Driver's Application for Employment

I authorize you to make such investigations and inquiries of my current and past personal employment, financial, and medical information (including DOT long form physicals past and present) as may be necessary in arriving at an employment decision and continued contractor/lease driver status. I hereby release employers, schools, health care providers and all other persons from all liability in responding to inquiries and releasing information in connection with my application and continuous contractor/lease driver status. In the event of contractor, or lease driver status offered, I understand that false or misleading information given in my application or interview(s) may result in discharge and/or cancelled contract (which ever applicable). I understand also that I am required to abide by all rules and regulations of the Company.

I understand that information that I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). I understand that I have the right to:

• Review information provided by 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.

Sign one time here to have your digital signature appear on this application wherever you see:

•Your Signature will appear here•

We will not apply your signature to any forms not specified in this application.
You must check "Agree" to apply your signature to each form.

• All persons considered for a driver must be a minimum of 25 years of age, hold a valid Class "A" CDL, and a valid TWIC card. If driver does not have a TWIC card, a TWIC card must be applied for before driver is eligible for dispatch. Applicant must have at least 1 year of verifiable driving experience. Have no more than 2 moving violations, or a combination of either moving violations or accidents in the last 3 years for which the driver was at fault. Any preventable accident listed or verified will need a copy of the police report to verify accuracy. If the accident was a result of a speeding ticket, it will be treated as one. Applicant must not have been involved in any accident or received any citation for careless or reckless operation or received any citation for any DWI or DUI or a refusal of any sobriety test in the last 5 years. L&B reserves the right to accept or reject any applicant based on the severity and any disclosed or undisclosed information about any accident either mentioned or not mentioned on the application.

• Liquid bulk applicants must hold a Class A CDL with an X endorsement. This X endorsement is not needed to apply to become a Dry Bulk or Flatbed driver.

• The application will be reviewed by the safety department to ascertain the criteria are met and will be followed up with an MVR to check his/her driving history before proceeding further.

• If the applicant appears qualified by past employment history, the application will be turned over to Louis Vielee or David Guillot for final approval.

• Upon determination that the applicant is qualified for employment with L&B, applicant will be required to obtain mandatory drug test and DOT physical if one is not valid.

• Upon receiving satisfactory results from the above test requirements and work history, the individual will be given the opportunity to complete the computer based training and attend an orientation class where the results must be satisfactory.

• Applicant will be required to read and familiarize himself with the company policy handbook/safety manual and is to verify this with signature below.

• Applicant is required to sign below that he has read and fully understands sections 383.51 and 383.53 in the Federal Motor Carrier Safety Regulation Handbook and agrees to become familiar with the company policies and procedures.

 

•Your Signature will appear here•

Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

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List your addresses of residency for the past 3 years:

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, stree number, city, state, and zip code. Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent).

Please list the previous 10 years of employment, including periods of unemployment. 

Inconsistencies may result in your application's review being delayed.

If you have had more than 12 employers in the last ten years, please use the space provided at the bottom of this section labled "Additional Employers".

List any additional previous employers in the following area.

Please include: Name of Employer, Employer's Address, Phone Number, Employment Dates, Position Held, Types of Trailers Pulled, and Reason for Leaving.

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This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as my 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 inquirires and releasing information in connection with my application.

•Your Signature will appear here•

I hereby authorize the company listed above to release all information regarding my employment or association, including oral assessments of my job performance ability, fitness and all information on my alcohol and controlled substances testing records to L&B Transport, LLC in connection with my application for qualification with said company. This is in compliance with the Federal Motor Carrier Safety Regulations Title 49 Part 382, 405 (f) (h). Part 382, 413 (b) (e) (f) and part 382.401 (b) (I through III) of the Federal Motor Carrier Safety Regulations. I hereby release you from any and all liability of any type as a result of providing such information.

•Your Signature will appear here•

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. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.

•Your Signature will appear here•

I hereby authorize you to release the following information to L&B Transport, LLC for purposes of investigation as required by Sections 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability which may result from furnishing such information.

•Your Signature will appear here•

The prospective employee is required by Sec. 40.25(j) to respond to the following questions.

I certify that the information provided on this document is true and correct.

•Your Signature will appear here•

General Consent for Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

I hereby provide consent to L & B Transport to conduct queries of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand that if the query conducted by L & B Transport indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to L & B Transport without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for L & B Transport to conduct a limited query of the Clearinghouse, L & B Transport must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

 

 

•Your Signature will appear here•

 

 

IMPORTANT DISCLOSURE

 

In connection with your application for employment with L&B Transport, LLC (“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 L&B Transport, LLC (“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.

This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written
or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole,
exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.
The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.

•Your Signature will appear here•