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1General

2Personal

3Safety

4Driving

5DOT

6Jobs

7Legal

8Sign

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Job ID

job

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Job Array

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Ops ID

ops

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DOT #

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Enter Referral Code

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Enter (*)

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Role

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Update

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Userid

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New User

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Stage 2 Interview ID

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Job Information

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OM UserID

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App ID

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Starting Balance

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Ending Balance

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Job Manager Contact

JM FName JM LInitial

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OM First OM Last

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Email – JM

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Email – DQF

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Email – Catch All

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Email – Stage 1 Interview

gppa_value_195_534

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Email – Interviewer1

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Email – Interviewer2

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Email – Examiner

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Phone Interviewer First

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Examiner First

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Remote Interview Date

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Remote Interview Time

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Onsite date

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Onsite Start

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Phone to Call

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Reason

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Mx2 Status*

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Mx2a Status*

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Mx3 Status*

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Mx3a Status*

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Mx3b Status*

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Mx4 Status*

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Phone Interview Date

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Onsite Interview Date

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ID Mx2a

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ID Mx3a

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ID Mx3b

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ID Mx4

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Assign JM

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Residential Pre Count

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License Pre Count

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Plan

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Contact of Free (OM)

First Last

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Offer Date

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Qualified Date

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ID Mxx1

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ID Mxx2

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ID Mx5

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ID Mx6

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Application Status

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MVR Status

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SPHR Status

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Verification Status

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Drug Test Status

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Pre-Employment Status

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Background Status

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Reason Code

EMPLOYMENT APPLICATION
09/04/2026

An Equal Opportunity Employer

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Job Ad

About You

Your Name*

First Middle Last Suffix

Preferred Name*

Cell Phone*

Home Phone*

Current Status*

Social Security*

Date of Birth*

Other Names Used

Years Used

Best Time To Call

Preferred Contact Method

Education Completed*

Gender*

Desired Position*

Desired Work*

Relevant Exp (Yrs)*

When can you start?*

Desired City*

Desired State*

Desired Hours*

Desired Relationship*

Do you own your own tools?

Your Email*

Enter Email Confirm Email

Password

Enter Password Confirm Password

Residence(s)

Residential History

The DOT requires 3 years of residential history.

Address	Date From	Date To	Years	Actions

There are no Residences.

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Residential Years

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OPID

Emergency Contact

Name

Phone

Contact Email

Licensing

Commercial Licenses

Please list all licenses held during the previous three years

License Number	Class	Issuing State	Expiration Date	Endorsements	Actions

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Accidents (3 Yr)

Accidents

Please list any accidents, regardless of fault, occurring within the previous 3 years

Date	City	State	# Fatalities	# Injuries	Hazmat Spill?	Ticketed?	Actions

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# Accidents

Moving Violations (3 Yr)

Moving Violations

Please list any moving violations received during the past 3 years

Date	City	State	Charge	Penalty/Fine	Points	Actions

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# Violations

Commercial Vehicle(s)

Please tell us about any commercial vehicles you own or lease

Make	Model	Year	Class	Vin	Approximate Miles	Do you have a chassis?	Do you have a trailer?	Actions

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Operating Authority

Federal DOT #	Motor Carrier #	State DOT #’s	Actions

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How much Liability Insurance do you carry?

How much liability insurance do you carry?

How much Cargo Insurance do you carry?

How much cargo insurance do you carry?

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Safety Counts

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Counts – Fatalities

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Counts – Injuries

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Counts – Points

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Counts – Years Driving

Travel

Do you have a passport?*

Yes

Do you have a TWIC?*

Yes

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Stats

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Candidate

gppa_value_195_33

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Age began driving

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AI Integration

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Clock Stop

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Drive History Years (*)

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Employed Years (*)

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# Employers last 10 years

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Avg Employ

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Drive History Miles (*)

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Email – Stage 1 (RI)

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Pay Amount

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Algorithm

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AYears

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AAccidents

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AViolations

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AEndorsements

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AHistory

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APorts

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Base

Instructions

There are several releases needed for DOT employment.

For easy viewing, they have been compiled below.

Scroll down to review them and press “Next” at the bottom when finished.

