application for employment with
Employment with*
(“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).
(“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.
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