Driver Information
Resume:
Driver Application
Personal Information
First Name: Victor
Last Name: Rodriguez
Address: *** **** ***
City: Brooklyn
State: NY
ZIP Code: 11206
Cell Phone: 917-***-****
Home Phone: 917-***-****
Email Address: *********@*****.***
Date Of Birth: 9/24/1967
License State: NY
DL#: 722925519
I have a current Class A commercial Driver's license (CDL): No Level Of Experience: SC
Are You A Veteran?: No
When would you like to start driving?: In Two Weeks Personal References
Name: Nancy ocasio
Relationship: Friend
Phone: 917-***-****
Name: Robert valentine
Relationship: Friend
Phone: 646-***-****
Name: Lissette Rodriguez
Relationship: Wife
Phone: 347-***-****
Qualifications
Have you had any traffic tickets in the last 5 years? No Have you had any auto accidents in the last 5 years? No Have you ever been convicted of driving while intoxicated? No Has your license ever been suspended or revoked? Yes Have you used illegal drugs or prescription marijuana in the past 12 months? No
Driver Application
In the past 5 years, have you failed or refused a pre-employment drug screen? No
In the last three years have you tested positive, or refused to test, on any 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? No Have you ever been convicted of a felony? Yes
Have you ever been convicted of a misdemeanor? No
Have you ever been employed as a company driver or independent contractor for C.R. England? No
Work History
Start: 3/01/2016
End: 8/01/2014
Company Name: Clean sweep
Job Title: Maintenance
Was this a driving position? No
Start: 3/01/2015
End: 8/01/2015
Company Name: Parks dept
Job Title: Maintenance
Was this a driving position? No
Driver Application
Disclaimer
DISCLOSURE: By submitting this application I certify that I personally have completed this application and that all of the information is true and correct. I hereby authorize C.R. England, Inc. and its agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, driving record, credit history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. If hired or contracted this authorization for the above reports shall remain on file and shall serve as ongoing authorization for C.R. England, Inc to procure consumer reports at any time during my employment or contract period. I have completed this application of my own free will and hold C.R. England, Inc., its agents and contractors harmless for all liability for providing this application for my use. I consent to receiving text (SMS) messages from CR England and/or its affiliates regarding or relating to my application for employment. I have read and understand the job description and certify that I am able to meet the requirements of this position and may be contacted by, which may include, but is not limited to, email contact, phone contact, direct mail contact. EMPLOYMENT VERIFICATION:
I hereby authorize C.R. England, Inc to do a complete background investigation, which includes contacting my past employers regarding my service, character and drug and alcohol test results as per Federal Motor Vehicle § 391.23 and 382.413. My past employers are released from any and all liability, which may result from furnishing such information. I authorize C.R. England to run a consumer report from USIS (DAC) services. These reports may include information concerning driving record, work experience, and motor vehicle reports. C.R. England is an E-Verify employer.
DRIVER RIGHTS NOTIFICATION
FMCSA NOTIFICATION OF DRIVER RIGHTS
In compliance with 49 CFR Part 40 § 391.23 you have certain rights regarding the performance history information that will be provided to prospective employers. I) You have the right to review information provided by previous employers. II) You have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to prospective employers. III) You have the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. Drivers who have previous DOT regulated employment history in the preceding three years and wish to review previous employer-provided investigative information must submit a written request to prospective employers. This may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. Prospective employers must provide this information within five business days of receiving the written request. If prospective employers have not yet received the requested information from the previous employer, then the five day deadline will begin when the requested safety performance history information is received. If you have not arranged to pick up or receive the requested records within 30 days of prospective employers making them available. Prospective employers may consider you to have waived your request to review the record. MANDATORY USE FOR ALL ACCOUNT HOLDERS - IMPORTANT NOTICE - REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
1. In connection with your application for employment with __C.R. England__ ('Prospective Employer'), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety Driver Application
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. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: 2. I authorize __C.R. England__ ('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 consenting to 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. 3. 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 am challenging 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. 4. Please note: 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 FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, 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. By entering your name and identifying information above, you are signing this Disclosure, Consent, and Application electronically. You understand and agree that your electronic signature is the legal equivalent of your manual signature, pursuant to the Electronic Signatures in Global and National Commerce Act (E-SIGN) and applicable state law. Driver Application
Signature:
Name: Victor Rodriguez
Timestamp: 2016-05-31-23:00:29
IP Address: 208.54.45.128
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