Application for Driver Position - Transportation Advisors

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Driver Application for Siesta Trolley Inc

5682 Fruitville Rd.
Sarasota, FL 34232
941-915-3232
Driver Application for Legacy Luxury Transportation

10451 State HWY 300
Gilmore, TX 75645
903-505-9800
Driver Application for Go Express Travel

3200 Venture Blvd.
Bloomington, IN 47404
812-534-9821

1801 S. Lawndale Ave
Indianapolis, IN 46241
888-424-2610
Driver Application for Alpine Shredding Trucks Ltd

151 Commerce Blvd
Statesville, NC 28625
866-246-5634
Driver Application for Thompson Black Car LLC

1000 W Wilshire Blvd
STE 220
Oklahoma, OK 73116
Driver Application for John Hall's Alaska

1127 N Lakeshore Dr
Lake City, MN 55041
800-325-2270
Driver Application for Silverfox Limos

3300 Monroe Rd
Ste C-2
Charlotte, NC 28205
Driver Application for Kelly Tours

(912) 964-2010

Savannah
2788 US Hwy 80 W
Garden City, Ga 31408

Macon
2303 Seventh St
Macon, GA 31206

Yulee
850737 Hwy 17 N
Yulee, FL 32037

Charleston
6484 Savannah Hwy
Ravenel, SC 29470

North GA
5271 Mountain Center Plaza
Lula, GA 30554

Anderson
307 North Main St
Anderson, SC 29621
Driver Application for Alta Bus

PO Box 8
Chester, PA 19013
844-258-2287
Driver Application for Voigt’s Bus Service, Inc.

P.O Box 1
St. Cloud, MN 56302
Driver Application for Mountain Motor Coach

766 Highway 107 South
Cashiers, NC 28717
(888) 506-1907
Driver Application for Embark Coach Line
Driver Application for Agape Travel and Tours

805 Live Oak Dr, #104
Chesapeake, VA 23320
(757) 410-5713
Driver Application for Delaware Limo

2305 Pyle St.
Wilmington, DE 19805
302-319-3329
Driver Application for Shred Industry Solutions Inc

713 Sharples Dr
Fort Mill, SC 29715
Driver Application for Varsity Travel

220 Imboden Drive
Winchester, VA 22603
Driver Application for Alto Bus Charter

2200 Pennsylvania Ave
Washington, DC 20037
Driver Application for Elite Limousine
Driver Application for Campbell Bus Lines

PO Box 340
Slippery Rock, PA 16057
Driver Application for Allied Coach Leasing

211 Babb Dr.
Lebanon, TN 37087
Driver Application for Elegance Limousines & Black Car Services

201 3rd Street Suite 1950 Office #17
Albuquerque, NM 87102
505-918-8002
Driver Application for Luxury Cars DC

Luxury Cars DC
6120 Hibbling Ave
Springfield, VA 22150
Driver Application for Atlantic Coast Charters INC

Atlantic Coast Charters INC
1344c W Nursery Rd
Linthicum Heights, MD 21090
Driver Application for Brisbon Transportation Group

6508 Mt. Herman Rd.
Raleigh, North Carolina 27617
Driver Application for My Limousine Service

350 Clark Drive, Suite 235
Mount Olive, NJ 07828
Driver Application for American Executive Transportation

23571 Pebble Run Pl. Ste 130
Sterling VA 20166
703-662-7273
Driver Application for Diaz Logistics

1515 East 28th St
Lorain, OH 44055
Driver Application for Mint Life Limo

925 Research Center Atlanta Dr SW
Atlanta GA 30331
404-699-9100
Driver Application for Dan Dipert Coaches

Dan Dipert Coaches
7301 W. Pioneer Parkway
Arlington, TX 76013-2802
817-543-3700
Driver Application for Galveston Limousine LLC

PO Box 3190
Galveston, TX 77552
409-744-5465
Driver Application for OD Transportation

