[vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]TRUCK 4 YOU LLC 8565 S EASTERN AVE, STE 130, LAS VEGAS, NV 89123
NAME (First/Middle/Last) (required)
ADDRESS (Street/City/State/ZIP) (required) [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]DATE OF BIRTH (required)
TELEPHONE # (required) [/vc_column_text][/vc_column_inner][vc_column_inner width="1/2"][vc_column_text]SSN (required)
CELL PHONE # (required) [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][vc_column_text]PREVIOUS ADDRESSES FOR PAST 3 YEARS[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Street 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]City 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]State 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]ZIP 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Street 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]City 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]State 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]ZIP 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][vc_column_text]DRIVER LICENSES[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]State 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]License No. 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Type 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Expiration Date 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]State 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]License No. 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Type 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Expiration Date 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner][vc_column_text]DRIVING EXPERIENCE[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][vc_column_text]CLASS OF EQUIPMENT[/vc_column_text][vc_column_text]STRAIGHT TRUCK[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]EQUIPMENT (VAN, TANK, FLAT, ETC)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]DATE(s) FROM[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]DATE(s) TO[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]APPROX. NO. OF MILES (TOTAL)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][vc_column_text]CLASS OF EQUIPMENT[/vc_column_text][vc_column_text]TRACTOR & SEMI-TRAILER[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]EQUIPMENT (VAN, TANK, FLAT, ETC)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]DATE(s) FROM[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]DATE(s) TO[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]APPROX. NO. OF MILES (TOTAL)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][vc_column_text]CLASS OF EQUIPMENT[/vc_column_text][vc_column_text]OTHER[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]EQUIPMENT (VAN, TANK, FLAT, ETC)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]DATE(s) FROM[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]DATE(s) TO[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]APPROX. NO. OF MILES (TOTAL)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner][vc_column_text]ACCIDENT RECORD FOR PAST 3 YEARS[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]DATES[/vc_column_text][vc_column_text]LAST ACCIDENT[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]NATURE OF ACCIDENT (HEAD-ON, REAR-END, UPSET, ETC.)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]FATALITIES[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]INJURIES[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]DATES[/vc_column_text][vc_column_text]NEXT PREVIOUS[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]NATURE OF ACCIDENT (HEAD-ON, REAR-END, UPSET, ETC.)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]FATALITIES[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]INJURIES[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]DATES[/vc_column_text][vc_column_text]NEXT PREVIOUS[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]NATURE OF ACCIDENT (HEAD-ON, REAR-END, UPSET, ETC.)[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]FATALITIES[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]INJURIES[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner][vc_column_text]TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS – ATTACH SHEET IF MORE SPACE IS NEEDED)[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]LOCATION[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]DATE[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]CHARGE[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]PENALTY[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]LOCATION[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]DATE[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]CHARGE[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]PENALTY[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]
Motor Vehicle Driver’s Certification of Violations and Annual Review of Driving Record
(Completed in accordance with 49 CFR 391.25 and 391.27)
[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_column_text]Drivers Name: [/vc_column_text][vc_column_text]I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months.[/vc_column_text][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]Date 1[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Offense[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Location[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Type of Vehicle Operated[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]Date 2[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Offense[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Location[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Type of Vehicle Operated[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]Date 3[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Offense[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Location[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Type of Vehicle Operated[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][/vc_row_inner][vc_column_text]If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months.[/vc_column_text][vc_column_text]I have reviewed the driving record and safety history of the above named driver in accordance with 49 CFR Part 391 and determined that the driver:[/vc_column_text][vc_row_inner][vc_column_inner width="1/6"][/vc_column_inner][vc_column_inner width="2/3"][vc_column_text]Meets minimum safe driving requirementsIs disqualified to drive a commercial motor vehicle pursuant to 49 CFR 391.15 or does not meet our safety fitness standards[/vc_column_text][/vc_column_inner][vc_column_inner width="1/6"][/vc_column_inner][/vc_row_inner][vc_column_text]
New Hire or Intermittent Hours of Service Sheet Total Time On-Duty for Preceding 7 Days Required by Part 395.8(j)(2)
[/vc_column_text][vc_column_text]PREVIOUS DAYS[/vc_column_text][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Day 7[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Date[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Hours Worked[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Day 6[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Date[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Hours Worked[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Day 5[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Date[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Hours Worked[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Day 4[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Date[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Hours Worked[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Day 3[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Date[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Hours Worked[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Day 2[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Date[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Hours Worked[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/5"][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Day 1[/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Date[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][vc_column_text]Hours Worked[/vc_column_text][vc_column_text][/vc_column_text][vc_column_text]TOTAL HOURS[/vc_column_text][vc_column_text][/vc_column_text][/vc_column_inner][vc_column_inner width="1/5"][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]Off-Duty Time. Drivers may record all time not defined as on-duty time, defined below, as off-duty time. On duty time means all time from the time a driver begins to work or is required to be in readiness to work until the time the driver is relieved from work and all responsibility for performing work. On duty time shall include:
The company permits its drivers to log off-duty or sleeper berth whenever the driver is relieved from work and all responsibility for performing work. The company allows drivers to record meals as off duty. It is the responsibility of the driver to properly secure all equipment and cargo before going off duty.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]Pre-Lease Owner Operator Agreements and Requirements
Fair Credit Reporting Act Disclosure Statement
In accordance with the provision of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.
