APPLICANT INSTRUCTIONS / INFORMATION

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1 APPLICANT INSTRUCTIONS / INFORMATION Please print legibly. Answer all questions completely. Incomplete or illegible applications will not be considered. Use the abbreviation N/A if a particular provision or section in the form is not applicable to you. If you need additional space, you may use the back of the application. This application is not a contract for employment Employment decisions are made solely on the basis of qualifications to perform the work applied for. Qualifications include education, training, work experience, driving record (if job requires driving.) Credentials and experience will be verified through: Schools, former employers, and any other applicable sources. As an Equal Opportunity Employer, we make decisions to hire and promote without regard to race, color, creed, national origin, gender, sexual orientation, physical or mental disability (unrelated to ability to do the job), or age (as defined by law). Our Texas locations are a voluntary non-subscriber to Workers Compensation of Texas, pursuant to Article 8308, V.A.C.S. Oklahoma locations are subscribers to Oklahoma Workers Compensation. This application shall be considered active for a period of time not to exceed 180 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are accepted at that time. The position you are applying for is considered at-will. Either you or the company can terminate employment for any reason, or no reason, at any time. By signing this application, you understand that passing a drug screen & other pre-employment tests is required prior to employment. 1) Drivers, Linehaul and all Operations Managers will be required to pass the following: DOT Physical examination Eye exam Dolly maneuverability up to 150lbs Drug screen 2) Background check requirements: No convictions within seven years for anything considered to be business related (DWI, etc). You must notify LSO immediately if you are convicted, receive deferred adjudication in, or otherwise plead guilty / no contest to a felony, or any crime involving dishonesty/breach of trust, while your application is pending or during your employment, if hired. 3) All driving related positions Employment is conditional upon your driving record meeting Company standards. No more than: One moving violation in the past three years Zero at fault accidents on motor vehicle report (MVR) in the past three years Zero DWI s, or DUI s on MVR in the past seven years. If there are any accidents listed on your MVR, you must provide, at your own cost, a police report clearing you of any liability connected with the accident. Page 1

2 By signing below, you authorize the investigation of all information contained in this application (and accompanying resume, if any) and release individuals, organizations and LSO ( the Company ) from any and all liability arising from such an investigation. You authorize persons, schools, and any current and previous employers and organizations named in the application to provide any relevant information that may be required to arrive at an employment decision. If employed, you agree that you will not divulge to others at any time during employment, or thereafter, any confidential information obtained during the course of your employment including, but not limited to, operational procedures used by the Company, names of customers or any information about customers, pricing policies, employment policies, or any other information which is not readily available to the general public. Employee Signature Print Name Date APPLICATION FOR EMPLOYMENT WE ARE AN EQUAL OPPORTUNITY EMPLOYER (please print) Name (last) As appears on Social Security Card (first) (middle initial) (preferred name) City State Zip Cell Home Primary Telephone Secondary Telephone Cell Home Social Security Number Position(s) Desired: Are you over 18 years of age? Yes No Date available to start: Are you 21 years of age or over? Yes No Availability: (Driver only) It is company policy that all Drivers be at least 21 Full Time Any Shift Part Time (am) Part Time (pm) Page 2

3 Are you physically able to perform the duties of the job for which you are applying? Yes No If you are physically or otherise unable to perform the duties of the job, please explain: Are you legally eligible to work in the U.S.? Yes No Can you travel if a job requires it? Yes No Criminal History LSO only considers convictions within the past seven years for what the company deems to be business related. A criminal conviction does not automatically disqualify an applicant from employment. Any omissions in this section may disqualify you. 1)Have you ever been convicted or pled guilty/no contest to a misdemeanor offense? No /If yes, Date of conviction: Charge: Disposition: Please Explain: Please Explain: 2)Have you ever been convicted or pled guilty/no contest to a felony offense? No /If yes, Date of conviction: Charge: Disposition: Please Explain: Please Explain: Drug Testing: In the past three years, have you tested positive (or refused to test) on any pre-employment drug or alcohol test requested by an employer? Yes No Explain: U.S. Military Service: N/A Branch Rank Date in Date out (If service was within the last 10 years, a discharge document may be required) Special Training: Page 3

4 Education: High School attended Did you graduate? Yes No College attended City/State Did you graduate? Yes No Graduate under a different name? Hours Completed First Last Employment History: (10 years) Start with your present job. Include any job-related military service assignments or volunteer activities. You may exclude organizations which indicate race, color, religion, national origin, handicap, sexual orientation, or other protected status. If you do not have an employment history going back ten (10) years, include schools attended or other activity. Are you currently employed? Yes No May we contact your present employer? Yes No Current or most recent employer: Name Title Duties Supervisor Reason for leaving Were you subject to U.S. Department of Transportation s alcohol & controlled substance testing requirements and the Federal Motor Carriers Safety Regulations for this job listed? Yes No Dates employed: to Hourly rate/salary Page 4