561 NE 79th Street Suite #325
Miami, Florida 33138
(305) 456-2029
Driver Application for Bolt Transportation

121 Greenway Blvd
Carrollton, GA 30117
770-830-7226
Driver Application for American Transportation and Limo Service

3319 NW 74th Ave
Miami, FL 33122
305-885-5002
Driver Application for Traverse City Wine And Beer Tours

231-499-2656
Driver Application for Royalty Hawaii Luxury Transportation

1003 Bishop Street
Suite 2700
Honolulu, HI 96813
Driver Application for Paragon Environmental Construction, Inc.

5664 Mud Mill Road
Brewerton, NY 13029
(315) 699-0840
Driver Application for On The Town Limousines & Transportation

5112 Pegasus Ct, Suite V
Frederick MD, 21704
301-829-7999
Driver Application for iShuttle LLC

10355 Linwood Ave
Shreveport, LA 71106
318-872-2152
Driver Application for SHV

10355 Linwood Ave
Shreveport, LA 71106
318-603-5315
Driver Application for Strack Chauffeured Transportation INC

Strack Chauffeured Transportation INC
1521 W. Broadway
Anaheim, CA 92802
714-546-1446
Driver Application for Victory Ground

712 Dickerson Pike
STE 202
Nashville, TN 37207
615-510-7878
Driver Application for Unique Chauffeured Services

1900 Crooked Hill Road
Harrisburg, PA 17110
Driver Application for Boston Chauffeur
Driver Application for Blackbird Worldwide Corp
Driver Application for Elite Coach Transportation

4351 WILLIAM PENN HWY
MURRYSVILLE, PA 15668-1915
(724) 325-2626
Driver Application for Signature Transportation Services

1306 Antioch Pike
Nashville, TN 37211
615-244-5466
Driver Application for Signature Elite

1306 Antioch Pike
Nashville, TN 37211
615-244-5466
Driver Application for S & H Transportation

S & H Transportation
1801 E US 70 HWY
Durham, NC 27703
919-680-0700
Driver Application for Metropolis Passenger Logistics LLC

dba Metro Shuttle
One International Plaza Suite 550
Philadelphia, PA 19113
1-877-595-2525
Driver Application for DMC Livery

51 Main Street
South Paris, Maine 04281
207-576-4750
Driver Application for Sterling Charters LLC

222 Westinghouse Blvd
Suite 501
Charlotte NC 28273
Driver Application for Jano
Driver Application for PLB Charters LLC
Driver Application for Downtown Party Bus

1315 Ridgefield Loop
Round Rock, TX 78665
512-309-1182
Driver Application for Elder Charters

910-751-2228
Driver Application for Rochester Shuttle Express

1-888-663-3770
Driver Application for Fitzgerald Brothers
Driver Application for Urban Worldwide Coaches

1162 San Mateo Ave
South San Francisco, CA 94080
Driver Application for Majestic Limousine Service

1816 Fuller Rd
West Des Moines, IA 50265
515-650-5555
Driver Application for Ambassador Global Chauffeur

3355 Lenox Rd Suite 750
Atlanta, GA 30326
404-621-2544
Driver Application for Dulles Limousine, LLC & Dulles Luxury Coach, LLC

Dulles Limousine, LLC
9 Douglas Ct Suite 180
Sterling, VA 20166

Dulles Luxury Coach, LLC
9 Douglas Ct Suite 180
Sterling, VA 20166
Driver Application for Aadvanced Limousines

8614 Southeastern Ave.
Indianapolis, IN 46239
(317) 716-1201
Driver Application for Blue Lakes Charters

12154 N. Saginaw Rd.
Clio, MI 48420
800-282-4287
Driver Application for Beat the Street

Nashville TN 37219
407-614-1857
Driver Application for Renee’s Limousines

12813 Industrial Park Blvd.
Plymouth, MN 55441
Driver Application for Overland Transportation Services LLC

3119 Merriam LN
Kansas City, KS 66106
913-381-3504
Driver Application for CTA Worldwide Chauffeured Transportation

1202 Hallmark Drive # 204
San Antonio, Texas 78216
210-829-8608
Driver Application for For Hire Transportation Management Services

