Name | %first_name% %last_name% |
%user_email% | |
Current Address | %current_address% |
Address 2 | %address_2% |
City, State, Zip Code | %city% %state% %zip_code% |
Country | %country% |
Home Number | %home_number% |
Alternate Number | %alternate_contact_number% |
Social Security Number | %social_security_number% |
Date of Birth | %date_of_birth% |
Upload Resume | %upload_resume% |
Date Available To Start Work | %date_available_to_start_% |
Highest Level of Education Completed | %highest_level_of_education_completed% |
High School Years Completed | %high_school_years_completed% |
College Years Completed | %college_years_completed% |
Trade School Years Completed | %trade_school_years_completed% |
Field of Study | %field_of_study% |
Have you worked in the transportation industry before? | %have_you_worked_in_the_transportation_industry_before_% |
What Position | %what_position% |
Years Of Experience | %years_of_experience% |
List all skills and qualifications | %list_all_skills_and_qualifications% |
Other skills and certifications | %other_skills_and_certifications% |
Company 1 Name | %employer_1% |
Company Start & End Date | %company1_start_date% to %company1_end_date% |
Company Address | %company1_address% |
Company City, State, Zip Code | %company1_city_state_province_zip_code% |
Company Country | %company1_country% |
Company Phone | %company1_phone% |
Position Held | %company1_position_held% |
Reason for Leaving | %company1_reason_for_leaving% |
Company 2 Name | %employer_2% |
Company Start & End Date | %company2_start_date% to %company2_end_date% |
Company Address | %company2_address% |
Company City, State, Zip Code | %company2_city_state_zip% |
Company Country | %company2_country% |
Company Phone | %company2_phone% |
Position Held | %company2_position_held% |
Reason for Leaving | %company2_reason_for_leaving% |
Company 3 Name | %employer_3% |
Company Start & End Date | %company3_start_date% to %company3_end_date% |
Company Address | %company3_address% |
Company City, State, Zip Code | %company3_city_state_zip% |
Company Country | %company3_country% |
Company Phone | %company3_phone% |
Position Held | %company3_position_held% |
Reason for Leaving | %company3_reason_for_leaving% |
Company 4 Name | %employer_4% |
Company Start & End Date | %company4_start_date% to %company4_end_date% |
Company Address | %company4_address% |
Company City, State, Zip Code | %company4_city_state_zip% |
Company Country | %company4_country% |
Company Phone | %company4_phone% |
Position Held | %company4_position_held% |
Reason for Leaving | %company4_reason_for_leaving% |
Company 5 Name | %employer_5% |
Company Start & End Date | %company5_start_date% to %company5_end_date% |
Company Address | %company5_address% |
Company City, State, Zip Code | %company5_city_state_zip% |
Company Country | %company5_country% |
Company Phone | %company5_phone% |
Position Held | %company5_position_held% |
Reason for Leaving | %company5_reason_for_leaving% |
Company 6 Name | %employer_6% |
Company Start & End Date | %company6_start_date% to %company6_end_date% |
Company Address | %company6_address% |
Company City, State, Zip Code | %company6_city_state_zip% |
Company Country | %company6_country% |
Company Phone | %company6_phone% |
Position Held | %company6_position_held% |
Reason for Leaving | %company6_reason_for_leaving% |
What position are you applying for? | %what_position_are_you_applying_for% |
Years of Experience in this position? | %years_of_experience_in_this_position% |
Are you legally eligible for employment in the united states? | %are_you_legally_eligible_for_employment_in_the_united_states% |
Are you currently employed? | %are_you_currently_employed% |
Do you read, write, and speak English? | %do_you_read_write_and_speak_english% |
Have you ever worked for Infinity Transportation before? | %have_you_ever_worked_for_infinity_transportation% |
Are you able automate/drive Transmission Truck? | %are_you_able_automatedrive_transmission_truck% |
Commercial Driver License (CDL #) Number | %commercial_driver_license__cdl___number% |
CDL State of Residence | %cdl_state_of_residence% |
Country of License | %country_license% |
License Class | %license_class% |
License Expiration Date | %license_expiration_date% |
Physical Expiration Date | %physical_expiration_date% |
Current License | %current_license% |
%driver_owner_operator_select% |
Tanker Endorsement | %tanker_endorsement% |
Hazmat Endorsement | %hazmat_endorsement% |
X Endorsement | %x_endorsement% |
Doubles Triples Endorsement | %doubles_triples_endorsement% |
Equipment Description (Tractor1) | %equipment_description_tractor% |
Equipment Type | %equipment_type% |
Equipment Year | %equipment_year% |
Equipment Make | %equipment_make% |
Equipment Model | %equipment_model% |
Equipment Color | %equipment_color% |
Equipment Description (Tractor2) | %equipment_2_description_tractor% |
Equipment Type | %equipment_2_type% |
Equipment Year | %equipment_2_year% |
Equipment Make | %equipment_2_make% |
Equipment Model | %equipment_2_model% |
Equipment Color | %equipment_2_color% |
Equipment Description (Tractor3) | %equipment_3_description_tractor% |
Equipment Type | %equipment_3_type% |
Equipment Year | %equipment_3_year% |
Equipment Make | %equipment_3_make% |
