Job ApplicationPlease apply by filling out the details below.10%TO BE READ AND UNDERSTOOD BY APPLICANT PRIOR TO COMPLETING APPLICATION I authorize Freeport Transport Industries, Inc. to make such investigations and inquiries of my personal, employment, criminal, or medical history and other related matters as may be necessary for arriving at an employment decision. I hereby release employers, schools, health care providers, and other persons from liability in responding to inquiries and releasing information in connection with my application. I also release Freeport Transport from any liability for not offering me employment on the basis of any information they receive from their investigations. I understand that if I misrepresent or deliberately omit facts on my application or attached forms, including what is indicated on my MVR, I may be rejected for employment or if I am hired, terminated. I also understand that my application has to be completed fully, including names, addresses, and telephone numbers of prior employers, in order for my application to be considered active at Freeport Transport. I understand and accept that the needs of Freeport may make the following conditions mandatory: overtime, shift work, rotating work schedule, or a work schedule other than Monday through Friday. This application is current and active as an application for employment for three (3) months. At the conclusion of this time, if I have not had any contact from the employer and still wish to be considered for employment, it will be necessary for me to fill out a new application. I understand that Freeport Transport is an Equal Opportunity Employer and does not discriminate on the basis of any protected classification. I further understand that Freeport Transport is an at-will employer and that my employment will be at will and terminable at any time for any or no reason. I have read and agree to the foregoing and certify that the facts I will provide in my employment application and attached forms are true and correct. Notice: This form iş made available to monthly account holders by NICT 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 provided in paragraphs 1-4 of this document to obtain an Applicant's consent. The language must be used in whole, exactly as provided. The language may be included with other consent forms or language at the discretion of the account holder, provided the four paragraphs remain intact and the language is unchanged. 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, or non-job-related disability.I have read and agree to the foregoing and certify that the facts I will provide in my employment application and attached forms are true and correct.NextDRIVER'S RIGHTS UNDER FMCSR 391.23 As a driver, you are provided with certain rights under the Federal Motor Carrier Safety Regulations in Part 391.23. These rights are: 391.23(a) Except as provided in subpart G of this part, each motor carrier shall make the following investigations and inquiries with respect to each driver it employs, other than a person who has been a regularly employed driver of the motor carrier for a continuous period which began before January 1, 1971: 391.23(a)(1) An inquiry to each State where the driver held or holds a motor vehicle operator's license or permit during the preceding 3 years to obtain that driver's motor vehicle record. 391.23(a)(2) An investigation of the driver's safety performance history with Department of Transportation regulated employers during the preceding three years. 391.23(i) (1) The prospective employer must expressly notify drivers with Department of Transportation regulated employment during the preceding three years—via the application form or other written document prior to any hiring decision—that he or she has the following rights regarding the investigative information that will be provided to the prospective employer pursuant to paragraphs (d) and (e) of this section: (i) The right to review the information provided by previous employers; (ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; (iii) The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. 391.23(i)(2) Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of the denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business day's deadline will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records. 391.23(1/1) Drivers wishing to request correction of erroneous information in records received pursuant to paragraph (i) of this section must send the request for the correction to the previous employer that provided the records to the prospective employer. 391.23(1)(2) After October 29, 2004, the previous employer must either correct and forward the information to the prospective motor carrier employer, or notify the driver within 15 days of receiving a driver's request to correct the data that it does not agree to correct the data. If the previous employer corrects and forwards the data as requested, that employer must also retain the corrected information as part of the driver's safety performance history record and provide it to subsequent prospective employers when requests for this information are received. If the previous employer corrects the data and forwards it to the prospective motor carrier employer, there is no need to notify the driver. 391.23(1) (3) Drivers wishing to rebut information in records received pursuant to paragraph (i) of this section must send the rebuttal to the previous employer with instructions to include the rebuttal in that driver's safety performance history, 391.23(i (4) After October 29, 2004, within five business days of receiving a rebuttal from a driver, the previous employer must: (i) Forward a copy of the rebuttal to the prospective motor carrier employer; (ii) Append the rebuttal to the driver's information in the carrier's appropriate file, to be included a as part of the response for any subsequent investigating prospective employers for the duration of the three-year data retention requirement. 391.23(2)(5) The driver may submit a rebuttal initially without a request for correction, or subsequent to a request for correction. 391.23(1) ( The driver may report failures of previous employers to correct information or include the driver's rebuttal as part of the safety performance information, to the FMCSA following procedures specified at $ 386.12. 391.23(k) (1) The prospective motor carrier employer must use the information described in paragraphs (d) and (e) of this section only as part of deciding whether to hire the driver. 391.23(k)(2) The prospective motor carrier employer, its agents and insurers must take all precautions reasonably necessary to protect the records from disclosure to any person not directly involved in deciding whether to hire the driver. The prospective motor carrier employer may not provide any alcohol or controlled substances information to the prospective motor carrier employer's insurer. 