Driver Notification
This notice serves to fulfill the requirements of 49 CFR Part 391.23(i). Each motor carrier must notify each driver, who is regulated by the Department of Transportation, of their rights regarding investigative information that will be provided to a prospective employer.
Drivers have:
[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_column_text]Past Pre-Employment Drug & Alcohol Testing
In accordance with 49 CFR Part 40.25(j) the employer is required to ask the employee:
Have you ever tested positive 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?[/vc_column_text][vc_column_text]
YesNo
[/vc_column_text][vc_column_text]ACKNOWLEDGMENT OF RECEIPT OF MOTOR CARRIER DRUG AND ALCOHOL TESTING PROGRAM AGREEMENT
I, hereby acknowledge that I have received a copy of Truck 4 You LLC . Motor Carrier Drug Testing Program (“Program”), which has been developed pursuant to 49 CFR Part 382.
In conjunction with my receiving a copy of the Program, I further acknowledge the following:
I have read the Program and fully understand the terms contained therein and the consequences for violating any term of the Program.
I understand that my compliance with all terms of the Program is a condition of my lease/employment with Truck 4 You LLC. and I agree to abide by all terms of the Program.
If a post – accident drug rest is required under the Program and I am seriously injured and unable to provide specimen at the time of the accident, then this Acknowledgment shall be considered my authorization for Truck 4 You LLC. or its designated representative to obtain hospital reports and other documents which would indicate whether there were any controlled substances in my system.
I authorize the collection site, laboratory and/or medical review officer retained by Truck 4 You LLC. to perform any and all functions, which those entities and/or individuals may be, required to perform pursuant to the applicable Federal Department of Transportation regulations. Such authorization shall include, but is not limited to Truck 4 You LLC. verification of the use of prescribed medications, obtaining information from the driver’s physician, hospital, dentist or pharmacist and the reporting of negative test results with a qualifying statement in cases wherein a driver may be taking a legally – prescribed Schedule II drug.
I hereby release and hold harmless the Company, Truck 4 You LLC., and its employees and agents from any liability whatsoever arising from the Program.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]Have you ever been convicted of a Felony, DUI or DWI?
If yes, please explain
[/vc_column_text][vc_column_text]Has any license, permit or privilege ever been suspended or revoked?
[/vc_column_text][vc_column_text]Have you ever tested positive for drugs and/or alcohol?
[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_column_text]Past Employment Record
(List ALL past employment for the last three years and ALL DOT regulated past employers for the past 10 years)[/vc_column_text][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo][/vc_column_text][/vc_column_inner][vc_column_inner width="1/2"][vc_column_text]Was this employer regulated by U.S. DOT?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Second Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Third Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Fourth Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Fifth Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Sixth Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Seventh Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Eighth Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Ninth Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Tenth Last Employer [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Name: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Address/City/State: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Phone: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Fax: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Position Held: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Reason for Leaving: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Where you subject to U.S. DOT drug & alcohol testing?
YesNo[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]PAST EMPLOYMENT SAFETY HISTORY REQUEST
The person named herein has applied to Truck 4 You LLC for employment in a safety-sensitive position.
I, the listed applicant below, hereby authorize the following company(s) to release all records of employment, including assessments of my job performance, ability, fitness and drug testing results to Truck 4 You LLC. I hereby release this company, and its employees, officers, directors, and agents from any and all liability of any type as a result of providing the following information to the above-mentioned company. The applicant’s signature on this form releases all liability of you and your company. Information is being requested in accordance with 49 CFR Parts 40, 382 and 391.
