Apply Now - United Road Freight Inc.

APPLICANT INFORMATION

First Name

Last Name

Current Address

Address line 1

Address line 2

City

Street

State/ZIP Code

How Long?

Previous Address(es)

Address line 1

Address line 2

City

Street

State/ZIP Code

How Long?

Phone

Date of Birth

Social Security

Emergency Contact Name

Relation

Contact Address

Phone

DRIVER’S LICENSE INFORMATION

State

License

Type

Expiration Date

DRIVER EXPERIENCE

Type of Equipmen

From (Date)

To (Date)

Approx. # of Miles

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes No

Has any license, permit or privilege ever been suspended or revoked?

Yes No

If you answered yes to either of the above 2 questions, attach a statement of explanation

TICKETS / ACCIDENTS / ETC

Accident Record for Past 3 Years

Date

Description

# of Injuries / Fatalities

Traffic Convictions and Forfeitures for Past 3 Years

Location

Date

Charge

Penalty

EMPLOYMENT RECORD

NOTE: DOT requires employment for 3 years previous and/or commercial driving experience for past 10 years be shown

Employer

First Name

Last Name

Employed From

Employed To

Address

Country

Address Line 1

Address Line 2

City

Street

State/ZIP Code

Phone

Supervisor

First Name

Last Name

Position

Reason for Leaving

Were you subject to the FMCSRs while employed?

Yes No

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?

Yes No

SUPPLEMENTAL EMPLOYMENT RECORD

NOTE:DOT requires employment for 3 years previous and/or commercial driving experience for past 10 years be shown.

Employer

First Name

Last Name

Employed From

Employed To

Address

Country

Address line 1

Address line 2

City

Street

State/ZIP Code

Phone

Supervisor

First Name

Last Name

Position

Reason for Leaving

Were you subject to the FMCSRs while employed?

Yes No

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?

Yes No

If more space is needed, please request another sheet to complete history

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

Applicant Signature

Date

Appendix E – Controlled Substance and Alcohol Questionnaire

ALCOHOL AND CONTROLLED SUBSTANCE CONSENT AND RELEASE

Have you ever refused to be tested for drugs & alcohol at any time in the last 2 years?

Yes No

Have you ever tested positive for drugs or alcohol at any time in the last 2 years?

Yes No

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

Yes No

If you answered yes to any of the above questions, attach a statement of explanation and provide proof of return to duty process.

I understand that, as required by the Federal Motor Carrier Safety Regulations and company policy, all drivers must submit to alcohol and controlled substance testing as a condition of employment. I 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:

1 Pre‐Employment, to determine employment eligibility
2 Random
3 Reasonable Suspicion
4 Post‐Accident

I certify that I have read, understand, and agree to abide by the condition of this consent and release form

Applicant’s Signature

Date

Print Name

Social Security Number

Employer Witness

Company Name

Appendix O – Criminal Background Check Disclosure Statement

In connection with your employment application or your actual employment, Fonfara Trucking LLC may obtain a criminal background report about you for employment purposes. The information contained in such criminal background reports may be used by Fonfara Trucking LLC for employment purposes, such as hiring you. If you are hired by the company, the information in the criminal background report and/or investigative criminal background report may be used for other employment purposes such as promotions, retention and termination.

A criminal background report may contain the following types of information about your: criminal history including felony fillings, misdemeanor filings, and motor vehicle records, general reputation, personal characteristic, or mode of living that is compiled through the use of personal interviews with references, employers, neighbors, friends, associates, etc. You have a right to request disclosure of the nature and scope of the reports.

If Fonfara Trucking LLC obtains a criminal background report about you, and if the company considers any information when making an employment decision that directly and adversely affects you, you will be provided with a copy of the applicable reports before the decision is finalized.

I authorize Fonfara Trucking LLC to obtain a criminal background report and/or investigative criminal background reports for the pre‐employment background investigation, and, if I am hired, at any time during my employment. I understand that these reports might include, but are not limited to, a search of my criminal background, reference checks, driving record checks, and verification of my identification and Social Security Number. I agree that this disclosure/authorization, in original or copy form, is valid for all current and future criminal background reports.

I understand that Fonfara Trucking LLC may use such criminal background reports for employment purposes, including, but not limited to, hiring, promotion, retention, and termination.

Driver’s Name

First Name

Last Name

Other Names Used (i.e. Maiden, Alias, Nick Names)

Social Security Number:

Date of Birth

Address

Address Line 1

Address Line 2

City

State

ZIP Code

Home Phone

Cell Phone

Email Address

Appendix P – Consent for limited and Full Queries FMCSA Clearinghouse

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

Driver Name

Fonfara Trucking LLC to conduct limited and Full queries of the FMCSA’s Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand that this consent is for the initial limited query for application for employment as a CMV operator and for the annual limited queries that Fonfara Trucking LLC will be required to complete in the future during my continual employment.

I understand that if the limited query conducted by Fonfara Trucking LLC indicates that drug or alcohol violation information about me exists in the Clearinghouse, Fonfara Trucking LLC will conduct a full query and my signature below gives them my consent to complete that query. I further understand that by signing this consent form I agree to allow Fonfara Trucking LLC to complete the limited and full queries and further investigate the information found in the FMCSA’s Clearinghouse data base as part of my continued employment as a CMV driver.

I understand that if I refuse to provide consent for Fonfara Trucking LLC to conduct a limited query of the Clearinghouse, Fonfara Trucking LLC must prohibit me from performing safety‐sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

Employee (driver) Signature

Supervisor Signature

Date

Appendix Q – Driver Hiring Check list

Driver Hiring Check List

Driver

First Name

Last Name

Date

DQ File

Completed By

Driver Hired

Add driver to UIIA for Intermodal Access Add Driver to Random Program Driver Orientation of Policies and Procedures

Are Files Complete?

Yes No

Truck File

Completed By

Add driver to UIIA for Intermodal Access Add Driver to Random Program Driver Orientation of Policies and Procedures

Are Files Complete?

Yes No

Safety Manger Signature

Driver Termination

Delete Driver from Random Delete Driver from UIIA

Hire Date

Termination Date

Training

Training Started Date

Training Ended Date

must have Training Cert in File

APPLICATION FOR EMPLOYMENT

APPLICANT INFORMATION

DRIVER’S LICENSE INFORMATION

DRIVER EXPERIENCE

TICKETS / ACCIDENTS / ETC

EMPLOYMENT RECORD

SUPPLEMENTAL EMPLOYMENT RECORD

Appendix O – Criminal Background Check Disclosure Statement

Appendix P – Consent for limited and Full Queries FMCSA Clearinghouse

Appendix Q – Driver Hiring Check list

Driver Hiring Check List