Driver Application

DRIVER’S APPLICATION FOR EMPLOYMENT

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without 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. (Generally, inquiries regarding medical history
will be made only if and dafter 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 interview(s) may
result in discharge. I understand, also, that I am required to abide by all rules and regulations of Olson Carriers, Inc.
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 I have the fight 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.

Answer all questions. Please, print. If the answer to any questions is “No” or “None”, do not leave the item blank, but write “No” or “None”.

Type
Are you a citizen of the United States?
If no, are you authorized to work in the U.S.?
Have you ever worked for this company before?
Are you employed now?

List your addresses of residency for the past 3 years.

Current Address

Street
City
State
Zip Code
yr./mo.

Previous Address

Street
City
State
Zip Code
yr./mo.
Street
City
State
Zip Code
yr./mo.
Street
City
State
Zip Code
yr./mo.

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on ALL employers during the preceding 3 years. Applicants to drive a commercial motor vehicle shall also provide an additional 7 years’ information on those employers for whom the applicant operated such vehicle (Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in a quantity requiring placarding).
(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

EMPLOYER

DATE

FROM
MO.
YR.

DATE

TO
MO.
YR.

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 AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE?

EMPLOYER

DATE

FROM
MO.
YR.

DATE

TO
MO.
YR.

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 AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE?

EMPLOYER

DATE

FROM
MO.
YR.

DATE

TO
MO.
YR.

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 AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE?

EMPLOYER

DATE

FROM
MO.
YR.

DATE

TO
MO.
YR.

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 AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE?

EMPLOYER

DATE

FROM
MO.
YR.

DATE

TO
MO.
YR.

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 AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE?

EMPLOYER

DATE

FROM
MO.
YR.

DATE

TO
MO.
YR.

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 AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
MAY WE CONTACT YOUR PREVIOUS EMPLOYER FOR A REFERENCE?

The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) weighs or has a GVWR of 10,001 pounds or more, (2) is designed or used to transport 8 or more passengers (including the driver), OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD for the past 3 years or more (attached sheet if more space is needed). If none, write “NONE”

DATES - LAST ACCIDENT

(HEAD-ON, REAR-END, UPSET, ETC.)

DATES - NEXT PREVIOUS

(HEAD-ON, REAR-END, UPSET, ETC.)

DATES - NEXT PREVIOUS

(HEAD-ON, REAR-END, UPSET, ETC.)

TRAFFIC CONVICTIONS and forfeitures for the past 3 years (other than parking violations). If none, write “NONE”.

EXPERIENCE AND QUALIFICATIONS - DRIVER

Driver's licenses
or
permits held
in the
past 3 years

DATE
DATE
A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
B. Has any license, permit, or privilege ever been suspended or revoked?

DRIVING EXPERIENCE CHECK YES OR NO

CLASS OF EQUIPMENT -STRAIGHT TRUCK

FROM (M/Y)
TO (M/Y)

CLASS OF EQUIPMENT -STRAIGHT TRUCK

CLASS OF EQUIPMENT -TRACTOR AND SEMI-TRAILER

FROM (M/Y)
TO (M/Y)

CLASS OF EQUIPMENT -TRACTOR AND SEMI-TRAILER

CLASS OF EQUIPMENT -TRACTOR - TWO TRAILERS

FROM (M/Y)
TO (M/Y)

CLASS OF EQUIPMENT -TRACTOR AND SEMI-TRAILER

CLASS OF EQUIPMENT -TRACTOR - THREE TRAILERS

FROM (M/Y)
TO (M/Y)

CLASS OF EQUIPMENT -TRACTOR AND SEMI-TRAILER

OTHER

FROM (M/Y)
TO (M/Y)

OTHER

EXPERIENCE AND QUALIFICATIONS – OTHER

EDUCATION

1 2 3 4 5 6 7 8 9 10 11 12
COLLEGE 1 2 3 4
(NAME)(CITY, STATE)

MILITARY SERVICE

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.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Olson Carriers, Inc.
Job Description – Truck Driver

TYPE:

Load, transport and deliver cargo via a Commercial Motor Vehicle/Semi-Trailer combination on
company, commercial and private property and on public roadways.