2450 Pleasantdale Rd
Atlanta, GA 30340
404-747-8096
Driver Application for Atlantic Limousine & Transportation

2450 Pleasantdale Rd
Atlanta, GA 30340
770-751-7078
Driver Application for Network Transportation

10311 Orangewood Blvd
Orlando, FL 32821
407-422-2522
Driver Application for Destination MCO

10311 Orangewood Blvd
Orlando, FL 32821
407-422-2522
Driver Application for Best Transportation Inc.

4628 Crossroads Industrial Drive
St. Louis, MO 63044
314-989-1500
Driver Application for NW Navigator Luxury Coaches LLC

13940 N Rivergate Blvd
Portland, OR 97203
Christian Bros

8745 Old State Rd.
Holly Hill, SC 29059
803-682-5073
Starline Collection

9801 Martin Luther King Jr Way S
Seattle WA 98118
206-763-5817
DTS Transportation

15210 Dino Drive, Suite H
Burtonsville MD 20866
800.914.2855
Royal Parking Inc
DBA Ecostyle

8870 Westgate Park Drive, suite 100
Raleigh, NC 27617
(919) 890-3839
Chariots of Hire Inc

1204 Topside Road
Louisville, TN 37777
(865) 522-8108
Driver Application for Adventures By Dawn LLC
DBA Adventure Tours

Charlotte, NC
(301)868-1141
Driver Application for Adventures By Dawn LLC
DBA Adventure Tours

17517 B Indian Head Hwy
Accokeek, MD 20607
(301)868-1141
Driver Application for Umbrella Buses Inc.

555 N John Young Parkway
Orlando, FL 32805
Driver Application for Carolina Limousine & Coach

9525 Scipio Ln.
Myrtle Beach, SC 29588
(843) 294-5466
Driver Application for Quick-Livick Inc
DBA Quick's Bus Company

2309 Poplar St
Staunton, VA 24401
(540) 886-6297
Driver Application for Appellation Tours Inc
DBA Beau Wine Tours
DBA Napa & Sonoma Valley Wine Trolley

21707 8th Street East
Sonoma, CA 95476
(800) 387-2328
Driver Application for Royalty Events Group Inc.

149-35 177th Street Suite 102
Jamaica, NY 11434
718-928-9966
Driver Application for PREMIER Transportation Company

1500 Breda Drive
Knoxville, TN 37918

1619 Shepherd Rd.
Chattanooga, TN 37421
(865) 694-0304
Driver Application for Carreras Tours LLC

408 E Transit St
Ontario, CA 91761
(909) 467-4949
Driver Application for DEMO

ADDRESS
CITY, STATE ZIP
PHONE
Driver Application for Gentry
DBA Olympus Car and Coach

2425 Burnside Street
Knoxville, TN 37921
(865) 522-2796
Driver Application for Going Coastal

4211 Fellowship Rd
N. Charleston SC 29418
843-216-8483
Driver Application for Peak Limo

2300-C Stevens Mill Rd
Charlotte, NC 28104
704-568-1200
Driver Application for North Point

1454 Willingham Dr.
Atlanta, GA 30344
678-935-5000
Driver Application for Atlanta Elite

1810 Water Place SE
Suite 140
Atlanta, GA 30339
(770) 955-4565
Driver Application for Charlotte Scale

1510 Ameron Dr
Charlotte, NC 28206
704-376-8496
Please review the Personal History section
Select your location*
- Savannah
- Macon
- Yulee
- Charleston
- North GA
- Anderson
Which terminal location are you applying to?*
- El Paso
- San Antonio
Your Preferred Base of Operations?*
- Seattle
- Yakima
- Pasco
- Boise
Full Name*
First Name Middle Name Last Name
Are you CDL or Non-CDL Driver?*
- CDL Driver
- Non-CDL Driver
Are you CDL or Non-CDL Driver?*
- CDL Driver - Vehicles Combined Weight Over 26,001 LBS GVWR
- Non-CDL Driver - Vehicles Combined Weight Under 26,000 LBS GVWR

Have you registered for the Drug and Alcohol Clearinghouse?*
- Yes
- No
Register Immediately on
https://clearinghouse.fmcsa.dot.gov/

Applicant Information
Phone*
Emergency Contact*
Emergency Contact Phone*
Age*
Date of Birth*
Month
Day
Year
Place of Birth (City and State)
Social Security #*
Email*
How did you hear about this position?*
Required rate of pay?*
Do you have a valid passport permitting you to drive outside the USA?
- Yes
- No
Passport Number
Are you cleared to travel in Canada?
- Yes
- No
Were you referred by another employee in the company?
- Yes
- No
Name of Referrer
(The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.)
Current & Previous Three Years Addresses

Current & Previous Three Years Addresses

Address	From Date (MM/DD/YYYY)	To Date (MM/DD/YYYY)	Actions

There are no Entries.