Releases & Disclosures

DOT D&A Disclosure and Authorization for Prior Employers

DOT Drug & Alcohol Disclosure and Authorization

PART I – DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES – 49 CFR PART 391.23, DOT DRUG AND ALCOHOL TESTING

In accordance with DOT Regulation 49 CFR Part 391.23, I hereby authorize release of my DOT-regulated drug and alcohol testing records by the DOT-regulated employer(s) listed below to HireRight for the purpose of HireRight transmitting such records to the HireRight customer listed above. I understand that information/documents released pursuant to this Part I is limited to the following DOT-regulated testing items, including pre-employment testing results, occurring during the previous three (3) years:(i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including adulterated and/ or substituted tests);(iv) other violations of DOT drug and alcohol testing regulations (i.e.,violations of 49 CFR 382 Sub part B); (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) any documentation of completion of the return-to-duty process following a rule violation.

If any company listed below furnishes HireRight with information concerning items (i) through (vi) above, I also authorize such company to furnish the following information to HireRight, if applicable: (i) dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the previous three (3) years; and(ii) the name and phone number of any substance abuse professional who evaluated me during the previous three (3) years.

List all DOT-regulated employers you have applied with and/or worked for in a safety-sensitive function during the previous three (3) years. If necessary, attach additional pages, including the date, your name, social security number and signature.

Motor carriers where you have been employed in a safety-sensitive position

– No Results –

Prospective Employers

Please list all DOT-regulated carriers where you have applied for a safety-sensitive position within the past 3 years

Employer Name

Location

Phone

From Date

To Date

PART 2 FMCSA NOTIFICATION OF DRIVER RIGHTS

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. I) You have the right to review information provided by previous employers. II) You have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to prospective employers. III) 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 employers. 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 employer, then the five day 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.

Identifying Information for Consumer Reporting Agency

Personal Information
Last Name:
First Name:
Middle Name:
Social Security:
Date of Birth:
Gender:
Other Names Used:
Years Used:
Daytime Phone (Cell):
Email:
License Number: {license:356}
Issuing State: {cdl state:463}

Current Address
Address: {addy1:358.1} {addy1:358.2}
City: {addy1:358.3}
State: {addy1:358.4}
Zip: {addy1:358.5}
Country: {addy1:358.6}
Date From: {addy1 date to:361}
Date To: {addy1 date to:360}

Previous Address
Address: {addy2:359.1} {addy2:359.2}
City: {addy2:359.3}
State: {addy2:359.4}
Zip: {addy2:359.5}
Country: {addy2:359.6}
Date From: {addy2 date from:362}
Date To: {addy2 date to:491}

* This information will be used only for background screening purposes and will not be taken into consideration in any employment decisions.

Disclosure and Authorization Regarding Background Investigation for Employment Purposes

Disclosure

(the “Company”) may request from a consumer reporting agency and for employment-related purposes, a “consumer report(s)” (commonly known as “background reports”) containing background information about you in connection with your employment or application for employment (including independent contractor or volunteer assignments, as applicable).

HireRight, Inc. (“HireRight”) will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.com.

The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.

Authorization

I hereby authorize the Company to obtain the consumer reports described above about me.

Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as HireRight, LLC, and to the release of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or contract period.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background reports that may be requested by or on behalf of the Company.

Other Disclosures, Acknowledgments & Authorizations Regarding Background Investigation for Employment Purposes

Disclosures
Investigative Consumer Report:
(the “Company”) may request an investigative consumer report about you from HireRight, Inc. (“HireRight”), a consumer reporting agency, in connection with your employment or application for employment (including independent contractor or volunteer assignments, as applicable). An “investigative consumer report” is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews), the most common form of which is checking personal or professional references through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.

Ongoing Authorization:
If the Company hires you or contracts for your services, the Company may obtain additional consumer reports and investigative consumer reports about you without asking for your authorization again, throughout your employment or your contract period, as allowed by law.

Additional State Law Notices:
Please see the “Additional State Law Notices” for California, Massachusetts, Minnesota, New Jersey, New York, and Washington that are provided below, as applicable. A California disclosure and summary of your rights under California Civil Code Section 1786.22, and a copy of New York Article 23-A, are being provided to you separately.

