Driver Application – Red Stag LLC

PRE-EMPLOYMENT APPLICATION

*We offer equal employment opportunities to all persons without regard to race, religion, age, marital status, veteran status, sex, national origin, disability, or any other legally protected status.
*Job applications will only be considered active for 90 days after which the applicant must reapply for further consideration.
APPLICANTS MAY REQUEST ANY NEEDED ACCOMMODATIONS TO PARTICIPATE IN THE APPLICATION PROCESS. FOR EXAMPLE, AN APPLICANT MAY REQUIRE ASSISTANCE IN FILLING OUT THE APPLICATION FORM, OR PARTICIPATING IN THE JOB INTERVIEW.

Date : *

Position you are applying for : *

Contact Number : *

Name : (print) *

Second Number :

Address :(STREET, CITY, STATE AND ZIP)

How long ?

Email Address : *

Driver’s License : State :

Type : A = Combination of vehicles with GVWR of 26,001 lbs or more if vehicle is towing an excess of 10,000 lbsB = Single vehicle with GVWR of 26,001 lbs or more and not towing an excess of 10,000 lbs of GVWRC = Single vehicle with GVWR of less than 26,001 lbs or vehicle towing another vehicle that has GVWR that does not exceed 10,000 lbsD = Other

Date First Received : *

Rate of Pay Expected?

If employed, why do you desire to make a change ?

Who referred you to Red Stag?

If yes, please specify those days and hours you would be unable or unwilling to work : *

If yes, please explain : *

EDUCATION

Last school attended :

Please provide any additional information such as skills, training, management experience, equipment operation, or qualifications you feel would be helpful for us in considering your application.

PREVIOUS EMPLOYERS

List employers from the last 10 years, starting with the most current. Attach additional sheet(s) if necessary.

EMPLOYER :

Address :

Phone :

Immediate Supervisor :

Position Held :

From :

To :

Wage :

Description of Duties :

Reason For Leaving ?

EMPLOYER :

Address :

Phone :

Immediate Supervisor :

Position Held :

From :

To :

Wage :

Description of Duties :

Reason For Leaving ?

EMPLOYER :

Address :

Phone :

Immediate Supervisor :

Position Held :

From :

To :

Wage :

Description of Duties :

Reason For Leaving ?

EMPLOYER :

Address :

Phone :

Immediate Supervisor :

Position Held :

From :

To :

Wage :

Description of Duties :

Reason For Leaving ?

EMPLOYER :

Address :

Phone :

Immediate Supervisor :

Position Held :

From :

To :

Wage :

Description of Duties :

Reason For Leaving ?

PERSONAL / PROFESSIONAL REFERENCES

Name :

Phone :

Name :

Phone :

Name :

Phone :

EXPERIENCE AND QUALIFICATIONS

Fill out this section if applying for a Dot-Regulated Position
LIST ANY CURRENT OR UNEXPIRED LICENSES

State :

License :

Expires :

State :

License :

Expires :

If yes to either of the above questions, please explain :

DRIVING EXPERIENCE

Fill out this section if applying for a Dot-Regulated Position

Straight Truck :

How Long ?

Approx. Miles ?

Tractor Trailer :

How Long ?

Approx. Miles ?

Double/Triple :

How Long?

Approx. Miles?

Van/ Tanker/ Flat/ others :

VIOLATIONS OF MOTOR VEHICLE AND ORDINANCES

Fill out this section if applying for a Dot-Regulated Position

Violation :

Date :

Location :

Violation :

Date :

Location :

List courses of training that will help you as a driver :

COMMERCIAL MOTOR VEHICLES ACCIDENTS

Fill out this section if applying for a Dot-Regulated Position
I certify that the following is a true and accurate list of all commercial accidents and any *Fatalities and Personal Injuries* as a result of said accident in accordance with DOT 392.27(7) for the 3 years preceding this application.

