PRE-EMPLOYMENT PACKET 1. Print forms; fill out, sign and date all forms. Return by fax 615-895-9294 or email careers@mailtmi.com. 2. Please send a copy of your CDL, Social Security Card and Med Card. You may fax, email or text them to 615-542-9838. If faxing them make a bigger, lighter copy of the CDL and Social Security Card then fax. 3. Disqualifying factors for employment: DUI or Drug Possession within last 10 years Multiple violations, tickets, accidents, etc on MVR Suspension of CDL within last 5 years for moving violations On probation, parole or with pending charges Felony conviction within last 5 years Postal Application Instructions **ONLY USE BLACK INK**MUST BE LEGIBLE** KEEP THE ORIGINAL OF THE POSTAL APPLICATION AS YOU WILL NEED IT IN ORDER TO BE BADGED Frequently Asked Questions and Common Mistakes: Line 10 Check Contractor s Employee Line 15 Residence Must be 5 years and have no gaps in months or years Line 16 Employment History Must be 5 years with no gaps in months or years Example: 01/2013 Present Company A Address, City ST Zip 10/2012 01/2013 unemployed Home address City, ST Zip 02/2010 10/2012 Company B Address, City ST Zip If you checked yes to any questions numbered 21a-22, you must send in an explanation of the conviction. Use 21e as example of info needed. Use extra paper if needed; sign your name and date the additional paper if used.
Contract Personnel Questionnaire Prepare in duplicate. Type or print all responses. If answer is, state so. Attach sheets if more space is needed. Privacy Act: The collection of this information is authorized by 39 U.S.C. 401. This information will be used as a basis for an investigation to determine your fitness and suitability for contractual service to the U.S. Postal Service. As part of the investigation, FD-258, Fingerprint Chart -- Applicant, will be sent to the FBI for a criminal record check. As a routine use, the information may be disclosed to an appropriate government agency, domestic or foreign, for law enforcement purposes; where pertinent, in a legal proceeding to which the USPS is a party or has an interest; to a government agency in order to obtain information relevant to a USPS decision concerning security clearances, contracts, licenses, grants, permits or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or complaints examiner appointed by the Equal Employment Opportunity Commission for an investigation of a formal EEO complaint under 29 CFR 1614; and to the Merit Systems Protection Board or Office of Special Counsel for proceedings or investigations involving personnel practices and other matters within their jurisdiction. Completion of this form is voluntary; however, if this information is not provided you may be denied access to postal premises, denied access to the mail, or you may be denied participation under a USPS contract. A false answer to any question on this form is punishable by law (18 U.S.C. 1001). 1. Print Your Full Name (Last, first, middle name) 2. Print Your Mailing Address (Include Apt./Suite.) 3. City, State and ZIP+4 Code 4a. Home Telephone. (Include Area Code) 4b. Work Telephone. (Include Area Code) 5. List Other Names Used. (i.e., maiden name, names by former marriages, names changed legally or otherwise, aliases, nicknames. Specify which and dates used.) 6. Social Security. (SSN) 7. Date of Birth 8. Place of Birth (City and State/Country) 9. Sex Male Female 10. Type of Screening (Check one) 11. Highway Contract. and Termini (If applicable) Contractor Contractor s Employee Sub-Contractor ADP Other 12. Contractor s Name and Mailing Address 13. Have You Had a Security Screening by USPS or Other Federal Agencies Within the Last Year? Agency: 14. Are You Presently a Highway Contract Driver? (If, include Contract. and Termini.) 15. Dates and Places of Residence. (If actual places of residence differ from the mailing addresses, furnish and identify both. Begin with present residence and go back for the past five years.) From To Number and Street City State ZIP+4 Code (Date) (Date) 16. Employment. (List ALL periods of employment for the past five years starting with your present employment. Include dates when unemployed. Give name under which employed if different from name now used.) From (Date) To (Date) Employer s and Supervisor s Names Employer s Address Occupation Reason for Leaving Your Name During Period of Employment 17. Education. (List ALL education. Include highest level of education obtained.) From To School Name School Location Degrees Highest Level Obtained (Date) (Date) 18a. Do You Have a Valid License? (Driver/Chauffeur) If, include License., State, and Expiration Date. 18b. Commercial Driver s License PS Form 2025, April 1995 (Continued on Reverse)