Summary of Rights under the Fair Credit Reporting Act:
A summary of your rights under the Fair Credit Reporting Act is being provided to you separately.

San Francisco Fair Chance Ordinance Official Notice:
A copy of the San Francisco Fair Chance Ordinance Official Notice is being provided to you separately.

HireRight Privacy Policy:
Information about HireRight’s privacy practices is available at www.hireright.com/Privacy-Policy.aspx. I acknowledge that I have received and carefully read and understand the separate “Disclosure and Authorization Regarding Background Investigation for Employment Purposes”; and the separate “Summary of Rights under the Fair Credit Reporting Act” that have been provided to me by the Company. I also acknowledge receipt of and that I have carefully read and understand (as applicable), the separate California Disclosure and Summary of Rights under California Civil Code Section 1786.22; the separate New York Article 23-A; and the separate San Francisco Fair Chance Ordinance Official Notice that have been provided to me.

By my signature below, I authorize the preparation of background reports about me, including background reports that are “investigative consumer reports” by HireRight, and to the furnishing of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor or volunteer assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain from HireRight (or from a consumer reporting agency other than HireRight) additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period.

I understand that if the Company obtains a credit report about me, then it will only do so where such information is substantially related to the duties and responsibilities of the position in which I am engaged or for which I am being evaluated.

I understand that information contained in my employment (or contractor or volunteer) application, or otherwise disclosed by me before or during my employment (or contract or volunteer assignment), if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services.

I understand that the information included in the background reports may be obtained from private and public record sources, including without limitation and as appropriate: government agencies and courthouses; educational institutions; and employers. Accordingly, I hereby authorize all of the following, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local government agencies and courts; educational institutions (public or private); testing agencies; information service bureaus; credit bureaus and other consumer reporting agencies; other public and private record/data repositories; motor vehicle records agencies; my employers; the military; and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my: employment and earnings history; education, credit, motor vehicle and accident history; drug/alcohol testing results and history; criminal history; litigation history; military service; professional licenses, credentials and certifications; social security number verification; address and alias history; and other information.

By my signature below, I also promise that the personal information I provide with this form or otherwise in connection with my background investigation is true, accurate and complete, and I understand that dishonesty or material omission may disqualify me from consideration for employment. I agree that a copy of this document in faxed, photocopied or electronic (including electronically signed) form will be valid like the signed original. I further acknowledge that I have received additional state law notices that I have reviewed and read.

California, Minnesota, or Oklahoma consumers:

Please check this box if you would like to receive (whenever you have such right under the applicable state law) a free copy of your background report if one is obtained on you by the Company.

Additional State Law Notices

If you are a California, Maine, Massachusetts, New York or Washington State applicant, employee or contractor, please also note:

CALIFORNIA: Pursuant to section 1786.22 of the California Civil Code, you may view the file maintained on you by HireRight during normal business hours. You may also obtain a copy of this file, upon submitting proper identification and paying the actual copying costs, by appearing at HireRight’s offices in person, during normal business hours and on reasonable notice, or by certified mail. You may also receive a summary of the file by telephone, upon submitting proper identification and written request. HireRight has trained personnel available to explain your file to you, including any coded information, and will provide a written explanation of any coded information contained in your file. If you appear in person, you may be accompanied by one other person, provided that person furnishes proper identification. “Proper identification” includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. If you cannot identify yourself with such information, HireRight may require additional information concerning your employment and personal or family history to verify your identity.

MAINE: You have the right, upon request, to be informed of whether an investigative consumer report was requested, and if one was requested, the name and address of the consumer reporting agency furnishing the report. You may request and receive from the Company, within five business days of our receipt of your request, the name, address and telephone number of the nearest unit designated to handle inquiries for the consumer reporting agency issuing an investigative consumer report concerning you. You also have the right, under Maine law, to request and promptly receive from all such agencies copies of any such reports.

MASSACHUSETTS: If we request an investigative consumer report, you have the right, upon written request, to a copy of the report.

NEW YORK: You have the right, upon written request, to be informed of whether or not an investigative consumer report was requested. If an investigative consumer report is requested, you will be provided with the name and address of the consumer reporting agency furnishing the report. You may inspect and receive a copy of the report by contacting that agency. Please see https://www.HireRight.com/NY_Article_23_A.pdf?enable_url=true for additional information about New York law, as applicable.

