Alabama Carriers Driver Application

Alabama Carriers Driver Application

Thank you for your interest in Alabama Carriers. If you have any questions regarding this application or about leasing on with Alabama Carriers, please contact Randy Bailey at rbailey@alabamacarriers.com or 205-397-9160.

Qualifying Criteria:

Must have a current Class A CDL
Must be at least 23 years of age
Must have a total of two (2) years of industrial/commercial driving experience
Must be able to pass background and criminal checks
Drivers that lease on must have Non-Business Liability Insurance (Bobtail) and Occupational Accident Insurance (OCC ACC)
NOTE: Both of these are available through Alabama Carriers, but they may be purchased assuming adequate coverage amounts through any vendor

Additional Requirements:

To haul loads to government installations without paying escort fees, you will need a TWIC card
If you plan to haul coils, you must pass the Alabama Coil Certification Test

Disqualifying Factors:

Conviction for driving under the influence (DUI) or driving while intoxicated within the last five (5) years
Conviction for leaving the scene of an accident
Conviction for the use of a vehicle to elude law enforcement
Conviction for reckless and/or negligent driving
NOTE: Some states consider excessive speeding as careless and/or negligent driving; all convictions must be reviewed by the safety department
More than one (1) at-fault accident within the last three (3) years
More than three (3) moving violation convictions within the last three (3) years
Combination of one (1) at-fault accident and three (3) moving violation convictions within the last three (3) years
Any drug-related conviction within the last five (5) years
NOTE: Applicants with any drug-related conviction older than five (5) years must agree to:
- Being evaluated by a Substance Abuse Professional (SAP) and complete any required program
- Submit to monthly drug tests for the first six (6) months of contract and random tests thereafter

ESSENTIAL EQUIPMENT LIST

Alabama Carriers, Inc., requires every truck to have a headache rack.

The following is a checklist of minimal equipment required by Alabama Carriers to safely load and transport various commodities: [Please indicate the number you have by each piece of equipment below]

3" Belly Straps (minimum requirement is two)

Chains (minimum requirement is ten)

Binders (minimum requirement is ten)

4" Straps (minimum requirement is 12)

2" Straps (minimum requirement is two)

Dunnage Strap (minimum requirement is one)

Steel Tarps with 4’ Drop

Coil Racks

Rubber for Coils

4x4x8’ L Dunnage/Timbers (minimum requirement is eight)

Beveled Timbers/Coil Boards (minimum requirement is enough for two coils; enough for three coils is preferred)

Pipe Stakes (minimum requirement is 2’ long; 4’ long is preferred)

Edge Protectors

All of this equipment must be DOT approved!

Do you have experience hauling and securing coils? YES NO

In addition to the list above, Alabama Carriers recommends that you have the following items in order to increase the amount of freight we are able to offer:

TWIC Card: YES NO PLAN TO OBTAIN

Alabama Coil Certification: YES NO PLAN TO OBTAIN

DRIVER INFORMATION PACKET

Complete all sections. This is your personal, contact and basic application information.

First Name: Middle Name: Last Name:

Social Security #: Date: Email Address:

Current Address:

1. Street: City:

State: Zip:

How long? Home Phone #: Cell Phone #:

Additional Addresses for Last 3 Years:

2. Street: City:

State: Zip:

3. Street: City:

State: Zip:

4. Street: City:

State: Zip:

Are you applying as an Independent Contractor or as a Driver?

Do you have the legal right to work in the United States? YES NO

Date of Birth: (REQUIRED FOR TRUCK DRIVERS)

Can you provide proof of age? YES NO

Have you contracted with this company before? YES NO

If yes, where?

If yes, when? From: To:

If yes, reason for leaving:

Are you currently employed? YES NO

If no, how long since leaving your last employment?

If yes, where?

Who referred you to Alabama Carriers?

Is there any reason you might be unable to perform a safety-sensitive function? YES NO If yes, please explain below:

WORK HISTORY

You MUST provide a ten-year (10-year) work history. Failure to provide all ten years will result in delays processing your application, and it may result in the denial of your application. You must also provide current contact information for the most recent three (3) years.
Provide ACCURATE work history information. Failure to provide accurate information will result in delays processing your application, and it may result in the denial of your application.
Any gaps of more than 30 days MUST be explained. Unexplained gaps of more than 30 days will result in the denial of your application.

1. Company Name Position

Street Address City/State/Zip

Date From Date To

Contact Person Phone Number

Reason for Leaving

Were you subject to FMCSA or Transport Canada Safety Regulations while employed/contracted by this company?
YES NO

Did you perform any safety sensitive functions in this job, regulated by DOT, and subject to drug and alcohol testing?
YES NO

2. Company Name Position

Street Address City/State/Zip

Date From Date To

Contact Person Phone Number

Reason for Leaving

Were you subject to FMCSA or Transport Canada Safety Regulations while employed/contracted by this company?
YES NO

Did you perform any safety sensitive functions in this job, regulated by DOT, and subject to drug and alcohol testing?
YES NO

3. Company Name Position

Street Address City/State/Zip

Date From Date To

Contact Person Phone Number

Reason for Leaving

Were you subject to FMCSA or Transport Canada Safety Regulations while employed/contracted by this company?
YES NO

Did you perform any safety sensitive functions in this job, regulated by DOT, and subject to drug and alcohol testing?
YES NO

4. Company Name Position

Street Address City/State/Zip

Date From Date To

Contact Person Phone Number

Reason for Leaving

Were you subject to FMCSA or Transport Canada Safety Regulations while employed/contracted by this company?
YES NO

Did you perform any safety sensitive functions in this job, regulated by DOT, and subject to drug and alcohol testing?
YES NO

5. Company Name Position

Street Address City/State/Zip

Date From Date To

Contact Person Phone Number

Reason for Leaving

Were you subject to FMCSA or Transport Canada Safety Regulations while employed/contracted by this company?
YES NO

Did you perform any safety sensitive functions in this job, regulated by DOT, and subject to drug and alcohol testing?
YES NO

6. Company Name Position

Street Address City/State/Zip

Date From Date To

Contact Person Phone Number

Reason for Leaving

Were you subject to FMCSA or Transport Canada Safety Regulations while employed/contracted by this company?
YES NO

Did you perform any safety sensitive functions in this job, regulated by DOT, and subject to drug and alcohol testing?
YES NO

Complete all sections of this page.