19a. Are You a United States Citizen? 19b. Are You a Citizen of American Samoa or Any Other Territory Owing Allegiance to the United States? 19c. Are You an Alien With Permanent Residence Status? (If "yes," be prepared to show Form I-151 or I-551.) 20a. Military Service (Past or Present). (If, complete Items 20b, 20c, 20d, 20e, and 20f.) 20b. Dates of Service 20c. Branch of Service (Army, Navy, Air Force, Marines, etc.) 20d. Serial. (If none, provide Grade or Rating at time of separation) To From 20e. Were You Discharged from the Military Service Under Honorable Conditions? (If your discharge was changed to "honorable" or "general" by a Discharge Review Board, answer "". If you received a clemency discharge, answer "".) If, enter the date and type of discharge you received in the blocks below. Discharge Date (Month, Day, Year) Type of Discharge 20f. While in Military Service, Were You Ever Convicted by Court Martial? Court Martial Date (Month, Day, Year) Place (City and State/Country) Charge Disposition 21a. Have You Ever Been Convicted of, or Forfeited Collateral for Any Felony/Misdemeanor Violation (Except Traffic Violations)? (Generally, a felony is defined as any violation of law punishable by imprisonment of one year or longer.) 21b. During the Last 10 Years Have You Forfeited Collateral, Been Convicted, Been Imprisoned, Been on Probation, or Been on Parole for any Violation of Law? (Do not include violations reported in question 21a.) 21c. Have You Ever Been Convicted of, or Forfeited Collateral for Any Assaults, Firearms or Explosives Violations? 21d. Are You w Under Charges for Any Violation of Law? If any answers to 21a-21d are "", provide date, place, court location, charge, and disposition on an attached sheet. 21e. Are You Delinquent on any Federal Debt? (Include delinquencies arising from Federal taxes, overpayment of benefits, or other debts to the U.S. Government plus defaults on Federally guaranteed or insured loans such as student and home mortgage loans.) Date Place (City and State) Court Charge Action Taken If necessary, attach additional sheets. 22. In the Past 5 Years, Have You Been Convicted of any Traffic Violations (Other Than Parking) or Currently Have Charges Pending? (If, complete information below.) Date Place (City and State) Court Charge Action Taken If necessary, attach additional sheets. Warning Check Here if Your 5 Year Driver s Abstract from Department of Motor Vehicles is Attached. Review this form carefully to ensure you have answered all questions fully and correctly. Failure to answer all questions may result in your being denied access to mail and/or Postal premises. A fine not to exceed $250,000 or imprisonment of not more than five years or both is provided by law (18 U.S.C. 1001) for making a false statement or concealing any material fact on this Questionnaire. Certification I certify that the statements made by me on this questionnaire are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. Applicant s Signature I attest I have advised the Applicant to truthfully complete this Questionnaire, and the Applicant has passed the Drug Screening Test (If applicable, provide documentation). Contractor s Signature (Sign and print name) Telephone. (Include area code) For Use of Postal Official Responsible for Reviewing for Completeness and Legibility. (See Administrative Support Manual 272.23, Contractor Clearance, for complete instructions.) USPS Official Signature (Sign and print name) Telephone. (Include Area Code) Organization, City, State, and ZIP+4 Code PS Form 2025, April 1995 (Reverse)
U.S. Postal Service Authorization and Release - Background Investigation (USPS Contractors and Employees of Contractors) Applicant: Carefully read the following information before you complete and sign this form. Privacy Act Statement: The collection of this information is authorized by 39 USC 404, 18 USC 3061, and 5 USC, App. 3. This authorization will be used to obtain information from organizations and individuals pertaining to your character, personal history, credit standing, educational claims, current or prior employment, military service, and other information which may be relevant and necessary to determine your fitness and suitability to perform services under contract with the Postal Service, including a security clearance and evaluation of your loyalty to the United States. This authorization does not consent to the collection of information by the Postal Service except as otherwise permitted by law. r does it waive any remedy you may have against the Postal Service in the event of a violation of the Privacy Act or other rights established by law. As a routine use, this information may be disclosed to an agency for which information is requested in the course of a background check; to an appropriate government agency, domestic or foreign, for law enforcement purposes; where pertinent, in a legal proceeding in which the USPS is a party or has an interest; to a government agency in order to obtain information relevant to a USPS decision concerning employment, security clearances, contracts, licenses, grants, permits or other benefits; to a government agency upon its request when relevant to its decision concerning employment, security clearances, security or suitability investigations, contracts, licenses, grants or other benefits; to a congressional office at your request; to an expert, consultant, or other person under contract with the USPS to fulfill an agency function; to the Federal Records Center for storage; to the Office of Management and Budget for review of private relief legislation; to an independent certified public accountant during an official audit of USPS finances; to an investigator, administrative judge or complaints examiner appointed by the Equal Employment Opportunity Commission for investigation of a formal EEO complaint under 29 CFR 1614; to the Merit