WASHINGTON STATE: If the Company requests an investigative consumer report, you have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of the investigation requested by the Company. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

Important Disclosure Regarding Background Reports from The PSP Online Service

In connection with your application for 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).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with 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 your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. 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.

The Prospective Employer cannot obtain background reports from FMCSA without your authorization.

Authorization

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize (“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.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request 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 PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all 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, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

TO: [Previous Employer]		Date: 09/04/2026
Company: {e1 carrier:351}	Phone: {e1 phone:352}	Fax: {e1 fax:353}
Address: {e1 location:378}		Designated Employer Representative: {super:381}

In accordance with 49 CFR 382.405(f), by my signature below I authorize you and/or your Third Party Administrator to release any and all information regarding drug and alcohol testing done on myself including any and all information on this form and responses to questions set out on this form, while in your employment, acting as your agent, under contract with you, or acting as your representative in any capacity during the preceding three years from the above date. This information is to be released to the prospective employer named below and/or to their Third Party Administrator.

FROM: [Prospective Employer]
Company:	Phone:	Fax:
Address: ,	Attention: Safety & Compliance

I also understand that I have the right, under 49 CFR 391.23 (i) and (j), to review information provided by previous employers; to have errors in the information corrected by the previous employer and to have that employer resend the corrected information to the prospective employer; to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and myself cannot agree on the accuracy of the information.

Request for Check of Driving Record

Driving Record

Release of Interest

Sealed juvenile records. Information contained in a driving record related to a sealed juvenile record may not be used for any purpose unless required by federal law. The employee or prospective employee may furnish a copy of the court order sealing the juvenile record to the employer, prospective employer, or their agent.

Employee, prospective employee, or volunteer

Complete this section and return the form to the company Employer, prospective employer, or volunteer organization name:
Employer agent company name if acting on behalf of the company for employment purposes: HireRight

Authorization

I am an employee, prospective employee, or volunteer of the company named above and I request that a copy of my driving record be sent to them/their agent.

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing Records And changes in Parts 390 and 391 of the FMCSA

By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully understand this Part I disclosure and authorization for release as well as the attached FMCSA Notification of Driver Rights and any applicable state law notices; (iii) prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction; ( iv) I execute this authorization voluntarily and with the knowledge that the information obtained pursuant to this authorization could affect my eligibility for employment, promotion, retention or other lawful purpose; ( v) I understand I may review this document with legal counsel prior to signing; and (vi) facsimile or photographic copies of this authorization are as valid as an original.

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. I) You have the right to review information provided by previous employers. II) You have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to prospective employers. III) 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 employers. 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 employer, then the five-day 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.

Drug & Alcohol Testing Policy

—

Driver Acknowledgement Form

I acknowledge that I have received Company’s Alcohol and Controlled Substance Testing Policy. I understand that the contact person(s) outlined on this policy are the designated individual(s) to whom questions regarding this policy may be directed. He/she may also designate an alternate representative to assist in answering question on the policy and procedures. I understand that the terms described in this policy may be altered, amended or changed by Company to comply with the Federal DOT Regulations under Part 382 and its implementing regulations, with or without prior notice. I further understand that any violation of this policy may subject me to discipline, up to and including termination and/or removal from any platform.

Certifications

Right to Work

I certify that I have the legal right to work in the United States.

Certification of English Language Proficiency

I certify that I read and speak English sufficiently to converse with the general public and respond to official inquiries, to understand highway traffic signs and signals in English, and to complete and make entries on all required reports and records in English.

Certification of Accuracy*

I certify that all questions asked in this application have been answered truthfully, accurately, and completely to the best of my knowledge. Furthermore, I understand that any incorrect or false statement or misinformation furnished by myself intended or otherwise, will subject me to termination and/or cancellation at any time. In addition, I certify that this application was completed by me.

Permission to Communicate*

I want to receive information and communications, including text messages, concerning future opportunities or promotions. I may opt out at any time by texting STOP to unsubscribe. Message and Data Rates May Apply.