Note: Please enter the continuous addresses for the past 3 years to go to the next step.

Education
- Type Of School
- Name Of School
- Location
- Years Completed
- Major / Degree / Diploma
- High School
- High School Attended:
- Location:
- Years Completed:
- Major & Degree:
- College
- College Attended:
- Location:
- Years Completed:
- Major & Degree:
- Business/Trade School
- Business/Trade School Attended:
- Location:
- Years Completed:
- Major & Degree:
- Professional School
- Professional School Attended:
- Location:
- Years Completed:
- Major & Degree

Employment / Military History
Have You Worked For This Company Before?*
- Yes
- No
From*
To*
Reason for leaving?*
Did you serve in the military?*
- Yes
- No
Which branch?*
Dates of service?*
MOS?*
Do you have a certificate of release form DD2-14?*
- Yes
- No
Please Provide a Copy of your DD2-14
Max. file size: 50 MB.

Employment History
A COMPLETE employment application is required. List all employment for the past three (3) years, including any unemployment or self-employment periods, volunteer experience, and all commercial driving experience for the past ten (10) years. Failure to provide contact information or a complete 10-year history may result in disqualification of the application. Information provided may be used and the applicant’s prior employers may be contacted for the purpose of investigating the applicant’s safety performance history information as required by 49 CFR §391.23.

Employment History

Date (MM/DD/YYYY) From	Date (MM/DD/YYYY) To	Company Name	Actions

There are no Entries.

Note: List all employment for the past 3 years, including any unemployment or self-employment periods, volunteer experience, and all commercial driving experience for the past ten (10) years.

PLEASE RETURN AS SOON AS POSSIBLE!!!

**FOR OFFICE STAFF TO FILL OUT – APPLICANT PRINT NAME, SIGN AND DATE AT BOTTOM ONLY **

To (Previous Employer):_______________________________

Applicant Name:______________________________________

DATE:_______________________________

SS#:_________________________________

The person listed above has applied to this company. Your firm is listed by the applicant as a previous employer. Please complete the following items and return to us as soon as possible.
Carrier Representative: Transportation Advisors

Dates of Employment: From________ To________ Position:____________________________

Three-year Accident History

Date City/State # Injuries # Fatalities Hazmat? Preventable

Department of Transportation regulations 40 CFR Part 40.25 h require that you provide the following information:
In the past three years, has the individual listed below ever:
Had a verified positive drug test result?    ________Yes    ________No
Had an alcohol test result with a breath alcohol concentration of .04 or greater?    ________Yes   ________No
Refused to submit to an alcohol or drug test?    ________Yes    ________No
Had any other violations of DOT agency drug and alcohol testing regulations?    ________Yes    ________No

If any of the above questions were answered yes, please provide the following:

______________________________
Substance Abuse Professional

______________________________
Telephone

_______________________
Date Referred

_________________________________
Address

______________________
City

_______________________
State

________________
Zip

____________________________________
Signature of person supplying information

______________________________
Title

____/_____/_______
Date
APPLICANT RELEASE AND CONSENT:
I,*
do hereby authorize my previous employers to release and forward all information regarding my alcohol and controlled substance testing and all other records of employment to the above-named carrier in connection with my application for employment. I release my former employers from any and all liability of any type as a result of providing the above information.
Signature*
Your Name
Your Name
Your Name
Date*

Driving Experience
Straight Truck
From Date*
Month
Day
Year
To Date*
Month
Day
Year
Approximate Number of Miles*
- No Driving Experience
Tractor & Semi-Trailer, Two or Three Trailers
From Date*
Month
Day
Year
To Date*
Month
Day
Year
Approximate Number of Miles*
- No Driving Experience
Mini Bus
From Date*
Month
Day
Year
To Date*
Month
Day
Year
Approximate Number of Miles*
- No Driving Experience
Motor Coach
From Date*
Month
Day
Year
To Date*
Month
Day
Year
Approximate Number of Miles*
- No Driving Experience
Other
Vehicle*
From Date*
Month
Day
Year
To Date*
Month
Day
Year
Approximate Number of Miles*
- No Driving Experience
List states operated in, for the last five (5) years*
List special courses/training completed (PTD/DDC, HAZMAT, ETC)*
- No Special Courses/Training
List any Safe Driving Awards you hold and from whom*
- No Safe Driving Awards
Accident Record for past three (3) years
Accident Record for past three (3) years*
Date of Accident Nature of Accidents (Head on, rear end, etc.) Location of Accident # of Fatalities # of People Injured Involved CMV?
- No Accidents
Traffic Convictions and Forfeitures for the last three (3) years (INCLUDING tickets from an accident, EXCLUDING parking violations)
Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations)*
Date Location Charge Penalty / Points
- No convictions
Single License Compliance

DRIVER REQUIREMENTS:

Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain certain driver licensing requirements that you as a driver must comply with, including the following:

1) POSSESS ONLY ONE LICENSE: You, as a commercial vehicle driver, may not possess more than one motor vehicle operator's license.

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 any time 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 the state must be in writing.

3) CDL DOMICILE REQUIREMENT: Section 383.23(a)(2) requires that your commercial driver’s license be issued by your legal state of domicile , where you have your true, fixed, and permanent home and principal residence and to which you have the intention of returning whenever you are absent. If you establish a new domicile in another state, you must apply to transfer your CDL within 30 days.

The following license is the only one I will possess:
Driver’s License No.*
State*
Exp. Date*
Driver’s License list EACH driver’s license held in the past three(3) years
Driver’s License list EACH driver’s license held in the past three(3) years*
State Type Endorsements License Number Expiration Date
Upload Current Driver's License (Front & Back)
Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 50 MB, Max. files: 2.
Upload Current Driver's License (Front & Back)*
Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 50 MB, Max. files: 2.
Do you have a current DOT Medical Card?*
- Yes
- No
Expiration Date*
Upload image of your DOT Medical Card
Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 50 MB.
Upload image of your DOT Medical Card*
Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 50 MB.
Expiration Date*
Personal History
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
- Yes
- No
Give details
Has any license, permit or privilege ever been suspended or revoked?*
- Yes
- No
Give details
Do you have a pending charge or past conviction for driving while intoxicated?*
- Yes
- No
Give details
Do you have a pending charge or past conviction for possession of a controlled substance?*
- Yes
- No
Give details
Do you have a pending charge or past conviction for possession of a controlled substance or paraphernalia?*
- Yes
- No
Give details
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?*
- Yes
- No
Give details
Have you ever been convicted of a felony?*
- Yes
- No
Give details
Have you ever been convicted of a felony or misdemeanor?*
- Yes
- No
Give details
Drug and Alcohol History
Have you ever tested positive for Drugs or Alcohol on a pre-employment or a random test?*
- Yes
- No
Please list when, where and any explanation you care to provide:
Have you ever failed to complete a pre-employment or a random test immediately upon notification or ever refused to test?*
- Yes
- No
Please list when, where and any explanation you care to provide:
Have you participated and completed the return to duty process through an approved Substance Abuse Professional?*
- Yes
- No
Please provide documentation:
Max. file size: 50 MB.
Do You Smoke/Vape?*
- Yes
- No

Rights

Pursuant to 49CFR, part 391.23 (j), you have the following rights regarding investigative information
- The right to review information provided by previous employers.
- 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.
- 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.
To Be Read and Signed by Applicant
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquire 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 releasing information in connections 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.
Signature*
Your Name
Your Name
Your Name
Date*

Rights

Pursuant to 49CFR, part 391.23 (j), you have the following rights regarding investigative information
- The right to review information provided by previous employers.
- 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.
- 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.
If you wish to review previous employer-provided investigative information you 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 denial of employment. The prospective employer must provide this information to the applicant within five 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 days deadline will begin when the prospective employer received the requested safety performance history information. If the driver has not arranged to pick up or received the requested records within the thirty 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.

Drivers wishing to request correction of erroneous information in records must send the request for the correction to the previous employer that provided the records to the prospective employer. 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.

Drivers wishing to rebut information in records must send the rebuttal to the previous employer with instructions to include the rebuttal in that driver's safety performance history.
Signature*
Your Name
Your Name
Your Name
Print Name*
Date*

DRUG & ALCOHOL CLEARINGHOUSE CONSENT FOR LIMITED QUERIES

NOTICE TO DRIVER: The Commercial Driver's License (CDL) Drug & Alcohol Clearinghouse is a federal database containing information about CDL drivers who have violated the Federal Motor Carrier Safety Administration's (FMCSA's) drug or alcohol regulations in 49 CFR Part 382. Whether you have committed such a violation or not, each motor carrier for whom you drive is required to check whether the Clearinghouse has any information about you, both at the time of hire and annually. When conducting an annual inquiry, the motor carrier has the option to request a "limited" report that only indicates whether the Clearinghouse has any information about you; it does not release any violation or testing information. Before a motor carrier may request a limited report, they must have your written authorization, per §382.701 (b). This authorization may be valid for more than one year. If a limited query ever reveals that the Clearinghouse has information about you, you will be required to log in to the Clearinghouse website within 24 hours to grant electronic consent for the motor carrier to obtain your full Clearinghouse record.

NOTICE TO MOTOR CARRIER: This consent form authorizes you to run a "limited query" to check whether the Clearinghouse has information about the driver identified below. If it does, then you must obtain a full Clearinghouse record within 24 hours, per §382.701 (b). This consent form must be retained until 3 years after the date of the last limited query you perfonn for this driver, based on the authorization below.
I,*
hereby authorize Elite Coach Transportation to conduct limited annual queries of the FMCSA's Drug & Alcohol Clearinghouse, to determine if a Clearinghouse record exists for me. This consent is valid from the date shown below until my employment with the above-named motor carrier ceases or until I am no longer subject to the drug and alcohol testing rules in 49 CFR Part 382 for the above-named motor carrier.

I understand that if any limited query reveals that the Clearinghouse contains information about me, I must grant electronic consent within 24 hours, via the Clearinghouse website, for the motor carrier to obtain my full Clearinghouse record. Refusal to provide such consent will result in my removal from safety-sensitive duties.
Signature*
Your Name
Your Name
Your Name
Drivers License Number:*
Date*

Electronic Disclosure Form

DISCLOSURE TO EMPLOYMENT APPLICANT & STAFF REGARDING INITIAL & ANNUAL PROCUREMENT OF INVESTIGATIVE & DRIVER’S LICENSE REPORTS: Please be advised that we may obtain an investigative report including information as to your character, general reputation, and personal characteristics. This information may be obtained by contacting your previous employers or references supplied by you. Please be advised that you have the right to request, in writing, within a reasonable time, that we make a complete and accurate disclosure of the nature and scope of the information requested. Such disclosure will be made to you within 5 business days of the date on which we receive the request from you or within 5 business days of the time the report was first requested. If the individual being reported on is under the age of 18, a guardian’s signature must accompany the individual’s signature on this form. By signing below, you hereby authorize us to obtain a driver’s license, criminal background check, education verification, credit report, past employment details, or any other information needed for employment. We, the employer, reserve the right to pull an updated report at our discretion for a period of five years or until employment is terminated.

Fair Credit Reporting Act

A Summary of Your Rights
Under the Fair Credit Reporting Act

The Federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every “consumer reporting agency” (CRA). Most CRA’s are credit bureaus that gather and sell information about you – such as if you pay your bills on time or have filed bankruptcy – to creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. section 1681-1681u. The FCRA gives you specific rights as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or state attorney general to learn those rights.
- You must be told if information in your file has been used against you.
- You can find out what is in your file.
- You can dispute inaccurate information with the CRA.
- Inaccurate information must be corrected or deleted.
- You can dispute inaccurate items with the source of the information.
- Outdated information may not be reported.
- Access to your file is limited.
- Your consent is required for reports that are provided to employers or reports that contain medical information.
- You may choose to exclude your name from CRA lists for unsolicited credit or insurance offers.
- You may seek damages from violators.
For questions and concerns regarding CRA’s, contact:
Federal Trade Commission – Consumer Response Center FCRA
Washington, DC 20580
202-326-3761

In compliance with consumer reporting and privacy legislation, I having signed below, authorize Transportation Advisors, Datasource Background Screening Service and any of their agents on behalf of the company listed above to acquire information on my behalf:
Applicant Full Name*
Signature*
Your Name
Your Name
Your Name

Pre-Employment Urinalysis Consent Agreement Drug & Alcohol Testing Consent Agreement Physical Examination Statement

ALCOHOL & DRUG SCREENING REQUIREMENT: Controlled Substance and Alcohol Use Testing under Part 382 of the Federal Motor Carrier Safety Regulations apply to all applicants and drivers of Elite Coach Transportation. This consent agreement outlines what notification and testing is required under this Part by the FMCSR’s, and by our Company.
A Medical Review Officer will maintain the results of all controlled substance tests and positive alcohol confirmation tests. Both Negative and positive results will be reported to Elite Coach Transportation. A positive test for alcohol or controlled substances will disqualify a driver from the operation of a commercial motor vehicle. Driver’s who test positive for controlled substances have 72-hours to request that their split sample be tested. Positive alcohol screening results in an automatic re-testing. Several conditions require testing under Part 382. They are as follows:
Types of Controlled Substance Testing:
- Pre-Employment
- Random Selection
- Reasonable Suspicion/Cause
- Post Accident
- Return to Duty
- Follow-Up
Test performed by split-sample urinalysis.
Types of Alcohol Testing:
- Random Selection
- Reasonable Suspicion/Cause
- Post Accident
- Return to Duty
- Follow-Up
Test performed by saliva or breath alcohol analysis and may require confirmation test.
NOTICE MUST BE GIVEN UNDER PART 382.113: Before performing an alcohol or controlled substances test under this part, each employer shall notify a driver that the alcohol or controlled substances test is required by this part. No employer shall falsely represent that a test is administered under this part.

PHYSICAL EXAMINATION AGREEMENT: Physical exams are required by the FMCSR’s for commercial drivers. The driver is responsible to keep their physical current. The physical must be completed by certified DOT Examiner.
Drug and Alcohol Release

APPLICANT AGREEMENT: As an applicant for employment with Elite Coach Transportation, I understand that Controlled Substance, Alcohol Testing and physical examinations as described above are a condition of my employment.
Signature*
Your Name
Your Name
Your Name
Date*

Consumer Report Disclosure and Release
MVR Consent and Release

In connection with your employment or application for employment (including contract for services), consumer reports may be requested from any consumer reporting agency. These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, academic history, professional credentials, and drugs/alcohol use. Such reports may contain public record information concerning your driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information concerning previous driving record requests made by others from such state agencies and state provided driving records.

You have the right to make a request to the consumer reporting agency, upon proper identification, the nature and substance of all information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that the consumer reporting agency has previously furnished within the three-year period preceding your request. The contact information for the consumer reporting agency will be provided to upon request.

I AUTHORIZE, WITHOUT RESERVATION, COMPANY NAME, AND/OR ANY PARTY OR AGENCY CONTACTED BY COMPANY NAME, TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION OBTAINED UNDER PART I.

I hereby consent to your obtaining the above information from a consumer reporting agency and/or any previous employer, and I agree that such information which any consumer reporting agency has or obtains, and my employment history (not DOT Drug and Alcohol information with a specific consent by me) with you if I am hired, will be supplied by Elite Coach Transportation and/or the consumer reporting agency to other companies which subscribe to said consumer reporting agency. I hereby authorized procurement of consumer reports(s). If hired or contracted this authorization, for Part II reports only, shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment or contract period.
Applicant Name*
Applicant Signature*
Your Name
Your Name
Your Name
Date*

IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Elite Coach Transportation (“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 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 Elite Coach Transportation (“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.

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.
IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with El Paso United Charters DBA Embark Coach Line (“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 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 El Paso United Charters DBA Embark Coach Line (“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.

