(503) 581-8787 info@oregontruss.com

Driver Application

Driver Application

Personal Information

Employment History

All Applicants wanting to drive in interstate commerce must provide the following information on all employers during the preceding three years. You must give the same information for all employers for whom you have driven a commercial vehicle seven years prior to the initial three years (total of ten years employment record).
Use the Text Field below to list your past employers.
For each past employer, please provide - Name of Company, Phone Number, Address, Position Held, Dates of Employment, Reason For Leaving. If you were subject to the Federal Motor Carrier Safety Regulation** , and if your job was designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40.
Any gaps in employment and/or unemployment must be explained.
Include dates and reason.

** The Federal Motor Carrier Safety Regulations 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 designated or used to transport 9 or more passengers. OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.

Motor Vehicle Driver's Certification of Violations

DRIVER REQUIREMENTS: Each driver shall furnish the list as required by the motor carrier. If the driver has not been convicted of, or forfeited bond or collateral on account of any violation which must be listed, he/she shall so certify (Section 391.27)
I Certify that the following is a true and complete list of traffic violations required to be listed (other than those i have provided under Part 383) for witch I have been convicted or forfeited bond or collateral during the past 12 months.
Please list all violations - Include Date of violation, Offense, Location, and Type of vehicle Operated

If no violations, I Certify that I have not been convicted or forfeited bond or collateral on account of any violation (other than those i have provided under Part 383) Required to be listed during the past 12 months.

Please provide your signature on the line above

Previous Pre-Employment Employee Alcohol and Drug Test Statement

Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?
If you answered yes, can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements?

Experience and Qualifications

List your CDL driving experience. Include: Class of Equipment (Straight Truck, Tractor & Semi Trailer, Tractor- Two Trailers, Tractor - Three Trailers, Motorcoach - School Bus, or Other), Type of Equipment (Van, Reefer, Tank, Flat), Dates or Approximate Number of Miles.
List any certificates you possess relating to commercial trucking job activities. Include current and expired certification: (Boom/Crane Operator, Heavy Equipment, Fork Lift, First Aid, CPR, or Other)
List all Accidents within the past 3 years. Include: Date, Nature of Accident (head-on, rear-end, upset, etc.) Number of Fatalities, Number of Injuries, and if there was a Hazardous Materials Spill.
List all traffic convictions and/or forfeitures within the past 3 years. Include: Date Convicted, Violation (other than violations involving parking only), State of Violation, Penalty (forfeited bond, collateral and/or points

Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license.” I Certify that I do not have more than one motor vehicle license, the information for which is listed below

Fair Credit Reporting Act Disclosure Statement

In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purpose. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations

Please provide your signature on the line below

Certification of Compliance with Driver's License Requirements

MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:

  1. POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motor vehicle operator’s license.
    If you have more than one license, keep the license from your state of residence and return the additional licenses to the states that issued them. DESTROYING a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed by that state.
  2. NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 391.15(b)(2) and 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver’s license. In addition, Section 383.31 requires that anytime you violate a state or local traffic law (other than parking), you must report it within 30 days to: 1) your employing motor carrier, and 2) the state that issued your license (if the violation occurs in a State other than the one which issued your license). The notification to both the employer and state must be in writing.
Please provide your signature on the line below

Consent

Oregon Truss is a drug-free employer. As a part of the hiring process, all individuals must submit to and pass a test for controlled substances defined as alcohol, narcotics, depressants, stimulants, hallucinogens and cannabis.

Twenty-four (24) hours after the final interviews for employment and as a condition of employment, this test must be completed and passed.

If you wish to complete the application process you must consent to such testing by completely filling out and signing this employment application

OFFER OF EMPLOYMENT CONSENT FORM



Employee Consents:

I do hereby, freely agree, consent and permit Oregon Truss Co., Inc. to arrange for a laboratory test on a specimen provided by me to determine the presence of controlled substances. I recognize, understand and agree that the results of an analysis of such specimen will be reported to Oregon Truss Co., Inc. and will be used to determine my suitability for employment.

I further recognize and understand the testing may detect the presence of controlled substances which may be properly taken pursuant to a doctor's prescription. Therefore, I acknowledge that it is important for the testing facility to know of all such substances, and that it is my sole responsibility to provide written medical reasons for and the nature of such medication if requested.

I hereby certify that I understand and I agree to pay for the test and I understand that I will be reimbursed for the actual cost of the test upon completion of my first full day of employment with Oregon Truss Co., Inc. I further agree to hold Oregon Truss Co., Inc. and it's representatives harmless of any liability whatsoever which may arise from any legitimate internal use of the information gained from the tests, whether known or unknown, suspected or unsuspected. I understand that Oregon Truss Co., Inc. shall take reasonable precautions to protect the confidentiality of such information.

NOTICE BEFORE ORDERING MOTOR VIHICLE REPORT



The Fair Credit Reporting Act (FCRA) provides individuals with certain rights regarding Motor Vehicle reports and places certain obligations on employers using this information.

Consistent with the FCRA's requirements, this notice is provided to inform you that Oregon Truss Co., Inc. for the purpose of determining Certified Driver Status, will obtain your driving record information from the Department of Motor Vehicles.

Oregon Truss Co., Inc will not obtain this report without your signature below authorizing us to do so.

AUTHORIZATION TO OBTAIN DRIVING RECORD INFORMATION

I hereby acknowledge that I have read and understand the contents of the above notice and, by signing below, specifically authorize Oregon Truss Co., Inc. to obtain this report for the purposes as outlined above.

By signing below, this certifies that I have read, understand and agree to all statements listed above.
Please provide your signature on the line below

Authorization

I authorize you to make such investigations and inquires 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 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 releases 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, for the purpose of investigating my safety 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 as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

  • Review information provided by current/previous employers; and
  • 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.
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