Permission to Access Your Personal Data*

I understand that by signing this application I am consenting to and have authorized the company, and/or its authorized agents to collect, use and disclose personal information. Furthermore, I hereby authorize this company, as required by the Federal Motor Carrier Safety Administration (FMCSA) regulations section 391.23, and/or its authorized agents to investigate and compile a complete history of my former work history together with any other information concerning my ability, personal character, credit, and arrest record. I do hereby authorize any present and past employers or lessor to furnish my previous work history record with them, with any reason for my separation; and any/all information which said company may have concerning me to the company’s investigating agency. I authorize release of information for purposes of investigation of drug and alcohol results as required by sections 382.405(f) and 382.413 of the FMCSA regulations. I hereby authorize any local, state, or federal law enforcement agency to furnish any and all information regarding arrests or convictions listed under my name which might be in file, to the company’s investigative agency. I hereby release all present and past employers, lessors and law enforcement agencies from any and all liability for damages whatsoever which may result from furnishing any information requested concerning me to the company’s investigating agency. I understand that I have the following rights concerning the investigative information that is being provided by a prior employer: (1) the right to review information provided by the previous employer, (2) the right to have errors in the information corrected by the previous employer and for the corrected information to be sent to the prospective employer and (3) the right to have a rebuttal statement attached to the alleged erroneous information if I and the previous employer cannot agree on the accuracy of the information provided.

Authorization for Investigation*

I authorize you to make investigations (including contacting current and prior employers) into my personal, employment, financial, medical history, and other related matters as may be necessary in arriving at an employment decision. 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 interview(s) may result in discharge. I also understand that I am required to abide by all rules and regulations of the Company. I understand that the information I provide regarding my current and/or prior employers may be used, and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.23. I understand that I have the right to: 1) Review information provided by current/previous employers; 2) Have errors in the information corrected by previous employers, and for those previous employers to resend the corrected information to the prospective employer; and 3) 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 that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. Note: A motor carrier may require an applicant to provide more information than that required by the Federal Motor Carrier Safety Regulations.

Permission to Use Your Personal Data*

I grant permission to use, display, and disseminate any and all information I have supplied including my past employment, driving record, criminal record and other potentially sensitive information. Furthermore, I release the parties from any and all current and future damages and or liability that may arise from this.

FCRA Summary of Rights (*)*

I acknowledge that I have read and understand the FCRA Summary of Rights.

Privacy and TOS (*)*

I acknowledge that I have read and understand the Privacy Policy and Terms of Service.

Signature*

Attachments

CDL

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License Class

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Medical Cert

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AI Integration

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Mx1 (*)

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Renewal Days

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Descriptive Tag

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Middle I

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30-Day Clock Ends

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First Impression

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Stage I Prep

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Company Information

Job Information

EMPLOYMENT APPLICATION 09/04/2026

About You

Residence(s)

Emergency Contact

About You

Licensing

Accidents (3 Yr)

Moving Violations (3 Yr)

Commercial Vehicle(s)

Operating Authority

Safety Counts

Driving History

DOT Disclosures

Employment History

Travel

Stats

Algorithm

Instructions

Instructions

Releases & Disclosures

DOT D&A Disclosure and Authorization for Prior Employers

DOT Drug & Alcohol Disclosure and Authorization

PART I – DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES – 49 CFR PART 391.23, DOT DRUG AND ALCOHOL TESTING

PART 2 FMCSA NOTIFICATION OF DRIVER RIGHTS

Identifying Information for Consumer Reporting Agency

Disclosure and Authorization Regarding Background Investigation for Employment Purposes

Disclosure

Authorization

Authorization of Background Investigation

Other Disclosures, Acknowledgments & Authorizations Regarding Background Investigation for Employment Purposes

Additional State Law Notices

Important Disclosure Regarding Background Reports from The PSP Online Service

Authorization

Request for Check of Driving Record

Driving Record

Release of Interest

Employee, prospective employee, or volunteer

Authorization

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing Records And changes in Parts 390 and 391 of the FMCSA

Drug & Alcohol Testing Policy

Driver Acknowledgement Form

Certifications

Attachments

AI Integration

First Impression

Stage I Prep

Stage II Prep

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EMPLOYMENT APPLICATION
09/04/2026