Information Safety

Location:

Manhattan, NY

Salary:

15.00 Hr

Posted:

September 20, 2018

Contact this candidate

Resume:

Pegasus Transportation

**** * ******* ******* **

Louisville, KY 40299

1-800-***-****

**-**-**** *:45:08PM CDT

IntelliApp

Thank you for your interest in Pegasus Transportation. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

Personal Information

Referral Code: pulse_app

Name Samuel C Shuler

Residence 3 years or longer (If No,

previous addresses shown below)

Current Address 316 Hart Street

Address 2 2r

City, State/Province Zip/Postal Brooklyn, NY 11206 Country United States

Addresses Over last 3 years Address 1

316 Hart Street

Brooklyn, NY 11206

United States

12-2014 to 10-2018

Address 2

131 Belmont ave

Brooklyn, NY 11212

United States

07-1996 to 06-2014

SSN/SIN 4913

Date of Birth

Primary Phone 347-***-****

Cell Phone 347-***-****

Preferred method of contact Email

Best time to contact you Afternoon

Email ***********@*****.***

Yes, I want to receive information and

communications from Pegasus

Transportation concerning future

opportunities or promotions.

Yes

Yes, I want to receive text messages from

Pegasus Transportation. *By participating,

you consent to receive text messages sent

by an automatic telephone dialing system.

Consent to these terms is not a condition

of hire. You may opt out at any time by

texting STOP to unsubscribe. Message

and Data Rates May Apply.

Yes

Company Questions

General Information

How did you hear about Pegasus

Transportation?

DriverRecruiting.com

Please be specific (i.e., if from a

magazine, put the magazine name here):

Were you referred by a Pegasus

Transportation Driver?

Please list the Pegasus Transportation

Employee's name, terminal and ID#, if you

have it:

If you have spoken with a Pegasus

Transportation recruiter, please select

his/her name:

What type of position are you applying for? Company Local Driver Are you interested in driving Team? Yes

Have you ever been known by any other

name?

List all names:

Do you read, write, and speak English? Yes

Are you legally eligible for employment in

the United States?

Yes

How many years have you had a valid

driver's license?

Have you ever been disqualified to drive

by Federal Regulations?

Please explain:

Have you ever been refused liability

insurance?

General Information 2

Please explain:

Are you currently an ACTIVE service

member in National Guard, Reserve or

Active Duty for any branch of the armed

services?

Do you have PREVIOUS military

experience?

How much Regional or Over the Road

experience do you have?

0-3 Months

How much Local experience do you have? 9-12 Months Licenses

License Number 261

State/Province NY

Country United States

License Class

License Expiration Date 12-13-1950

Physical Expiration Date 07-05-2014

Current License Yes

Commercial Driver License No

Endorsements None

Employment / Unemployment

metro one

Company metro one

Start Date 08-2015

End Date 06-2018

Address 90 john street

Address 2 1402

City, State/Province Zip/Postal Manhattan, NY 10007 Country United States

Phone 212-***-****

Position Held security

Reason for leaving? still work

Were you terminated/discharged/laid off? No

Is this your current employer? Yes

General Information 3

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job subject to drug and

alcohol testing?

Areas Driven

Miles driven weekly

Most common truck driven

Most common trailer

Trailer length

Dedicated Transport

Company Dedicated Transport

Start Date 11-2014

End Date 08-2017

Address 90 john st

City, State/Province Zip/Postal Brooklyn Heights, OH Country United States

Phone 718-***-****

Position Held security guard

Reason for leaving? still there

Were you terminated/discharged/laid off? No

Is this your current employer? Yes

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

Yes

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Yes

General Information 4

Areas Driven

Miles driven weekly 1500-2000

Most common truck driven Straight Truck

Most common trailer Van

Trailer length 53 feet or more

Unemployment

Start Date 06-2014

End Date 10-2014

Comment i was not work at thetime out hurt.

Unemployment

Start Date 08-2014

End Date 09-2014

Comment

Unemployment

Start Date 09-2010

End Date 07-2014

Comment n/a

Unemployment

Start Date 09-2009

End Date 08-2010

Comment n/a

father/son

Company father/son

Start Date 08-2007

End Date 08-2009

Address 48 Tilden ave

City, State/Province Zip/Postal Brooklyn, NY 11206 Country United States

Phone 347-***-****

Position Held truck drive

Reason for leaving? slow work

Were you terminated/discharged/laid off? No

Is this your current employer? Yes

May we contact this employer at this time? Yes

General Information 5

Did you operate a commercial motor

vehicle?