ACCIDENT RECORD FOR PAST THREE YEARS

1. Accident Date Nature of Accident
(Head-on, Rear-end, etc.)

Fatalities Injuries

2. Accident Date Nature of Accident
(Head-on, Rear-end, etc.)

Fatalities Injuries

3. Accident Date Nature of Accident
(Head-on, Rear-end, etc.)

Fatalities Injuries

TRAFFIC CONVICTIONS AND FORFEITURES, OTHER THAN PARKING TICKETS, FOR THE PAST THREE YEARS

1. Date Location

Charge Penalty

2. Date Location

Charge Penalty

3. Date Location

Charge Penalty

DRIVER QUALIFICATIONS

1. Driver's License State License Number

Type Expiration Date

2. Driver's License State License Number

Type Expiration Date

3. Driver's License State License Number

Type Expiration Date

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? YES NO

B. Has any license, permit or privilege ever been suspended or revoked? YES NO

If the answer to either A or B is yes, please include dates and details below.

DRIVING EXPERIENCE

1. CLASS OF EQUIPMENT Type of Equipment
(Van, Tank, Flat, etc.)

Date From Date To Total Approx. Miles

2. CLASS OF EQUIPMENT Type of Equipment
(Van, Tank, Flat, etc.)

Date From Date To Total Approx. Miles

3. CLASS OF EQUIPMENT Type of Equipment
(Van, Tank, Flat, etc.)

Date From Date To Total Approx. Miles

A. Have you ever been convicted of DUI or DWI or any other drug/alcohol related offense? YES NO

B. Have you tested positive or refused to take any drug/alcohol test within the last five years? YES NO

If the answer to either A or B is yes, please include dates and details below.

EDUCATION

Highest Grade Completed: Primary High School College

Last School Attended: Name: City: State:

DRIVER INFORMATION PACKET

This certifies that I have completed the driver information packet and that all entries are true and correct. Any false or misleading information provided by me will result in lease termination.

I understand that I am required to abide by all rules and regulations of Alabama Carriers, Inc.

Print Your Name:

Review Your Signature:

Draw Your Signature:

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PRE-QUALIFICATION URINALYSIS NOTIFICATION

HAVE YOU EVER TESTED POSITIVE FOR A DRUG SCREEN? YES NO

HAVE YOU EVER REFUSED A DRUG SCREEN? YES NO

The Federal Motor Carrier Safety Regulations, Section 382.301 - pre-employment testing requirements, apply to any driver leasing with Alabama Carriers, Inc.

382.301 Pre-employment testing requirements

a) Prior to the first time a driver performs safety-sensitive functions for an employer, the driver shall undergo testing for controlled substances as a condition prior to being used. No employer shall allow a driver, who the employer intends to hire or use, to perform safety-sensitive functions unless the employer has a controlled substance test result from the MRO or C/TPA indicating a verified negative test result for that driver.

As a condition of my qualification to drive for Alabama Carriers, Inc., I agree to the urine sample collection and controlled substance testing.

I understand a positive test for controlled substances based on the urinalysis test will medically disqualify me from the operation of a commercial motor vehicle for Alabama Carriers, Inc.

The Medical Review Officer will maintain the results of the urinalysis test. Both negative and positive results will be reported to Alabama Carriers, Inc.

My written authorization is required for the urinalysis test results to be given to other parties.

I have read and understand the above conditions for the Pre-Qualification Urinalysis Notification.

Print Your Name:

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PREVIOUS WORK HISTORY VERIFICATION FORM

I hereby authorize you to release the above information to Alabama Carriers, Inc. for the purpose of investigations as required by Sections 391.23 and 40.25 of the Federal Motor Carriers Safety Regulations. You are released from any and all liability that may result from furnishing this information.

Print Your Name:

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REQUEST FOR CHECK OF DRIVING RECORD

I hereby authorize you to release the above information to Alabama Carriers, Inc. for purposes required by Section 391.23 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability that may result from furnishing such information.

Print Your Name:

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THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Alabama Carriers, Inc., ("ACI"). ACI, 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 ACI uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, ACI 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, ACI 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 ACI uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, ACI 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 ACI, then, within 3 business days or receiving your request, together with proper identification, ACI must send or provide to you a copy of your report and a summary of your rights under the Fair Credit reporting Act.

Neither ACI 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.

ACI cannot obtain background reports from FMCSA without your authorization.

AUTHORIZATION

If you agree that ACI may obtain such background reports, please read the following and sign below:

I authorize Alabama Carriers, Inc.,("ACI") 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 ACI to make a determination regarding my suitability as an employee.

I further understand that neither ACI 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 crashed 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 ACI and I understand that if I sign this Disclosure and Authorization, ACI may obtain a report of my crash and inspection history. I hereby authorize ACI and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

Date:

Print Your Name:

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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.
LAST UPDATED 12/22/2015