Date :

State :

Nature of Accident :

Fatalities/Injuries :

Date :

State :

Nature of Accident :

Fatalities/Injuries :

I certify that the information is correct and accurate to the best of my knowledge.

Applicant Signature : *

Printed Name : *

Date : *

STATEMENT OF COMMERCIAL VEHICLE LICENSE SUSPENSIONS

Fill out this section if applying for a Dot-Regulated Position
I certify that the following is a true statement and a complete list of the facts and circumstances of any denial, revocation, or suspension of any license permit privilege to operate a commercial vehicle.

Date :

State :

Offense :

Date :

State :

Offense :

If no violations are listed above, I certify that I have not had my Commercial Driver’s License or any license permit, or privileges denied, revoked, suspended in relation to the operation of a commercial vehicle in accordance with DOT 391-27(9).

Applicant Signature : *

Printed Name : *

Date : *

90-DAY INTRODUCTORY PERIOD

All employees will work on an introductory basis for the first 90 days after their date of hire. This period of time is intended to give new employees the opportunity to demonstrate their ability to achieve a satisfactory level of performance and to determine whether the new position meets their expectations. The company uses this period to evaluate employee capabilities, work, habits, and overall performance.
Employees that are released (terminated) or leave the company and do not complete the 90-Day Introductory Period will be subject to a $300 fee, deducted from their final paycheck, for the expenses incurred from a pre-employment drug screen, certifications, training, and administrative costs. In addition, all uniforms and equipment issued must be returned in good condition at the time of termination, or the cost of these items will be deducted as well.

By signing below, you know and understand the 90-Day Introductory Period Policy.

Applicant Signature : *

Printed Name : *

Date : *

APPLICANT ADDRESSES FOR THE PRECEDING 3 YEARS PRIOR TO APPLICATION

Street :

City :

State :

Zip Code :

Street :

City :

State :

Zip Code :

Street :

City :

State :

Zip Code :

I certify that the above information is correct and accurate to the best of my knowledge in accordance with DOT 391.21(3)

Signature : *

Printed Name : *

Date : *

PLEASE READ THE FOLLOWING CERTIFICATIONS CAREFULLY BEFORE SIGNING JOB APPLICANT’S CERTIFICATION

I certify that the information that was given in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be found sufficient reason for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and accept as indicated above. I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous education or employment records. I release all such persons from liability damages on account of having such information. I consent to such investigation as this employer may make regarding driving records, law enforcement records, credit reports and my general background following a contingent offer, if applicable. I further understand that all applicable portions of this application must be completed or I will not be eligible for consideration for the position for which I am applying. I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment between this employer and myself for either employment or providing of any benefits. No promises regarding employment have been made to me and I understand that no promises or guarantee of employment for any specific length of time under any specified circumstances shall be binding upon unless made in writing by or with the express written consent and authorization of the president or owner. If an employment relationship is established, I understand that I have the right to terminate my employment at any time and for any reason and this employer retains the same right.

I understand that, if I am initially offered a position of employment, I will be required to submit to drug and/or alcohol tests which are a condition of employment and that refusal to submit to such tests when asked by this employer shall be considered sufficient reason for denial of employment or discharge.
I understand that, if employed, this employer may revise policies or procedures, in whole or in part, unilaterally at any time.
Any applicants wishing to request correction of erroneous information in records received from previous employers must send the request for the correction to the previous employer that provided the record. IMPORTANT: IF YOU DO NOT UNDERSTAND OR IF YOU DISAGREE WITH ANY PORTION OF THE ABOVE CERTIFICATION, DO NOT SIGN BEFORE DISCUSSING WITH EMPLOYER.

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

Applicant Signature : *

Printed Name : *

Date : *

RELEASE OF INFORMATION FOR VEHICLE REPORT AND BACKGROUND CHECK

I, (print), do hereby agree to authorize the running of my motor vehicle report and background check, following the receipt and acceptance of a contingent offer, the release of this information to and hold harmless the following: Red Stag, their respective affiliates, parent companies, officers, directors and employees and their respective insurance agencies and insurance companies.