Equipment Model | %equipment_3_model% |
Equipment Color | %equipment_3_color% |
Equipment Description (Tractor4) | %equipment_4_description_tractor% |
Equipment Type | %equipment_4_type% |
Equipment Year | %equipment_4_year% |
Equipment Make | %equipment_4_make% |
Equipment Model | %equipment_4_model% |
Equipment Color | %equipment_4_color% |
Equipment Description (Tractor5) | %equipment_5_description_tractor% |
Equipment Type | %equipment_5_type% |
Equipment Year | %equipment_5_year% |
Equipment Make | %equipment_5_make% |
Equipment Model | %equipment_5_model% |
Equipment Color | %equipment_5_color% |
Equipment Description (Tractor6) | %equipment_6_description_tractor% |
Equipment Type | %equipment_6_type% |
Equipment Year | %equipment_6_year% |
Equipment Make | %equipment_6_make% |
Equipment Model | %equipment_6_model% |
Equipment Color | %equipment_6_color% |
1. Has any license, permit or privilege ever been denied, suspended or revoked for any reason? |
%1_has_any_license_permit_or_privilege_ever_been_denied_suspended_or_revoked_for_any_reason% %license_suspend_revoke_explain% |
2. Have you ever been convicted of driving during license suspension or revocation, or driving without a valid license or an expired license, or are any charges pending? |
%2_have_you_ever_been_convicted_of_driving_during_license_suspension_or_revocation_or_driving_without_a_valid_license_or_an_expired_license_or_are_any_charges_pending% %explain_2% |
3. Have you ever been convicted for any alcohol or controlled substance related offense while operating a motor vehicle, or are any charges pending? |
%3_have_you_ever_been_convicted_for_any_alcohol_or_controlled_substance_related_offense_while_operating_a_motor_vehicle_or_are_any_charges_pending% %explain_convicted_alcohol_substance% |
4. Have you ever been convicted for possession, sale or transfer of an illegal substance (including but not limited to, marijuana, amphetamines, or derivatives thereof) while on duty, or are any charges pending? |
%4_have_you_ever_been_convicted_for_possession_sale_or_transfer_of_an_illegal_substance_including_but_not_limited_to_marijuana_amphetamines_or_derivatives_thereof_while_on_duty_or_are_any_charges_pending% %explain_4_possesion% |
5. Have you ever been convicted of reckless driving, careless driving or careless operation of a motor vehicle, or are any charges pending? |
%5_have_you_ever_been_convicted_of_reckless_driving_careless_driving_or_careless_operation_of_a_motor_vehicle_or_are_any_charges_pending% %explain_5_reckless_driving% |
6. Have you ever tested positive, or refused to test on a pre-employment drug or alcohol test by an employer to whom you applied, but did not obtain safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules in past three years, or have you ever tested positive or refused to test on any DOT-mandated drug or alcohol test? |
%6_have_you_ever_tested_positive_or_refused_to_test_on_a_pre_employment_drug_or_alcohol_test_by_an_employer_to_whom_you_applied_but_did_not_obtain_safety_sensitive_transportation_work_covered_by_dot_agency_drug_and_alcohol_testing_rules_in_past_three_years_or_have_you_ever_tested_positive_or_refused_to_test_on_any_dot_mandated_drug_or_alcohol_test% %explain_6_test_positive% |
Were you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)? |
%were_you_involved_in_any_accidentsincidents_with_any_vehicle_in_the_last_3_years_even_if_not_at_fault% %explain_vehicle_accident1% |
Have you had any moving violations or traffic convictions in the past 3 years? |
%have_you_had_any_moving_violations_or_traffic_convictions_in_the_past_3_years% %explain_moving_violations% |
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. Under the terms of the fair credit reporting act as amended by the consumer credit reporting act of 1996 job applicants must be notified that a consumer report may be obtained and considered as part of the employment or qualification decision this law amends the definition of consumer reporting agencies which could cause motor vehicle records to be considered as consumer credit reports under certain circumstances. |
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%a_summary_of_your_rights_under_the_fair_credit_reporting_act_% |
%date_fcra_rights%
%your_name_fcra_rights% |
In connection with your application for employment with Infinity Transportation ("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 Infinity Transportation ("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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%psp_disclosure_and_authorization% |
%psp_date%
%type_name_psp% |
(Policy sample allows for hands free use of phone) Recommended Usage: You can expand the policy language to include additional scenarios relevant to your organization’s needs. Although you may choose to edit the enforcement and disciplinary terms, the inclusion of specific terms strengthens compliance with a policy. It’s also recommended that your legal advisor review your final policy language. The DOT issued a rule effective January 3, 2012 regarding cell phone usage by CDL operators. The rule prohibits the use of handheld cell phones and imposes significant penalties on drivers and employers. A summary is below:
Therefore, (Company) is instituting a new policy.