NAME:
PREVIOUS COMPANY:
ADDRESS:
PHONE:
FAX:
SSN: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_column_text]Dates of employment: [/vc_column_text][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]From: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]To: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Full timePart time[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]Positon held: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Local: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Regional: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Over the road: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Did this driver operate commercial motor vehicles greater than 26,000 lbs GVWR? YesNo[/vc_column_text][/vc_column_inner][vc_column_inner width="1/2"][vc_column_text]Type of equipment operated: Dry VanFlatbadReeferOther[/vc_column_text][vc_column_text]If other please list: [/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/2"][vc_column_text]Reason for leaving: VoluntaryLay-OffTerminatedRetired[/vc_column_text][vc_column_text]If terminated why? [/vc_column_text][/vc_column_inner][vc_column_inner width="1/2"][vc_column_text]Eligible for rehire? YesNoUpon ReviewNo, Company policy[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner][vc_column_text]Motor Vehicle Accident/Equipment Damage/Incident Inquiry, If no accidents please check box
None[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]Accident Date 1
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]City/State 1
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Did the Accident Involve 1 ?
TowInjuryFatalityHM Release[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Brief description
[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]Accident Date 2
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]City/State 2
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Did the Accident Involve 2 ?
[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/4"][vc_column_text]Accident Date 3
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]City/State 3
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/4"][vc_column_text]Did the Accident Involve 3 ?
[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/6"][/vc_column_inner][vc_column_inner width="2/3"][vc_column_text]Alcohol & Controlled Substance Testing Inquiry
Has this driver ever had a breath alcohol test within the past 3 years a result of 0.04 or higher alcohol concentration?
Has this driver ever had a positive drug test in the past 3 years?
Has this driver refused a controlled substance test and/or alcohol test within the past 3 years?
Has this driver violated any other DOT drug/alcohol regulation?
To your knowledge has this driver violated any DOT drug and alcohol regulations at a previous employer?
YesNo[/vc_column_text][vc_column_text]**If the answer to any of the above questions is “Yes”, please provide details below:[/vc_column_text][/vc_column_inner][vc_column_inner width="1/6"][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]Reasons for test(s):
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Results of test(s):
[/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]Date of test(s):
[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_column_text]If the applicant tested positive, to your knowledge, have they satisfactorily completed all return to duty and follow-up testing requirements in accordance 49 CFR 382.503?
YesNo[/vc_column_text][vc_column_text]Any other remarks:
[/vc_column_text][vc_column_text]Verification Completed By:
[/vc_column_text][vc_column_text]Title:
[/vc_column_text][vc_column_text]Phone Number:
[/vc_column_text][vc_column_text]Verification Date:
[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner width="1/3"][vc_column_text]First Request Date:
Fax:
Mail:
Phone:
Initials: [/vc_column_text][/vc_column_inner][vc_column_inner width="1/3"][vc_column_text]First Request Date:
Initials: [/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]7) It is responsibility to the driver to weight after loading every time the weight on the shipping documents is greater than 25.000 pounds. If the weight of the load is over the limit the driver is to go back to the shipper and request to be reloaded. Failure to do so makes the driver responsible for any fees and tickets concerning the over-the-limit weight.
8) The driver must realize that the Dispatchers are doing their best to fulfill the interests of different parties, and it is their intention to make their best for the driver at all the times. If any problems or requirements the driver should inform the Dispatch Office on time. More patient the driver is, there's more time for the office staff to handle variety of tasks, which includes meeting driver's needs.
9) In case of accident the driver is responsible to gather information about: a. Vehicle involved in the accident (if commercial vehicle info on the truck and the trailer- registration and VIN #) b. Driver information c. Insurance information d. Carrier information e. Exact location of the accident It is driver's responsibility to fill the Accident report form (kept in the truck) and send it to our main office. No information about the accident is to be given to any parties (except Police). The driver has the right not to release any information about the accident to any party interested. It is company policy to retain any info on the accident until our representative check all these information first.
10) CASH ADVAVCES can be issued after the driver completes his first load with our company. The cash advances are to be used for expenses such as tolls and repairs on the truck and the trailer. The driver cannot get a cash advance for his own personal expenses. The maximum allowed amount for weekly cash advance per driver is $200.00. If the weekly cash advance is higher than this amount a $5.00 fee will be applied. The cash advance cannot exceed $400.00 under any circumstances.
11) REFUSING LOADS- If a driver take a load; it is his responsibility to deliver it on time. In case the driver drops the load someplace down the road, or refuse to pick up the load afterwards without a reasonable explanation, $2,500 fee will be deducted from his pay, and will be responsible to cover all attorney and legal fees.
12) Bill of lading and other shipping documents on completed loads should be sent weekly to the Main Office. The loads are to be paid to the Contractor (consequently to the driver) two weeks after the paperwork on the loads is received. The paperwork on certain load should be neatly organized and not mixed up with paperwork from other loads. Charges will be applied if paperwork sent is not organized properly, because it takes our time to mach it together.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]13) In case unloading service is required by the shipper the driver has to immediately call the Dispatch Office and inform the dispatcher about that. He has to wait until he receives an approval from the dispatcher before paying any unloading charges or unloading the load by himself. The driver must make sure to provide lumper receipt or have a signature on the shipping document with a written statement proving that the driver was loading/ unloading the load. The receipts of all the lumpers paid have to be sent to the main office, no reimbursement will be made to the driver unless a receipt is provided to the office.