I understand this report is being run to verify my driving record, the status of my driver’s license, my insurability, and whether I remain fit to drive the company vehicle.

Name as listed on Driver’s License :

Driver’s License Number :

State Issued :

Date of Birth:

Applicant Signature : *

Printed Name : *

Date : *

BACKGROUND CHECK DISCLOSURE AND RELEASE AUTHORIZATION FORM FOR EMPLOYMENT PURPOSES

Background Screening Disclosure
Red Stag, LLC (the “Company”) may request a comprehensive review of your background information from a consumer reporting agency if a contingent offer is made and accepted, and for other purposes, including promotion, reassigment, or retention as an employee. Your background information may be obtained in the form of consumer reports and/or investigative consumer reports. These reports may be obtained at any time after your acceptance of a contingent offer, if you are hired by the company, and throughout your employment. Corra, 201 Continental Boulevard, Suite 107, El Segundo,CA 90245, 1-310-524-9800, and its designated agents and representatives or another consumer reporting agency will prepare or assembel the reports. The scope of the consumer report/investigative consumer report may include,but not limited to, the following areas: consumer credit, names and dates of previous/current employment, workers compensation claims, criminal history records (from local, state, federal, international and other law enforcement agencies’ records), sexual offender lists, wants and warrant records, motor vehicle records, military records, educational verification, civil cases, OIG/GSA, OFAC/patriot act, any sanction lists, fingerprinting and drug testing.These reports may include information as to your general reputation, character, personal characteristics, mode of living, work habits, job performance and experience along with reasons for termination in the past employment from previous employers. You may request more information about the nature and scope of any investigative consumer reports by contacting the company. A summary of your rights under the Fair Credit Reporting Act is also being provided to you.

AUTHORIZATION AND RELEASE

Authorization and Release, authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, institution, school or university, law enforcement or public agency may have. I authorize the full release of the information described above, without any reservation, throughout any duration of my employment at the company. I certify that all information provided below is true and accurate to the best of my knowledge. This authorization and consent shall be valid in original facsimile(“fax”), or copy form. I understand that Corra’s privacy practices can be found at http://www.corragroup.com/privacy-policy.html

Applicant Signature : *

Printed Name : *

Date : *

The following information is required by the law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose.

PLEASE PRINT LEGIBLY

PRINT FULL NAME (FIRST MIDDLE LAST) :

MAIDEN/AKA/PREVIOUS NAME(S) :

DATE OF BIRTH (MM/DD/YYYY) (This will not affect hiring decision) :

DRIVER LICENSE NUMBER :

STATE OF ISSUE :

PHONE NUMBER :

Current Address :

City :

State :

Zip Code :

Corra Group Background Checks 201 Continetal BLVD, STE.107, El Segundo, CA 90245-4598
TEL(310)524-9800 FAX(310)774-3970 www.corragroup.com

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE

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

In connection with your application for employment with Red Stag / 3 Star Daylighting (“Prospective Employer”), Prospective Employer, its employees, agents or contractions 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 Red Stag / 3 Star Daylighting (“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.

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE

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.

Applicant Signature : *

Printed Name : *

Date : *

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.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.

Corporate Office / 13446 Cleburne Hwy. Cresson, Texas 76035 / 817.396.4601 / wwww.redstaglogistics.com

FMCSA
Drug and Alcohol ClearingHouse

I, hereby provide consent to Red Stag, LLC to conduct a query on the basis of candidacy for employment, and multiple queries upon determination of employment by Red Stag, LLC. The FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse determines whether drug or alcohol violation information about me exists in the Clearinghouse.

I understand that if a query is conducted by Red Stag. LLC and indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Red Stag, LLC without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for Red Stag, LLC to conduct a query of the Clearinghouse, Red Stag, 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, if I become an employee of Red Stag, LLC.

Applicant Signature : *

Date : *