(this job description does not take into account potential reasonable
accommodation):

  • Safely load and unload cargo
  • Properly tarp and untarp loads
  • Follow legal axle weight requirements when loading
  • Climb in and out of trailers to clean out, spray etc.
  • Drive truck to destination
  • Inspect truck for defects before and after trips and report any discrepancies indicating truck condition to Repair Shop Supervisor and/or mechanic
  • Drop and spot trailers as required
  • Back trailers in and out of receiving docks and service bays
  • Maneuver CMV/Semi-Trailer combination in and around tight corners, high volume traffic,
  • rough manufacturing areas and around high pedestrian traffic
  • Read, understand and follow instructions/training provided in training session(s).
  • Complete all required paperwork
  • Mandatory attendance of bi-weekly safety meetings and compliance with safety programs
  • Comply with all requirements and expectations detailed in the Safety, Accident Prevention &
  • licy Manual
  • Comply with all Federal Motor Carrier Safety Administration Regulations (FMCSRs) at all times on duty as a driver:
  • https://www.fmcsa.dot.gov/regulations
  • Other duties as assigned.

  • At least 23 years of age.
  • Hold a valid Class A Commercial Driver’s License
  • Hold a current Medical Examiner’s Certificate
  • Subject to pre-employment, reasonable suspicion, post-accident and random drug and
    alcohol testing through Olson Carrier’s Drug and Alcohol Program.
    Submit to company required drug and alcohol testing and receive a negative result.
  • No serious violations in the last three years
  • Tractor/trailer driving experience
  • Pass the company driving test
  • Driver furnishes their own minimum hand tools, shovel, broom and steel-toe boots

  • Work hours vary; no more than 70 on-duty hours in 8 days.
  • Must be able to lift and push/pull 50 pounds (tarp) and shovel.
  • Must be able to reach at, above and below shoulder height.
  • Must be able to twist, stoop/bend, squat, climb ladders and stairs, and walk on uneven ground.
  • Approximately 80% of the work day is spent sitting.

Applicant/Employee

MOTOR VEHICLE RECORD POLICY

It is the policy of Olson Carriers, Inc. to obtain and review Motor Vehicle Record (MVR) on each prospective employee before an offer for employment is extended to the individual. Motor Vehicle Records are checked annually on all employees where driving is part of their job· description.

Management of Olson Carriers, Inc. will review the Motor Vehicle Record to ascertain the applicant or employee holds a valid license and their driving record is within the parameters set by company policy. If the employee's driving record does not meet the criteria set by management, remedial training or other disciplinary action may be taken.

DRIVER

I hereby grant permission for Olson Carriers, Inc. to secure a Motor Vehicle Report on me.

Request for Drug and Alcohol Testing Information from Applicant/Employee

You have applied for a DOT safety sensitive position with Olson Carriers, Inc. According to DOT Regulations 49 CFR Part 40.25, we are required to obtain, and you are required to supply, certain information about any previous DOT drug and alcohol testing during the past two years.

Information to be obtained from Applicant/Employee:

During the last 2 years have you tested positive or refused to test on a DOT preemployment drug test for any employer who you applied to work for, but did not obtain a
DOT safety sensitive position with that employer?

if yes, was the test:

If yes, please give the name, address and phone number of the Substance Abuse Professional (SAP) who completed your evaluation. You must also provide proof of your successful completion of the DOT return to duty requirements including follow-up testing:

(NOTE FOR PROSPECTIVE EMPLOYER: If the applicant/employee has not completed the SAP evaluation and Return to Duty process required by 40.291-40.309, the applicant/employee may not perform DOT safety sensitive duties until he/she has completed this process.)

(NOTE FOR PROSPECTIVE EMPLOYER: the prospective employer must obtain written documentation verifying the applicant/employee’s successful completion of the SAP evaluation and DOT return to duty requirements including follow up testing.)

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

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

(“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:

(“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.

NOTICE: 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.