Apply to Truck with Us - Performance Corp

Personal Details

NAME(Required)

First Middle Last

DATE OF BIRTH(Required)

DRIVER LICENSE NUMBER(Required)

PHONE NUMBER(Required)

EMAIL(Required)

Contact Details

ADDRESS(Required)

Street Address Address Line 2 City State ZIP Code

If you have lived at the above address for less than 12 months, list the previous address:

DO YOU HAVE THE LEGAL RIGHT TO WORK IN THE UNITED STATES?(Required)

Yes

No

HAVE YOU WORKED FOR PERFORMANCE CORP BEFORE?(Required)

Yes

No

WHAT DATES DID YOU WORK FOR PERFORMANCE CORP?(Required)

AT WHAT RATE OF PAY?(Required)

AT WHAT POSITION?(Required)

REASON FOR LEAVING?(Required)

ARE YOU NOW EMPLOYED?(Required)

Yes

No

HOW LONG SINCE LAST EMPLOYMENT?(Required)

CAN YOU PROVIDE PROOF OF AGE?(Required)

Yes

No

HOW DID YOU HEAR ABOUT US?(Required)

RATE OF PAY EXPECTED?(Required)

IS THERE ANYTHING THAT MIGHT INHIBIT YOU FROM PERFORMING TASKS RELATED TO THE POSITION YOU HAVE APPLIED FOR?(Required)

Yes

No

Notice to Applicant: Before you continue in filling out the remainder of this application we must inform you that the information you have provided so far, and any and all information you are about to disclose, in accordance with 49 CFR part 391.21(b)(10) of the Federal Motor Carrier Safety Regulations (FMCSR's) may be used, and your previous employers "will be"contacted for the purpose of investigating your safety performance history as required by 391.23(d), and 391.23(e) of the FMCSR's. If it has not already been provided for you, please ask for a written copy of your "due process rights" regarding any and all information obtained during the processing of your history as specified in 391.23(i).

Experience and Qualifications

Please share your accident record for the past three (3) years or more.

Date of Accident

Fatalities

Injuries

Nature of the accident

Date of Accident

Fatalities

Injuries

Nature of the accident

Use this space (if needed) to describe other accidents.

Traffic convictions and forfeitures for the past three (3) years (other than parking violations.)

Date

Location

Charge

Penalty

Date

Location

Charge

Penalty

Use this space (if needed) to describe other traffic convictions and forfeitures.

Education

Elementary/High School

Last School Attended

College

Location (City/State)

Driver Qualification/Licenses

State

License #

Type

Expiration Date

State

License #

Type

Expiration Date

State

License #

Type

Expiration Date

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?(Required)

Yes

No

Has any license, permit, or privilege ever been suspended or revoked?(Required)

Yes

No

If any of the answers to the above questions are yes, please give a statement with details.(Required)

Driving Experience

Class of Equipment

Type of Equipment

Dates Driven (from MM/YYYY to MM/YYYY)

Approximate number of miles (total)

Class of Equipment

Type of Equipment

Dates Driven (from MM/YYYY to MM/YYYY)

Approximate number of miles (total)

Class of Equipment

Type of Equipment

Dates Driven (from MM/YYYY to MM/YYYY)

Approximate number of miles (total)

List states that you have operated in for the past five years

List special courses/training that will help you as a driver

Which safe driving awards do you hold and from whom?

List any trucking, transportation or other experience that may help in your work for Performance Corp.

List special equipment or technical materials you can work with (other than those already show)

To Be Read and Signed By Applicant

Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did notobtain, safety sensitive transportation work cover by DOT agency drug and alcohol testing rules during the past twoyears. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee toperformsafety sensitive functions for you until and unless the employee documents successful completion of the return-to-duty process. (see Sec. 40.25 (b)(5) and (e).The prospective employee is required by Sec. 40.25(j) to respond to the following questions.

1) Have you ever 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?

Yes

No

2) If you answered yes, can you provide/obtain proof that you have successfully completed the DOT return-to-duty requirements?

Yes

No

N/A

This certifies that I completed this application, and that all entries, and information documented by me are true and complete to the best of my knowledge. By my signature heretofore, I acknowledge having been given by this carrier which has presented me with this application, a statement of my right to due process as outlined by all parts of 49 CFR Part 391.23 of the Federal Motor Carrier Safety Regulations effective October29, 2004. Having made this acknowledgment, I therefore authorize you to make such previous employment and background investigations and inquires of my personal, employment, financial or medical history and other related matters as may be necessary to arrive at a possible employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended.) I understand that false or misleading information given in my application or interviews may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company.

Signature(Required)

Date(Required)

Background Reports from the PSP Online Service

1) In connection with your application for employment with Performance Transportation Corp ("Prospective Employer"), it may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). 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. 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 sign below.

2) 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 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 Data Qs 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.

Signature(Required)

Date(Required)

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Name

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Apply to Truck with Performance Corp.

Full Driver Application

Personal Details

Contact Details

Employment History

Employer 1

Employer 2

Employer 3

Other Employers

Experience and Qualifications

Please share your accident record for the past three (3) years or more.

Traffic convictions and forfeitures for the past three (3) years (other than parking violations.)

Education

Driver Qualification/Licenses

Driving Experience

To Be Read and Signed By Applicant

Background Reports from the PSP Online Service