5 Next previous employer: Name Title Duties Supervisor Reason for leaving Were you subject to U.S. Department of Transportation s alcohol & controlled substance testing requirements and the Federal Motor Carriers Safety Regulations for this job listed? Yes No Dates employed: to Hourly rate/salary Next previous employer: Name Title Duties Supervisor Reason for leaving Were you subject to U.S. Department of Transportation s alcohol & controlled substance testing requirements and the Federal Motor Carriers Safety Regulations for this job listed? Yes No Dates employed: to Hourly rate/salary Page 5

6 Next previous employer: Name Title Duties Supervisor Reason for leaving Were you subject to U.S. Department of Transportation s alcohol & controlled substance testing requirements and the Federal Motor Carriers Safety Regulations for this job listed? Yes No Dates employed: to Hourly rate/salary Next previous employer: Name Title Duties Supervisor Reason for leaving Were you subject to U.S. Department of Transportation s alcohol & controlled substance testing requirements and the Federal Motor Carriers Safety Regulations for this job listed? Yes No Dates employed: to Hourly rate/salary Page 6

7 References: Name three previous Supervisors/Managers that you have reported to. Include: Name, company where you both worked, contact information, working relationship & how many years you worked together. NO PERSONAL REFERENCES. Name Company Number Relationship How Many Years Name Company Number Relationship How Many Years Name Company Number Relationship How Many Years Have you ever been involuntarily terminated from employment? Yes No If yes, explain List name of friends or relatives, who refered you, that are currently employed by LSO: I certify that the answers given herein are true and complete to the best of my knowledge. I understand that any misrepresentation, falsification, or omission of facts called for in this application may be cause for disqualification or dismissal at any time in the future. Signature Print Name Date Page 7

8 PLEASE COMPLETE THE FOLLOWING SECTION OF THE APPLICATION IF APPLYING FOR: DRIVER LINE HAUL DRIVER OPERATIONS MANAGEMENT Release of DOT/ FMCSA Drug and Alcohol Testing Information For driving positions only. I hereby authorize release of information from my Department of Transportation regulated drug and alcohol testing records by my previous employer, listed below, to the prospective employer listed below. This information may also be released to the employer s authorized background check vendors, Concorde, Inc Market St., Philadelphia, PA : or ADP Screening and Selection Services, 301 Remington Street, Fort Collins, CO : This release is in accordance with DOT Regulations 49 CFR Parts 40.25, , I understand that the drug and alcohol testing information to be released in Section II-A by my previous employer, is limited to the following DOT-regulated testing items: Alcohol tests with a result of 0.04 or higher; Verified positive drug tests; Refusals to be tested; Other violations of DOT agency drug and alcohol testing regulations; Information obtained from previous employers of a drug and alcohol rule violation; Documentation, if any, of completion of the return-to-duty process following a rule violation. Release of FMCSA Driving and Safety Information I hereby authorize release of information from my Department of Transportation driving and safety records by my previous employer, listed below, to the prospective employer listed below. This information may also be released to the employer s authorized background check vendors, Concorde, Inc Market St., Philadelphia, PA : or ADP Screening and Selection Services, 301 Remington Street, Fort Collins, CO : This release is in accordance with DOT Regulation 49 CFR Part The information to be released will include my driving safety history and the items identified at 49 CFR Employee/Applicant Name (printed or typed) Employee Signature Date Social Security or ID Number Prospective Employer Name Previous Employer Name Page 8

9 DRIVER SECTION FOR DRIVING POSITIONS ONLY Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No Has any license, permit or privilege ever been suspended or revoked? Yes No Please explain the facts and circumstances for each denial, revocation, or suspension: Accident Record and Traffic Convictions: All vehicles, including those having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding. Accident Record for the past 3 years. If none, write none. (Attach sheet if more space required) Dates Type of Vehicle Nature of Accident Fatality Injuries (Head-on, rear end, etc.) Yes/No Yes/No Last Accident Next Previous Next Previous List all violations of motor vehicle laws or ordinances (other than parking violations) of which you were convicted, forfeited bond, or collateral during the past three years. Location Date Charge Penalty Page 9

10 Drug Testing: In the last two years, have you tested positive, or refused to test, on an pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules? Yes No If yes, please give details Experience and Qualifications-Driver State License No. Type Expiration Date Driver License Driver License Driver Experience (if none, write none) Class of Equipment Type of Equipment Dates Approx. No. of Miles Straight Truck Tractor & Semi-Trailer Tractor-Two Trailers Motorcoach-School Bus Other Page 10

11 Driver Experience (cont) State(s) operated in for the last five years: List special courses or training that will help you as a driver Which safe driving awards do you hold and from whom? Experience and Qualifications-Other List any trucking, transportation, or other experience that may help in your work for LSO: List courses and training other than those shown elsewhere in this application List special equipment or technical materials you can work with (other than those already shown) Page 11

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