Pre-Employment Alcohol and Controlled Substances Statement

Pre-Employment Alcohol and Controlled Substances Statement

I certify that this application was completed by me and that all entries on it and all information in it are TRUE and COMPLETE to the best of my knowledge. In the event of employment or contract, I understand that false, misleading, or omitted information in my application may result in discharge.

I authorize investigation of all statements contained in this application for employment or contract for services as may be necessary in arriving at an employment or contract for services decision. In making this application for employment or contract for services, I understand that an investigation may be made and information may be obtained through personal or telephone interviews, letters or other methods with my personal references, past employers, as well as state agencies and others.

I understand that in connection with my employment or application for employment (including contract for services), an investigative consumer report and consumer reports, which may contain public record information, may be requested from HireRight Commercial Services ("HireRight"). 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, drugs/alcohol use, information relating to my character, general reputation, personal characteristics, mode of living, educational background, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. Such reports may contain public record information concerning my 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 from HireRight concerning previous driving record requests made by others from such state agencies.

I have the right to receive, upon my written request within a reasonable period of time, (not to exceed 30 days) a complete and accurate disclosure of the nature and scope of the investigation requested. I have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on me at the time of request by Efficient Motor Freight, including the sources of information, and the recipients of any reports on me that HireRight has previously furnished within the two-year period preceding this request. HireRight may be contacted by mail at P.O. Box 33181, Tulsa, Oklahoma, 74153, or by phone at (800) 381-0645.

Attached to this disclosure is a written summary of applicant's rights under the Fair Credit Reporting Act (FCRA) as prepared by the Federal Trade Commission.

I hereby release all parties, including but not limited to Efficient Motor Freight, personal references, and previous employers, from any and all liability for any injury or damage that may result from their furnishing information to Efficient Motor Freight concerning me or any action Efficient Motor Freight takes on the basis of such information. Please click to view Terms of Use.

I understand that as a driver of a commercial motor vehicle, I am obligated to qualify under applicable state and federal regulations, including but not limited to the Federal Motor Carrier Safety Regulations. I understand further that Efficient Motor Freight may require me to submit to a physical examination and to drug and alcohol tests as required or permitted by the Regulations, and I consent thereto and authorize any doctor, hospital, clinic, laboratory or other medical facility to furnish to Efficient Motor Freight any medical information with reference to me as may be necessary in conjunction with such examinations, tests and related considerations.

I understand that, according to federal law, all individuals who are hired or contracted for services must, as a condition of employment or contract, produce certain documentation to verify their identity and U S. citizen status or, if aliens, their authorization to work in the U.S. As a consequence, I understand that any offer of employment or contract for services to me by Efficient Motor Freight is contingent upon my ability to produce the required documentation within the time period required by law.

I understand that, in consideration of all employees and contractors, smoking is permitted in designated areas and at designated times only and agree to comply with this policy.

I understand that this application is not, and is not intended to be, a contract of employment or contract for services and that any resulting employment or contract relationship is for no fixed period of time and is terminable at any time and for any reason by Efficient Motor Freight, or by me. I further understand that statements which may be contained in policies, practices, handbooks, or other Efficient Motor Freight material do not create any guarantee of employment or contract for services and that Efficient Motor Freight has the right to modify, amend, or terminate policies, practices, benefit plans, or other programs within the limits and requirements imposed by law. I understand that no representative of Efficient Motor Freight, other than an officer, has the authority to enter into any agreement for any specific period of time or to make any agreement contrary to the foregoing and that any such agreement must be in writing to be binding on Efficient Motor Freight.

Federal Motor Carrier Safety Regulations, Part 391.23 The applicant has 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.

Certification and Signatures

I have read the above Notice Regarding Background Reports provided to me by Efficient Motor Freight and I understand that if I sign this consent form, Efficient Motor Freight may obtain a report of my crash and inspection history. I hereby authorize Efficient Motor Freight and its employees, authorized agents, and/or affiliates to obtain the information authorized above. By inputting my signature, I certify that the information provided on this document is true and correct and that these signatures can act as my signature on this application.

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Signature Certificate
Document name: Pre-Employment Alcohol and Controlled Substances Statement
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Timestamp Audit
April 12, 2018 2:48 pm CSTPre-Employment Alcohol and Controlled Substances Statement Uploaded by Boyan Petrov - IP