List ALL accidents/incidents with vehicles for the past three years, include preventable and non-preventable, whether or not on MVR whether your fault or not.
(IF NONE, SELECT NONE)
AGREEMENT AND CERTIFICATION
I hereby authorize FERROUS METAL TRANSFER to make investigations of my persons, employment and other related matters as may be necessary at arriving at an employment decision or verifying the information related to my application. I have been told that this may include and Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.
I understand that before a final offer of employment is made I will be required, and agree to undergo, testing for the illegal use of drugs and/or alcohol. I understand that a confirmed positive test will disqualify me from employment by FERROUS METAL TRANSFER.
I also understand and agree that the Company has the right to modify, amend, or terminate policies, procedures, rules and benefit plans in its discretion and/or manner consistent with requirements imposed by law.
If I am employed by FERROUS METAL TRANSFER, I understand that my employment is at-will and for no definite period of time. Either FERROUS METAL TRANSFER or I may terminate my employment at any time, with or without reason and with or without notice. I further understand that my employment is at-will regardless of any statement made by an employee or agent of FERROUS METAL TRANSFER or in any policy, program, practice, handbook, or another written or oral materials of the Company. I further understand that no employee or agent of FERROUS METAL TRANSFER has any authority to make agreements with me concerning the duration of my employment.
My signature below constitutes full acceptance of this employment application in its entirety and certifies that all the information provided herein is true and correct to the best of my knowledge.
PRE-EMPLOYMENT CONTROLLED SUBSTANCES TESTING CONSENT FORM
The Controlled Substance and Alcohol Use and Testing Regulations, Section 382.301, apply to driver-applicants of FERROUS METAL TRANSFER CO. I understand that pursuant to these regulations, I must successfully complete testing for controlled substances prior to performing any safety-sensitive functions.
As a condition of my employment, I agree to the urine sample, collection and controlled substance testing. I understand that a positive test for controlled substances will disqualify me from the operation of a commercial motor vehicle for this Company. I authorize the testing laboratory to release my test results and related medical information to designated representatives of FERROUS METAL TRANSFER CO. and/or the outside reviewing agents chosen by FERROUS METAL TRANSFER CO.
I understand that the Medical Review Officer will maintain the results of the controlled substances test, and that the results will be reported to the Company. Should there be a positive test result, I understand that the Medical Review Officer may ask me to provide, and I agree to provide, information about any non-prescription and prescription drugs that I routinely take or have taken within the last thirty (30) days. I further understand that any communications I may have the collection site personnel, testing labors or Medical Review Officer is not meant to create or imply any form of doctor/patient relationship.
REQUEST FOR CHECK OF DRIVING RECORD
I hereby authorize you to release the following information to FERROUS METAL TRANSFER CO. for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability which may result from furnishing such information.
PLEASE READ THE LANGUAGE BELOW CAREFULLY, SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS LANGUAGE, PLEASE SEEK ASSISTANCE PRIOR TO SIGNING THIS DOCUMENT.
I certify that the information contained in this application is true, accurate and complete. I understand that falsification of this Application in any detail may result in disqualification from further consideration, or, if hired, immediate dismissal without notice from employment. As a condition of employment, I understand the Company reserves the privilege to thoroughly investigate and verify all information contained in this Application, including but not limited to contacting any of the aforementioned employers, supervisors and references.
I agree to conform to the rules and regulations of the Company, and I understand that my employment and compensation can be terminated, with or without cause, at any time, at the option of either the Company or myself. I further understand that no personnel recruiter or interviewer or other representative of the Company, other than its President or Vice President in an agreement signed by all parties, has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing.
By clicking the box below, I authorize Ferrous Metal Transfer and/or their Agents to do a complete background investigation as required by the D.O.T. including DAC inquiry, drug and alcohol results and accidents. I authorize previous employers to provide any information requested by Ferrous Metal Transfer and/or their Agents and release them from all liability for providing said information.
I authorize Ferrous Metal Transfer to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and 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 Ferrous Metal Transfer in making a determination regarding my suitability to operate a vehicle leased to Ferrous Metal Transfer.
This certifies that this application was completed by me, and all entries on it and information in it are true and complete to the best of my knowledge.