14) To provide better rate of compliance with the D.O. T. Safety rules, the driver will be rewarded $50.00 for every passing a D.O.T Inspection, and $250.00 for not passing DOT Inspection for first time. Every out of service for any violation concerning the log book, the truck and the trailer will result in $500.00 fine for the first violation and $1,000 for the second violation. In this case it is between the driver and his Employer (Independent Contractor) to decide who is covering this fine (which will depend if this fine resulted from driver's failure to do pre-trip inspection or inform the contractor for any problems on the equipment, or if this fine resulted from Contractor failure to fix the equipment). If out of service is reached third time there will be a charge of $1,500 and driver will not be eligible to work with the Carrier any longer.
15) It is duty of the driver to make sure that he has all documentation for the truck and the trailer, such as registration, insurance and other permits before he starts driving. In case the driver is moving to another truck he is not allowed to take any documentation in the other truck. In this case the driver should take his Fuel card, but no other documentation except this.
16) In case a driver is stopped by D.O. T Inspection or on a Weight Station a report from the Inspection should be sent to the main office, so we can sign and send the reports in 15 DAYS. In case the driver does not send this report on time and we are late because of that, the driver will be charged double fee than the D.O.T. fine for the Company.
17) Our policy does not allow any driver to drop loaded trailer while under load. If the trailer has to be dropped for any exceptional reason driver has to inform our dispatch office and ask for approval. In case the drop is approved by the dispatch the trailer has to be dropped in secured place, and has to have load-locks. Our company insurance covers damage or loss on the load or the trailer only if the trailer is hooked on the truck. If the trailer is left unhooked the driver is responsible for every possible loss or damage on the trailer or the load. In addition driver covers all attorney and legal costs.
18) If driver is not compliance with company rules Professional Express has a right to brake this contract and fire the driver with no any responsibilities to the driver.[/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]NOTICE TO DRIVERS AND CERTIFICATE OF COMPLIANCE
NOTICE TO DRIVERS
The commercial Motor Vehicle Act of 1986 provides the new law that applies to all drivers operating commercial vehicles with Gross Vehicle Weight Rating over 26000 pounds and any vehicle transporting hazardous materials. The following provisions of this legislation become effective July 1, 1987:
CERTIFICATION OF DRIVER
I hereby certify that I have read and understand the above mentioned provisions. I, further certify that the listed commercial vehicle license is the only held.[/vc_column_text][vc_column_text]Drivers name:
Licence state:
Type/Class:
ID/NO: [/vc_column_text][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_row_inner][vc_column_inner][vc_column_text]DRIVER ORENTATION COMMUNICATION IS THE CORNERSTONE FOR SUCCESS. IF YOU HAVE ANY QUESSTION ABOUT OUR COMPANY, PLEASE ASK. AFTER YOU FULLY UNDERSATAND THE COMPANY PROCEDURES DESCRIBED ON THIS PAGE PLEASE SIGN AND DATE. 1. ACCIDENT PROCEDURES (THE AMOUNT OF TIME REQUIRED TO CALL IN THE REPORT AND THE TIME FRAME OF GETTING IN THE WRITTEN COMPANY REPORT). 2. CAMERAS ARE MANDATORY (THIS IS FOR ACCIDENTS OF ANY KIND) 3. DRUG TESTING REGULATIONS (RANDOM, POST-ACCIDENTAL AND REASONABLE) 4. PAPERWORK (TRIP REPORTS, LOG SHEETS AND FUEL RECEIPTS) 5. SAFETY MANUAL. 6. PERMIT REQUIREMENTS 7. DOT HANDBOOK 8. DISPATCH INFORMATION 9. EQUIPMENT REQUIREMENTS 10. HAZARDOUS MATERIALS TRAINING (IF APPLICABLE).[/vc_column_text][vc_column_text]RIDERS PROGRAM
[/vc_column_text][vc_column_text]Date (required)
Signature (required)
Important note! This signature field is meant to be signed after the completion of all 5 steps of the application form. For desktop and laptop users please sign with a mouse. For mobile phone and tablet users please sign with your finger. The signature is required.[/vc_column_text][vc_column_text]Employee Receipt
I have received and been notified of the MOBILE COMMUNICATION DEVICES policy for Truck 4 You LLC All communication efforts I undertake in the future while on company business will follow the above guidelines,[/vc_column_text][/vc_column_inner][/vc_row_inner][vc_column_text][/vc_column_text][/vc_column][/vc_row]
