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 email@example.com or 205-397-9160.
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]
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:
DRIVER INFORMATION PACKET
Complete all sections. This is your personal, contact and basic application information.
Complete all sections of this page.
ACCIDENT RECORD FOR PAST THREE YEARS
TRAFFIC CONVICTIONS AND FORFEITURES, OTHER THAN PARKING TICKETS, FOR THE PAST THREE YEARS
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.
Review Your Signature:
Draw Your Signature:
PRE-QUALIFICATION URINALYSIS NOTIFICATION
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.
PREVIOUS WORK HISTORY VERIFICATION FORM
REQUEST FOR CHECK OF DRIVING RECORD
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.
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.
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