Employees are responsible for payment of civil penalties in the event a citation is issued. If an employee is cited by any enforcement agency for cell phone use violations or if an employee is observed using a handheld device and the use is confirmed by one or more supervisory or management employees of (Company), the employee will be subject to discipline up to and including termination. Correspondingly, any supervisor or management personnel found to allow, encourage, pressure, or threaten adverse action against an employee for complying with this policy shall be subject to discipline up to and including termination. This communication is for informational purposes only and is not legal advice. You are not insured against issues arising out of the use of our consulting, content, or tools and we suggest contacting your attorney for legal guidance. Acceptance 18 of the terms of this policy is a portion of the consideration required for your right to use our information. If you do not accept these terms, please contact us. Your signature below certifies your agreement to comply with this policy. |
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%disclosure_and_authorization_regarding_cell_phone_for_employment_purposes% |
%authorization_date_cellphone%
%type_name_cellphone% |
Attention: Carrier deliveries to General Motors have clear requirements which must be followed without fail please review, sign below, and return facts so that we may complete your dispatch return
Additionally - driver is to deliver to our dispatched location only . Shipper paperwork often has the incorrect doc number and delivery locations for General Motors. Please do not allow the driver to deviate from our dispatch delivery location under any circumstances. I understand these requirements and will ensure they have been completely communicated to the drivers . |
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%general_motors_guidelines_authorization% |
%gm1_date%
%your_name_fgm1% |
MAKE SURE YOU HAVE YOUR:
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%gm_rules_consent% |
%date_gm_rules%
%name_gm_rules% |
Paychecks
Termination
Safety/ Hours of Service
Trailer Seal Policy
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%carrier_policy__consent% |
%date_carrierp%
%name_carrierp% |
To All Infinity Transportation ContractorsContractor responsibility after each load is completed 1. Contractor must put Pro/PU number on BOL documents. 2. You must provide all copies of the Gas Receipts & Auto Expensive with the driver name 3. Each BOL if it has more than one documents make sure you keep them all together and you must staple them. If you do not have staplers or/and staples, please come to the office and get one. 4. Each drive must upload a Clear picture of BOL after delivery to Sylectus Mobile App, if do not know how to upload, please come to the office and we will show you. 5. In order to receive your check on time, you must provide all the documents mentioned above. if you fail to provide them you will not receive your check, or your check will be on hold till we have all the documents require from you. |
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%accounting_and_billing_consent% |
%date_billing%
%name_billing% |
DisclosureIn accordance with sections 391.23(a) (i). 391.23 (b) and 391.25 of the federal motor carrier safety regulations, Infinity Transportation Inc. are required to make an inquiry into the driving record of the driver listed above during the preceding three years therefore driver must furnish the above referenced driver’s driving record for the past three-year period. Infinity must give authorization to release this information as well as a statement of compliance to the applicable provisions of the FAIR CREDIT REPORTING ACT. AuthorizationI hereby authorize Company to obtain the consumer reports described above about me. |
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%background_disclosure_and_authorization% |
%date_background%
%name_background% |
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. 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. |
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%acknowledgments_and_authorizations% |
%date_acknowledge%
%name_acknowledge% |
In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed above to Infinity Transportation. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers/contractors of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers (company/school) listed above to release information about names and dates of previous employers/contractors, reasons for termination of employment/contract, work experience, accidents, academic history, professional credentials and other information. The information that I have authorized Infinity Transportation to review involves tests required by DOT. If any carrier (company/school) listed above furnishes Infinity Transportation with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years. 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 |
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%disclosure_and_release% |
%date_disclosure%
%name_disclosure% |
Download Driver's Road Test Certification Form (PDF) | Download Driver's Data Sheet Form (PDF) |
%i_certify_that_my_answers_are_true_and_complete_to_the_best_of_my_knowledgeif_this_application_leads_to_employment_i_understand_that_false_or_misleading_information_in_my_application_or_interview_may_be_grounds_for_immediate_termination_if_you_find_the_above_statements_to_be_true_type_your_name_in_the_box_below_% | %todays_date% |
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