Yes

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Yes

Areas Driven 5,Borogth

Miles driven weekly 0-500

Most common truck driven Straight Truck

Most common trailer Liftgate

Trailer length 45 to 52 feet

self-Help

Company self-Help

Start Date 10-2005

End Date 07-2007

Address 365 Lorivina ave

City, State/Province Zip/Postal Brooklyn, NY 11206 Country United States

Phone 347-***-****

Position Held truck drive

Reason for leaving? slow work

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

Yes

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Yes

Areas Driven ny,Queen,Manhatten,Brooklyn

Miles driven weekly 0-500

General Information 6

Most common truck driven Straight Truck

Most common trailer Liftgate

Trailer length 45 to 52 feet

Burauck

Company Burauck

Start Date 10-2004

End Date 09-2005

Address 56 w45 st

City, State/Province Zip/Postal Manhatten, NY

Country United States

Phone 347-***-****

Position Held security guard

Reason for leaving? go back to school

Were you terminated/discharged/laid off? No

Is this your current employer? Yes

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven

Miles driven weekly

Most common truck driven

Most common trailer

Trailer length

FMCSR

Under FMCSR 391.15, are you currently

disqualified from driving a commercial

motor vehicle? [49 CFR 391.15]

Has your license or privilege to drive ever

been suspended or revoked for any

General Information 7

reason? [49 CFR 391.21(b)(9)]

Have you ever been denied a license,

permit, or privilege to operate a motor

vehicle?[49 CFR(b)(9)]

Within the past two years, have you tested

positive, or refused to test, on a

pre-employment drug or alcohol test by an

employer to whom you applied, but did not

obtain, safety-sensitive transportation work

covered by DOT agency drug and alcohol

testing rules? [49 CFR 40.25(j)]

In the past three(3) years, have you ever

been convicted of any of the following

offenses: [49 CFR 391.15]:

Driving a commercial motor vehicle

with a blood alcohol concentration

("BAC") of .04 percent or more

•

Driving under the influence of

alcohol, as prescribed by state law

•

Refusal to undergo drug and

alcohol testing as required by any

jurisdiction for the enforcement of

Federal Motor Carrier Safety Act

regulations

•

Driving a commercial motor vehicle

under the influence of any 21

C.F.R. 1308.11 Schedule I

identified controlled substance, an

amphetamine, a narcotic drug, a

formulation of an amphetamine, or

a derivative of a narcotic drug

•

Transportation, possession, or

unlawful use of a 21 C.F.R.

1308.11 Schedule I identified

controlled substance,

amphetamines, narcotic drugs,

formulations of an amphetamine, or

derivatives of narcotic drugs while

you were on duty driving for a

motor carrier

•

Leaving the scene of an accident

while operating a commercial motor

vehicle

•

Or any other felony involving the

use of a commercial motor vehicle

•

Vehicle Accident Record

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?

General Information 8

No Accidents

Traffic Convictions \ Violations

Have you had any moving violations or traffic convictions in the past 3 years? No Violations

Federal FCRA Summary of Rights Acknowledgment

By checking this box, I acknowledge that I

have read and understand the Summary of

Rights.

Yes

Disclosure Agreement

I agree with the above language Yes

Drug and Alcohol Release

I agree with the above language Yes

Certification Release

I agree with the above language Yes

PSP Release

I agree with the above language Yes

User Requested Copy

User requested a copy to be sent to this

email address ***********@*****.***.

Yes

By my check of this box, I represent that I

understand and agree to the above and

that I intend to execute this document by

electronic signature in checking this box.

Yes

General Information 9

Signature

Full Name Samuel C Shuler

IP Address 24.228.125.225

Signature Date/Time 06-15-2018 3:45 PM

By clicking next, I agree that my electronic signature will be applied to my application. An electronic signature is as legally binding as an ink signature. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signed Date: 06-15-2018 3:45 PM

Signed:

General Information 10

CONSUMER DISCLOSURE AND AUTHORIZATION FORM

Disclosure Regarding Background Investigation

Pegasus Transportation (the "Company") may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports"). These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your employment or your contract period. HireRight, LLC, or another consumer reporting agency, will prepare or assemble the background reports for the Company. HireRight, LLC is located and can be contacted by mail at 3349 Michelson Dr. Suite 150, Irvine, CA 92612, and HireRight can be contacted by phone at 800-***-****. Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx. The background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing. The types of information that may be obtained include, but are not limited to: social security number verifications; address history; credit reports and history; criminal records and history; public court records; driving records; accident history; worker's compensation claims; bankruptcy filings; educational history verifications (e.g., dates of attendance, degrees obtained); employment history verifications (e.g., dates of employment, salary information, reasons for termination, etc.); personal and professional references checks; professional licensing and certification checks; drug/alcohol testing results, and drug/alcohol history in violation of law and/or company policy; and other information bearing on your character, general reputation, personal characteristics, mode of living and credit standing.

This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; personal interviews with sources such as neighbors, friends and associates; and other information sources. If the Company should obtain information bearing on your credit worthiness, credit standing or credit capacity for reasons other than as required by law, then the Company will use such credit information to evaluate whether you would present an unacceptable risk of theft or other dishonest behavior in the job for which you are being evaluated. You may request more information about the nature and scope of any investigative consumer reports by contacting the Company. Printed Name:

Samuel C Shuler

Social Security #:

4913

Signed Date: 06-15-2018

Samuel C Shuler

316 Hart Street

Brooklyn, NY 11206

347-***-****

Gender:

General Information 11

Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as HireRight, LLC, and to the release of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or contract period.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services. I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background reports that may be requested by or on behalf of the Company. Printed Name:

Samuel C Shuler

Social Security #:

4913

Signed Date: 06-15-2018

Samuel C Shuler

316 Hart Street

Brooklyn, NY 11206

347-***-****

Gender:

General Information 12

IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Pegasus Transportation ("Prospective Employer"), Prospective Employer, 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 the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer 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, the Prospective Employer 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 the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer 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 the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer 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. The Prospective Employer cannot obtain background reports from FMCSA without your authorization. AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Pegasus Transportation ("Prospective Employer") 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 the Prospective Employer to make a determination regarding my suitability as an employee.

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

Samuel C Shuler

Signed Date: 06-15-2018

General Information 13

Additional State Law Notices

If you are a California, Maine, Massachusetts, New York or Washington State applicant, employee or contractor, please also note: CALIFORNIA: Pursuant to section 1786.22 of the California Civil Code, you may view the file maintained on you by HireRight during normal business hours. You may also obtain a copy of this file, upon submitting proper identification and paying the actual copying costs, by appearing at HireRight's offices in person, during normal business hours and on reasonable notice, or by certified mail. You may also receive a summary of the file by telephone, upon submitting proper identification and written request. HireRight has trained personnel available to explain your file to you, including any coded information, and will provide a written explanation of any coded information contained in your file. If you appear in person, you may be accompanied by one other person, provided that person furnishes proper identification. "Proper identification" includes documents such as a valid driver's license, social security account number, military identification card, and credit cards. If you cannot identify yourself with such information, HireRight may require additional information concerning your employment and personal or family history to verify your identity. MAINE: You have the right, upon request, to be informed of whether an investigative consumer report was requested, and if one was requested, the name and address of the consumer reporting agency furnishing the report. You may request and receive from the Company, within five business days of our receipt of your request, the name, address and telephone number of the nearest unit designated to handle inquiries for the consumer reporting agency issuing an investigative consumer report concerning you. You also have the right, under Maine law, to request and promptly receive from all such agencies copies of any such reports. MASSACHUSETTS: If we request an investigative consumer report, you have the right, upon written request, to a copy of the report. NEW YORK: You have the right, upon written request, to be informed of whether or not an investigative consumer report was requested. If an investigative consumer report is requested, you will be provided with the name and address of the consumer reporting agency furnishing the report. You may inspect and receive a copy of the report by contacting that agency. Please see https://www.HireRight.com/NY_Article_23_A.pdf?enable_url=true for additional information about New York law, as applicable. WASHINGTON STATE: If the Company requests an investigative consumer report, you have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of the investigation requested by the Company. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act. Printed Name: Samuel C Shuler

Social Security #: 4913

Signed Date: 06-15-2018

Signed:

General Information 14

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing Records

And changes in Parts 390 and 391 of the FMCSA

X 06-15-2018

Date

X 4913

Social Security Number

Samuel C Shuler

316 Hart Street

Brooklyn, NY 11206

347-***-****

Gender:

X Samuel C Shuler

Print Name (First, MI, Last)

Signature

I, the above mentioned signer, hereby authorize Dedicated Transport To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Pegasus Transportation DISCLOSURE AND RELEASE

In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed above to Pegasus Transportation, or to HireRight for the sole purpose of transmitting such records to Pegasus Transportation. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers (company/school) listed above to release information about names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and other information. The information that I have authorized Pegasus Transportation or HireRight to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Pegasus Transportation or HireRight with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years.

General Information 15

CONSUMER DISCLOSURE AND AUTHORIZATION FORM

Disclosure Regarding Background Investigation

Contact this candidate