Systems Protection Board or Office of Special Counsel for proceedings or investigations involving personnel practices and other matters within their jurisdiction; and to a labor organization as required by the National Labor Relations Act; to an appropriate foreign or international law enforcement agency, an organization, or individual for investigative or prosecutorial purposes, to assist in crime prevention or detection, to obtain information relating to a pending investigation, trial or hearing, to obtain the cooperation of a witness or informant or to notify of the status of the case; to a party or his attorney to discuss settlement, plea bargaining, or discovery proceedings; to an agency or individual concerned with maintenance, extradition, or release of a person held in custody; to a foreign country pursuant to an international treaty, conventions, or executive agreement; to the public, news, media trade associations or organized groups if it is information of interest on accomplishments of the Postal Service or its employees; to a foreign country when apprehending and/or returning a fugitive to a jurisdiction seeking return; to American Insurance Association Index System members if it is information relating to accidents or injuries. Completion of this form is voluntary; however, if consent to obtain this information is not given, it may have an adverse effect on your opportunities to perform services under contract with the USPS. Applicant's Name (Last, First, Middle) Mailing Address Date of Birth (Month, Day, Year) Home Phone Number This constitutes my consent and authorization to the disclosure or furnishing of any relevant and necessary information or records to any duly authorized official of the USPS by any person, corporation, agency, or association concerning my character, personal history, credit standing, educational claims, current or prior employment, military service, and other information which may be relevant and necessary to determine my fitness and suitability to perform services under contract with the USPS. This authorization is executed with full knowledge and understanding that the USPS will take measures to protect the aforementioned information against unauthorized disclosure to any parties not having a legitimate need for it in the discharge of official business of the United States, or its agencies and instrumentalities. I hereby RELEASE the aforementioned persons, corporators, agencies, associations and their employees, agents and representatives from any and all liability for damages resulting from a decision by the USPS not to contract for my services on account of compliance with this authorization, except for any damages resulting from knowingly providing false or misleading information or records about me. A copy of this authorization shall be as effective and valid as the original. This authorization shall be valid for 12 months from the date it is signed. Signature of Applicant TransFORM PS Form 2181-C, April 1996
REQUEST INFORMATION FROM PREVIOUS EMPLOYER *Please fax completed form to (615) 895-9294 Name of Applicant: Social Security #: Name of Previous Employer: APPLICANT S SIGNATURE & DATE Fax Number: Prospective Employer: McCormick 625 S Church St., Ste. 100 Murfreesboro, TN 37130 Ph: (615) 867-7618 Fax: (615) 895-9294 I hereby authorize you to provide McCormick with my safety performance history, accidents, and drug/ alcohol testing records as required by applicable Federal Motor Carrier Safety Regulations, sections 40.25, 391.15. I hereby release this company, and its employees from any and all liability of any type as a result of providing the information to McCormick Your company has been listed by the applicant as a past employer. The above named applicant has applied for a safety sensitive position with McCormick. Does this applicant work for you? : : If YES, what position? Dates of Employment: From: To: (MM/DD/YYYY) If employed as a DRIVER, please answer the following: (MM/DD/YYYY) Was applicant a: Company Driver: Owner/Operator: Type of tractor operated: Type of trailer operated: Other equipment operated: Please list any accidents that involved the applicant in the three (3) years prior to the application date shown above. If there is no accident data on this applicant, please check NO. Accidents: : : If YES, please list accident details below: Date Location of Accident # of injuries # of fatalities Preventable? : : Any Traffic Violations? : : If YES, please list the type of violation and the date: : : License(s) suspended? : : If YES, please give the date(s) of suspension: Reason for leaving your Company: Resigned: Discharged: Laid Off: Would you re-employ this person: : : If NO, please explain: INQUIRY FOR ALCOHOL AND CONTROLLED SUBSTANCES INFORMATION, PRECEDING 3 YEARS: 1. Did the employee have alcohol tests with a result of 0.04 or higher? : : 2. Did the employee have verified positive drug tests? : : 3. Did the employee refuse to be tested? : : 4. Did the employee have other violations of the DOT agency drug and alcohol testing regulations? : : 5. Did the previous employer report a drug and alcohol violation to you? : : 6. If you answered YES to any of the above items, did the employee complete the return-to duty process? N/A: : : Name of Person Giving Information Title Date: