Welcome to Hot Land Carrier

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 after conditional offer of employment had 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 to 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 history as by 49 CFR 391.23(d) and (e). I understand that I have the right 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 employers; and
  • Have a rebuttal statement attached to the alleged erroneous information, in the previous employer(s) and I cannot agree on the accuracy of the information

NOTE: Typing in your name for the Signature field below will act as a binding signature

Applicant To Complete

(answer all questions - please print)

Last
First
Middle

List your addresses of residence for the past 3 years

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

( for Commercial Drivers)

(Answer only if a job requirment)

If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment- all circumstances will be considered.

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent.)

Employer

Date

Employer

Date

Employer

Date

*Includes vehicles having a GVWR of 26,001lbs. or more, vehicles designed to transport 16 or more passengers (including the driver), or any size vehicle used to transport hazardous materials in quantity requiring placarding.

†The Federal Motor Carrier Safety Regulations (FMCSR's) 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 more than 8 passengers (including the driver), OR (3) is of any size and it used to transport hazardous materials in a quantity requiring placarding

Accident record for past 3 years or more (attach sheet if more space is needed) if none, write none

Traffic Convictions And Foreitures For The Past 3 Years (Other Than Parking Violations) If None, Write None

(Attach Sheet If More Space Is Needed)

Experience And Qualifications - Driver

List all driver licenses or permits held in the past 3 years

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?

More than 8 passengers
More than 15 passengers

Experience And Qualifications - Other

Education

(NAME)
(CITY, STATE)

To Be Read And Signed By Applicant

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.

The below discosure and authorization language is for mandatory use by all account holders

Important Disclosure

Regarding background reports from the psp online service

In connection with your application for employment with ("Prospective Employer"). Prospective Employer. Its employees, agents or contractors may obtain one or more reports regarding your driving, and safety in spection 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 hite 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 sagety 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 do 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 obrained 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 avtion 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 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 cpability to correct any safety data that appears to be incorrect. You may challenge the accuracy or the data by submitting a request to https://dataqs.FMCSA.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA can not change or correct this data. Your Request will be forwarded by the DataQs system to the appropriate State for adjudiction.

Any crash or inspection in which your 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 Regulation (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

The Prospective Employer can not 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 ("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 form 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 meither the Prospective Employer nor the FMCSA contractor supplying the crash and safety infromation has the capability to correct any safety data that appears to be incorrect. I understand I amy 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 can not 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 involed will displayon 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 cilations associated with FMCSR violations that have been adjudicated by a count 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 Transportain, Federal Motor Carrier Safety Administration (FMCSA). Account holders are by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's 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 defination of "employee" contained at 49 C.F.R.383.5.