Driver Employment Application

Please fill out all required fields to submit your request. Soon we will contact you to provide more information about the process.

You can also download HERE the document to print. Once it is filling, you can deliver it personally, or you scan it and send it by an e-mail.

Name: (first, middle, last):

Hire Date (office use only):

Phone Number:

E-mail:

Date of Birth (dd/mm/yyyy):

Social Security Number:

Are you legally authorized to work in the U.S.?

Emergency Contact Name:

Relation:

Address:

Phone Number:

You must list all previous addresses for 3 years.

Address (Street, city, state, zip code)

DRIVER LICENSE INFORMATION

Driver License Number:

State:

Type:

Expiration Date:

DRIVER EXPERIENCIE

Type of Equipment:

From (Date):

To (Date):

Approx. # of Miles:

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Type of Equipment:

From (Date):

To (Date):

Aprox. # of Miles:

REQUIRED QUESTIONS

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?

Have you ever been convicted of any criminal act involving the use of a CMV or while driving a CMV?

Have you ever been convicted of any law violation? (Include any plea of "Guilty" or "No Contest" except for minor traffic violation)

If you answered yes to any of the above 4 questions, attach a statement of explanation:

TICKETS / ACCIDENTS / ETC.

Accident Record for Past 3 Years

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Date:

Description:

# of Injuries / Fatalities:

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Date:

Description:

# of Injuries / Fatalities:

Traffic Convictions & Forfeitures for past 3 Years

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Date:

Location:

Charge:

Penalty:

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Date:

Location:

Charge:

Penalty:

EMPLOYMENT RECORD

Employer:

From:

To:

Address:

Phone Number:

Position:

Were you subject to the FMCSRs while employed?

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

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Employer:

From:

To:

Address:

Phone Number:

Position:

Were you subject to the FMCSRs while employed?

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

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Employer:

From:

To:

Address:

Phone Number:

Position:

Were you subject to the FMCSRs while employed?

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

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Employer:

From:

To:

Address:

Phone Number:

Position:

Were you subject to the FMCSRs while employed?

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

DECLARATION OF EMPLOYMENT STATUS (GAPS IN HISTORY)

Of you were driving a CMV, you must provide complete employment history for the past 10 years. Any gaps in employment longer than 1 month are explained as follows:

Activity During Break:

From:

To:

In addition, I was not employed by any company or individual

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Activity During Break:

From:

To:

In addition, I was not employed by any company or individual

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Activity During Break:

From:

To:

In addition, I was not employed by any company or individual

TO BE READ AND ACCEPTED 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 hereby 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 interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand information I provide regarding current and/or previous employers may be used, and those employers 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 the 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.

This certifies 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.

I Accept:

Date:

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

In accordance with the provisions 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. Your employer may obtain this information from Equifax, TransUnion, Experian or other vendors of information services.

I Accept:

Date:

Print Name:

Social Security Number:

Employer Witness

PSP DRIVER BACKGROUND INVESTIGATION RELEASE

In connection with your application for employment with UNITED RECYCLING TRANSPORTATION LLC, it may obtain one or more reports regarding your credit, driving, and/or criminal background history from a consumer reporting agency and/or other sources. If the Prospective Employer uses any information it obtains from a background report in a decision to not hire you or make any other adverse employment decision regarding you, the Prospective Employer will provide you a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon a background report, the Prospective Employer with notify you that the action has been taken and that the background report was the reason for the action. The Prospective Employer cannot obtain background reports from the consumer reporting agencies or other sources regarding you unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize UNITED RECYCLING TRANSPORTATION LLC to contact any organization or individual that I have listed on my employment application or resume or mentioned in job interviews and obtain from them any relevant information about myjob qualifications, including my experience, skills, and abilities. I understand that I am consenting to the release of safety performance in' *nation including crash data from the previous five (5) years and inspection history from the previous .. tree (3) years, as well as any reference-related informational bout me held or known by my former employers, supervisors, and co-workers. ln addition, I consent to the release of any information about my education, experience, abilities, or work-related characteristics or traits held or known by other organizations or individuals, including school and educational institutions, professional or business associates, and friends and acquaintances that Prospective Employer might contact in the course of conducting a reference check or background investigation of my suitability for employment.