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 Name*
Applicant Signature*
Your Name
Your Name
Your 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.

COMPANY NAME: Elite Coach Transportation

DRIVER NAME: {gfef_decrypt_8}

FEDERAL MOTOR CARRIER SAFETY REGULATIONS

*Required for all drivers.

I {id:8}, hereby acknowledge that I have access to a copy of the Federal Motor Carrier Safety Regulations available to me at the company office. In addition a copy of regulations are available at https://www.law.cornell.edu/cfr/text/49/subtitle-B/chapter-III/subchapter-B to view electronically and free of charge.

I agree to familiarize myself with the Federal Motor Carrier Safety Regulations of the US Department of Transportation, Subchapter B, Chapter 3, Title 49.

Save the above link for your records
Driver Signature*
Your Name
Your Name
Your Name
Date*

HIPAA Authorization for Use/Disclosure of Protected Health Information and Consent to Receive Text Messages
Effective Date*
Companies: Transportation Advisors (dba EZ-DrugTest.com), 228 Westinghouse Blvd

Suite 104 Charlotte, NC 28273, Phone: 980-999-8484, Email: info@theadvisors.org, Websites: theadvisors.org | ez-drugtest.com

Purpose: For your convenience, we may communicate with you by text message about DOT/FMCSA drug and alcohol testing services, including scheduling, random selections, reminders, results notifications (limited), compliance updates, and related administrative matters.

By signing or electronically agreeing below, you consent and authorize as follows:

1. Consent to Text Communications

I authorize Transportation Advisors and EZ-DrugTest.com (and their agents) to send text messages to the mobile phone number I provide. I understand:
- Text messages are transmitted over public networks and are not encrypted or fully secure.
- There is a risk that PHI or sensitive information could be intercepted, read, or accessed by unauthorized persons.
- We will make every effort to avoid sending detailed PHI via text and will direct you to secure portals or phone calls when possible.
- Standard carrier message and data rates may apply.
- I may reply “STOP” to unsubscribe from texts (this will not affect other required communications under DOT rules).
- I can revoke this consent at any time by contacting us in writing.
2. HIPAA Authorization

I authorize the Companies to use and disclose my Protected Health Information (including drug/alcohol test results, scheduling data, and related records) for the purposes described above. This authorization expires five (5) years from the date signed unless I revoke it earlier in writing.

I understand:
- I am not required to sign this to receive services.
- Revocation will not affect actions already taken in reliance on this authorization.
- Information disclosed under this authorization may be re-disclosed by the recipient and may no longer be protected by HIPAA.
3. Notice of Privacy Practices

I acknowledge that I have received or have been given access to the Companies’ Notice of Privacy Practices:

https://mydotdocs.com/assets/Documents/mdd-privacy.pdf

I understand my rights under HIPAA.

Carrier Disclaimer: Message and data rates may apply. Text messaging is not guaranteed to be 100% reliable for time-sensitive matters.
Printed Name*
Consent to Receive SMS text messages
I agree to receive SMS text messages from Transportation Advisors about my application, documents, and compliance status.
Msg & data rates may apply. Msg frequency varies. Reply STOP to opt out, HELP for help. See our Privacy Policy
Signature*
Your Name
Your Name
Your Name
Date*
Mobile Phone Number Authorized*
If signing on behalf of minor or incapacitated individual, state relationship:
You may revoke this authorization in writing at any time by mailing or emailing us at the address/email above.

Please click the link below to review the drug and alcohol policy.
Date*
Driver Signature*
Your Name
Your Name
Your Name

Consent*
I acknowledged and support that this company uses forward & aft facing cameras as part of their ongoing safety program. I understand that I am not to tamper with these systems.

Are you ready to move forward with this applicant? Click this link: http://www.theadvisors.org/drugtestbackgroundrequest/
Please only click Submit once. It will take a little bit of time to process.

Date	City/State	# Injuries	# Fatalities	Hazmat?	Preventable

Date of Accident	Nature of Accidents (Head on, rear end, etc.)	Location of Accident	# of Fatalities	# of People Injured	Involved CMV?

Date	Location	Charge	Penalty / Points

State	Type	Endorsements	License Number	Expiration Date

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