391.231 (1) No action or proceeding for defamation, invasion of privacy, or interference with a contract that is based on the furnishing or use of information in accordance with this section may be brought against (i) A motor carrier investigating the information, described in paragraphs (d) and (e) of this section, of an individual under consideration for employment as a commercial motor vehicle driver, (ii) A person who has provided such information; or (iii) The agents or insurers of a person described in paragraph (1) (1) (i) or (ii) of this section, except insurers are not granted a limitation on liability for any alcohol and controlled substance information. 391.23(1)(2) The protections in paragraph (1)(1) of this section do not apply to persons who knowingly furnish false information, or who are not in compliance with the procedures specified for these investigations.I, the undersigned, have received a copy of, read and understand the above mentioned rights. BackNextIMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE 1. In connection with your application for employment with Freeport Transport (“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 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. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and check below: 2. I authorize Freeport Transport (“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 consenting to 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. 3. 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 am challenging 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. 4. Please note: 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 FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, 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. BackNextAbout YouName*FirstLastSocial Security Number*How would you like to be contacted?Home / officeMobile / cell phoneEmailText / SMSHome TelMobile TelEmail address*Do you have the legal right to work in The United States?*YesNoAre you over the age of 21?*YesNoCurrent Address*Address Line 2City*State*Zip*Have you lived at this address longer than 3 years?YesNoPrevious AddressPrevious Address*Address Line 2City*State*Zip*Lived here since*BackNextEmploymentHave you worked for Freeport Transport before?*YesNoWhich location?FromToJob titleBase payPlease explain your reason for leavingAre your currently employed?*YesNoName of current employerFromToJob titleSalary / WageAddressPhoneEmail addressPlease explain your reason for leavingWere you previously employed?*YesNoName of previous employer 1FromToJob titleSalary / WageAddressPhoneEmail addressPlease explain your reason for leavingName of previous employer 2FromToJob titleSalary / WageAddressPhoneEmail addressPlease explain your reason for leavingName of previous employer 3FromToJob titleSalary / WageAddressPhoneEmail addressPlease explain your reason for leavingDo you need to list more employers?YesNoAdd any additional employment information hereWere you referred to us?*YesNoWho referred you?FirstLastAre there any reasons you might not be able to perform the job for which you have applied?*YesNoPlease explainBackNextEducationPlease select your highest grade completed*Grade School DiplomaSome High SchoolHigh School DiplomaSome CollegeAssociate DegreeBachelor's DegreeGraduate or Professional DegreeLast school attended*City*State*List any special courses or training that has helped you as a driverList any special equipment training or technical expertise that has helped you as a driverBackNextExperienceDriver's License(s)State*License Number*Type*Expiration*StateLicense NumberTypeExpirationStateLicense NumberTypeExpirationHave you ever been denied a license, permit or privilege to operate a motor vehicle?*YesNoPlease explainHas any license, permit or privilege ever been suspended or revoked?*YesNoPlease explainClass of EquipmentStraight Truck ExperienceTypeVan, Tank,, Flat, etc.FromToApprox. Total MilesTractor and Semi-Trailer ExperienceTypeVan, Tank,, Flat, etc.FromToApprox. Total MilesTractor - Two Trailer ExperienceTypeVan, Tank,, Flat, etc.FromToApprox. Total MilesBus ExperienceTypeSchool, City, Motorcoach, etc.FromToApprox. Total MilesOther ExperienceTypeFromToApprox. Total MilesSelect all states where you have operated in the last five yearsAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingList any safe driving awards hereBackNextAccident HistoryHave you had an accident in the past 5 years?*YesNoPlease explain any details here*BackNextTraffic ConvictionsHave you had any traffic convictions and/or forfeitures over the past three years?*Please do not include parking violations.YesNoPlease explain any details here*BackNextCERTIFICATE OF COMPLETIONI authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary for 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 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 the Company.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.PRE-EMPLOYMENT URINALYSIS CONSENT AGREEMENTThe Federal Motor Carrier Regulations, Section 382.301, pre-employment testing requirements, apply to driver applicants of Freeport Transport Industries, Inc. 382.301 Pre-employment testing requirements A. A motor carrier shall require a driver applicant, who the motor carrier intends to hire or use, to be tested for the use of controlled substances as a prequalification condition. B. A driver applicant shall submit to controlled substance testing as a prequalification condition. C. Prior to collection of a urine sample, a driver applicant shall be notified that the sample will be tested for the presence of controlled substances. As a condition of my Employment Application, I consent to the urine sample collection and controlled substance testing. I understand a positive test for controlled substances based on the Urinalysis Test will medically disqualify me from the operation of a commercial motor vehicle for this Company. The Medical Review Officer will maintain the results of the urinalysis test. Negative and positive results will be reported to the Company. My written authorization is required for Urinalysis Test results to be given to other parties.I have read and understood the above conditions for the Pre-Employment Urinalysis Consent Agreement. MOTOR VEHICLE DRIVER'S CERTIFICATE OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTSMOTOR 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 more than 15 people, or 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 multiple licenses have 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 392.42 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 to 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.The Following License is The Only One I Will PossessDriver's License Number*State*Expires*I certify that I have read and understood the above requirements. I hereby authorize Freeport Transport Inc. of Pennsylvania and/or its agents to make investigation of my background, references, character, past employment, consumer reports, education, and criminal history.Sign below* Clear SignatureBackSendThis field should be left blank