I understand and acknowledge that is release of information can involve my qualifications, performance, credentials, or other characteristics or factors affecting my suitability for employment with Prospective Employer. Specifically, I am authorizing the release of any information about my performance, experience, capability, attitude, specific events, or other work-related characteristics that currently are in the possession of the requested organizations or their managers or representatives.

In exchange for Prospective Employer’s consideration of my employment application, I agree not to file or pursue any complaints, claims, or legal actions of any kind against any organization or individual that provides work-related information about me to Prospective Employer or its agents in accordance with the terms and intent of this retease. I also agree not to file or pursue any complaints, claims, or legal actions against Prospective Employer or any of its employees, representatives, or agents arising out of their efforts to obtain work-related information about me.

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I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, Prospective Employer and/or any entity it retains to obtain such background reports and may obtain reports of my credit, driving, and/or criminal background history in addition to infomation regarding my background, references, education, specific events, and past employment.

I hereby authorize Prospective Employer and its employees, agents, and its affiliates to obtain the information authorized above.

I Accept:

Date:

Print Name:

ALCOHOL AND CONTROLLED SUBSTANCE CONSENT AND RELEASE

Have you ever refused tobe tested for drugs or alcohol?

Have you ever tested positive for drugs or alcohol?

Have you ever tested positive for any pre-employment drug or alcohol test for a job wich you applied for but did not obtain?

If you answered yes to any of the above questions, attach a statement of explanation and provide proof of Return to Duty Process.

Attach files:

l understand that, as required by the Federal Motor Carrier Safety Regulations or company policy, all drivers must submit to alcohol and controlled substance testing as a condition of employment. l also understand that any offer of employment will be contingent upon the results of an alcohol and controlled substance test.

Therefore, I agree to submit to the following alcohol and controlled substance tests in accordance and as defined by the Federal Motor Carrier Safety Regulation and this company’s policies:

- Pre-Employment, to determine employment eligibility

- Random

- Reasonable Suspicion

- Post Accident

- Follow Up (see company policy)

- Retum-to-duty (see company policy)

I certify that l have read, understand, and agree to abide by the condition of this consent and release form. Failure to sign will prevent this employer from using you as a CMV driver.

I Accept:

Date:

Print name:

Social Security Number:

Employer Witness:

Applicants for positions that require ‘driving a commercial motor vehicle (CMV) requiring a CDL at any time will be required to undergo controlled substances and at our discretion, alcohol testing prior to employment and will be subject to further testing throughout their period of employment.

The company’s policy is that if a person has ever been in violation of the rules in part 40 (DOT) or 382 (FMCSA) they will NOT be considered eligible for any job which includes operation of a CMV (Greater than 10,000 G\/\NR) unless they have completed the return to duty process.

CDL drivers will be subject to random and reasonable suspicion drug testing each day they report for work.

CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS

MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:

1. You, as a commercial vehicle driver, may not possess more than one license.

2. If you currently have more than one license, you should keep the license from your state of residence, and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, you should close your record by notifying the state of issuance that you no longer want to be licensed by that state.

3. Sections 392.42 and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver’s license. In addition, Section 383.31 requires that any time you violate a state or local traffic law (other than parking), you must report it to your employing motor carrier and the state that issued your license within 30 days.

DRIVER CERTIFICATION: I certify that I have read and understand the above requirements.

