• DRIVER'S APPLICATION FOR EMPLOYMENT

    WWW.OWACC.COM
  • ATLANTIC COAST CARRIERS

    P.O. BOX 820, HAZLEHURST, GEORGIA 31539
  • In compliance with Federal and State equal employment opportunity laws, qualified applicants are consired for all positions withou regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
  • TO BE READ AND SIGNED 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. (Generaly, inquiries regarding medical history will be made ony 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 even of employment, I understand that False or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. I understand that information I provide regarding Current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 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 correccted 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.
  • FOR COMPANY USE PROCESS RECORD

    APPLICANTHIRED__________________REJECTED_______________DATE EMPLOYED_________________ POINT EMPLOYED__________ DEPARTMENT_____________________ CLASSIFICATION_________ (If rejected, summary report of resons should be placed in file) SIGNATURE OF INTERVIEWING OFFICER_______________________ .
  • TERMINATION OF EMPLOYMENT

    DATE TERMINATED_____________ DEPARTMENT RELEASED FROM_______________ DISMISSED______________VOLUNTARILY QUIT_____ OTHER____ TERMINATION REPORT PLACED IN FILE_____________________ SUPERVISOR__________________________ (If rejected, summary report of resons should be placed in file) SIGNATURE OF INTERVIEWING OFFICER_______________________ .
  • APPLICANT TO COMPLETE

    (answer all questions)
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  • Employment Desired:

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  • Education:




  • Employment History

    All driver applicants to drive in interstate commerce must provide the following information on all employers during the precending 3 years. List complete mailing address, street number, city, state, and zipcode. 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. Add another sheet as necessary
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  • Previous Employment:

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  • ACCIDENT RECORD FOR PAST 3 YRS OR MORE (ATTACH SHEET IF MORESPACE IS NEEDED) IF NONE, WRITE NONE
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  • TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE
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  • Skills/Qualifications-DRIVER

    List all driver licenses or permits in the past 3 yrs.
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  • EXPERIENCE AND QUALIFICATION-OTHER

  • References:



  • Cover Letter & Resume (Optional):

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  • THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL
    ACCOUNT HOLDERS
    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.

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