The following license is the only one I will possess:

Driver License Number:

State:

Expiration:

Driver Signature:

Date:

SAFETY PERFORMANCE HISTORY RECORDS REQUEST

Section 1 | To be Completed by Prospective Employee

Name (First, Middle, last):

Social Security Number:

Date of Birth (dd/mm/yyyy):

Hereby Authorize (Previous Employer):

Address (Street):

Address (City, State, Zip):

Phone:

Fax:

To release and forward the information requested by section 2 and 3 of this document concerning my Alcohol and Controlled Substance testing records within the previous 3 years

From:

To:

Attn:

Phone:

Fax:

Prospective Employer:

UNITED RECYCLING TRANSPORTATION LLC.

Address:

1034 CITIZENS PKWY, MORROW, GA 30260

In compliance with 40.25(g) and 391.23(h) , release of this information must be made in a written form that ensures confidentiality, such as fax, letter or e-mail.

I Accept:

Date:

Section 2 | To be Completed by Previous Employer

This applicant named above was employed by us:

Employed:

From:

To:

Did he/she drive a motor vehicle for you?

If yes, What type?

__ Straight Truck
__ Tractor Trailer
__ Other

If you selected other, explain:

Reason for leaving your employ

__ Discharged
__ Resignation
__ Lay Off
__ MIlitary Duty

If there is no safety performance history to report, chek, accept below & return.

__ Check

Complete the following for any accidents included on you accident register (§390.15(b) that involved the applicant in the 3 years prior to the application date shown above, or check if there is no accident register data for this driver.

__ Check

Date:

Location:

Nº of Injuries:

Nº of Fatalities:

Hazmat Spill:

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Date:

Location:

Nº of Injuries:

Nº of Fatalities:

Hazmat Spill:

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Date:

Location:

Nº of Injuries:

Nº of Fatalities:

Hazmat Spill:

Please provide information concerning any other accidents involving the application that were reported to government agencies or insurers or retained under internal company policies:

I Accept:

Title:

Date:

Section 3 | To be Completed by Previous Employer

If the applicant was not subject to DOT testing requirements while employed by you please check:

__ Check

Fill in the dates of employment

From:

To:

Complete the bottom of Section 3 sign, and return.

Has this person had an alcohol test with a result of 0.04 or higher?

Has this person tested positive, adulterated or substituted a test specimen for controlled substances?

Has this person refused to submit to a post accident, random, reasonable suspicion or follow up controlled substance test?

Has this person committed other violations of Subpart B of Part 382 or Part 40?

Has this person committed other violations of Subpart B of Part 382 or Part 40? lf this person has violated a DOT drug & alcohol regulation did this person complete a SAP prescribed rehabilitation program in your employ, including return-to-duty and follow-up tests? lf yes, please send documentation with this form.

For a driver who successfully complete a SAP’s rehabilitation referral and remained in your employ, did this driver subsequently have an alcohol test result of 0.04 or greater, a verified positive drug test, or refuse to be tested?

In answering these questions. include any required DOT drug or alcohol testing information obtained from prior previous employers in the previous 3 years prior to the application date shown in Section 1.

Name:

Company:

Phone:

Address (Street, City, State, Zip):

Date:

I Accept:

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Driver Employment Application

You must list all previous addresses for 3 years.

DRIVER LICENSE INFORMATION

DRIVER EXPERIENCIE

REQUIRED QUESTIONS

TICKETS / ACCIDENTS / ETC.

Accident Record for Past 3 Years

Traffic Convictions & Forfeitures for past 3 Years

EMPLOYMENT RECORD

DECLARATION OF EMPLOYMENT STATUS (GAPS IN HISTORY)

TO BE READ AND ACCEPTED BY APPLICANT

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

PSP DRIVER BACKGROUND INVESTIGATION RELEASE

ALCOHOL AND CONTROLLED SUBSTANCE CONSENT AND RELEASE

CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS

SAFETY PERFORMANCE HISTORY RECORDS REQUEST

Section 1 | To be Completed by Prospective Employee

UNITED RECYCLING TRANSPORTATION LLC.

1034 CITIZENS PKWY, MORROW, GA 30260

Section 2 | To be Completed by Previous Employer

Section 3 | To be Completed by Previous Employer

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