Information Safety
Resume:
Name Scott Bandeen
Current Address Po Box ***
City, State/Province Zip/Postal Cocolalla, ID 83813 Country United States
SSN/SIN 3571
Date of Birth
Primary Phone 701-***-****
Cell Phone 701-***-****
Preferred method of contact Primary Phone
Best time to contact you Any
Email acw5cf@r.postjobfree.com
GENERAL INFORMATION
Position applying for: Driver
Do you have any relatives who worked for
this company?
No
Enter names and positions:
Do you have a current TWIC card? No
Expiration date:
How did you hear about us? Recruitment
DRIVING EXPERIENCE
For each class of equipment, enter type of equipment (van, tank, flat, etc.), start and end dates, and approximate number of total miles. If no experience in a class, enter
"NONE".
Straight Truck Pickup with 40'gooseneck trailer.
6/13 to 1/16
Tractor and Trailer Daycab w/ 53' flatbed
Tractor and Two Trailers
Other
List states operated in for the last 5 years: North Dakota Number of years of commercial driving
experience:
4
List any additional training you have had
that will help you as a commercial truck
driver:
DTS truck driving school
List any safety and/or safe driving awards
you have earned and from whom:
EDUCATION
List highest grade completed: College - 2
List last school attended (name, city, and
state):
Mesa community college
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship: First Reference: George Thornbill
Rathdrum,Idaho
Second Reference: Andre Deluge
Dufort road
Sagle,Idaho
Third Reference: Rob McCarthy
1003 Best Ave
Coeur d'Alene, Idaho
Licenses
License Number 60J
State/Province ID
Country United States
License Class Class A
License Expiration Date 08-22-2016
Physical Expiration Date 09-22-2016
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement Yes
Other Endorsement No
Employment / Unemployment
Unemployment
Start Date 06-2016
End Date 09-2016
Comment
Unemployment
Start Date 01-2016
End Date 05-2016
Comment
Petroleum Services
PLEASE DO NOT CONTACT
Company Petroleum Services
Contact / Supervisor Name
Start Date 02-2013
End Date 12-2015
Address 4th ave.
City, State/Province Zip/Postal Williston, ND 58801 Country United States
Phone
Position Held
Reason for leaving? Oil pricex
Were you terminated/discharged/laid off? Yes
Termination Explanation Mutual agreement
Is this your current employer? No
May we contact this employer at this time? No
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?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT, and
subject to drug and alcohol testing?
Yes
Areas Driven N.&S. Dakota's
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Other
Most common trailer Flatbed
Trailer length 32 to 44 feet
Unemployment
Start Date 05-2006
End Date 08-2012
Comment
Trucking School
Start Date 09-2012
End Date 01-2013
School DTS
City, State/Province Medical Lake,washington, WA
Country United States
Phone
Did you graduate? Yes
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while attending this truck
school?
Did you perform any safety sensitive
functions at this truck school, regulated by
DOT, and subject to drug and alcohol
testing?
Yes
GPA 4.0
Hours of Instruction 60
Border Crossing No
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials No
Motor Vehicle Record
1. Has any license, permit or privilege ever
been denied, suspended or revoked for
any reason?
No
2. Have you ever been convicted of driving
during license suspension or revocation, or
driving without a valid license or an expired
license, or are any charges pending?
No
3. Have you ever been convicted for any
alcohol or controlled substance related
offense while operating a motor vehicle, or
are any charges pending?
No
4. Have you ever been convicted for
possession, sale or transfer of an illegal
substance (including but not limited to,
marijuana, amphetamines, or derivatives
thereof) while on duty, or are any charges
pending?
No
5. Have you ever been convicted of
reckless driving, careless driving or
careless operation of a motor vehicle, or
are any charges pending?
No
6. Have you ever 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 in past three years, or have
you ever tested positive or refused to test
No
on any DOT-mandated drug or alcohol
test?
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?
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
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 acw5cf@r.postjobfree.com.
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
Signature
Full Name Scott Bandeen
IP Address 97.45.144.251
Signature Date/Time 09-19-2016 11:16 PM
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: 09-19-2016 11:16 PM
Signed:
CONSUMER REPORT DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) with Sherman Brothers Trucking, consumer reports may be requested from USIS Commercial Services (USIS). These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, academic history, professional credentials, and drugs/alcohol use. Such reports may contain public record information concerning your driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from USIS concerning previous driving record requests made by others from such state agencies and state provided driving records. You have the right to make a request to USIS, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that USIS has previously furnished within the three-year period preceding your request. USIS may be contacted by mail at P.O. Box 33181, Tulsa, Oklahoma, 74153, or by phone at 800-***-****.
I AUTHORIZE, WITHOUT RESERVATION, USIS, AND ANY PARTY OR AGENCY CONTACTED BY USIS, TO FURNISH THE ABOVE-MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION OBTAINED UNDER PART I.
I hereby consent to your obtaining the above information from USIS, and I agree that such information which USIS has or obtains, and my employment history (not DOT Drug and Alcohol information without a specific consent by me) with you if I am hired, will be supplied by USIS to other companies which subscribe to USIS. I hereby authorize procurement of consumer report(s). If hired or contracted, this authorization, for reports covered by this release only, shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment or contract period. Notice to California Applicants
Under California law, the consumer reports we order on you for employment purposes within the State of California are defined as investigative consumer reports. These reports may contain information on your character, general reputation, personal characteristics and mode of living. Under section 1786.22 of the California Civil Code, you may view the file maintained on you by USIS during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services, by appearing at USIS in person or by mail. The agency is required to have personnel available to explain your file to you and the agency must explain to you any coded information appearing in your file. If you appear in person, a person of your choice may accompany you, provided that this person furnishes proper identification. Printed Name:
Scott Bandeen
Social Security #:
3571
Signed Date: 09-19-2016
Scott Bandeen
Po Box 581
Cocolalla, ID 83813
Gender:
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS ("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 Sherman Brothers Trucking ("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:
Scott Bandeen
Signed Date: 09-19-2016
TO BE READ AND SIGNED BY APPLICANT
If I am selected as an employee or independent contractor for the Company I understand and authorize that a periodic investigation may be requested for the duration of my association with the Company. I understand that this release and authorizations shall remain in effect for the duration of my association with the Comapny. Additionally, I hereby authorize the Company to investigate any incidents of workplace misconduct made against or involving me both during and after the term of my association with the Company. I understand and agree that any information provided by me that is found to be false, incomplete or misrepresented in any respect in the Company's sole judgement, will be cause to cancel further consideration of my application for employment and/or contracting services whenever such discrepancies are discovered. Further, I understand that by requesting this information that no promise of employment is being made. I am willing that a photocopy of this authorization will be accepted with the same authority as the original. I HEREBY CERTIFY THAT THIS FORM WAS COMPLETED BY ME, AND THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AS OF THE DATE HEREOF.
Printed Name: Scott Bandeen
Social Security #: 3571
Signed Date: 09-19-2016
Signed:
PRE-EMPLOYMENT AGREEMENT
I consent to the testing of specimens provided by me in order to determine the presence of controlled substances and I recognize that the analysis results of such specimens will be used to determine suitability of employment. I understand that favorable test results will not necessarily guarantee that I will be offered employment at SBI. At this time I consent to a drug and/or alcohol test.
Printed Name: Scott Bandeen
Social Security #: 3571
Signed Date: 09-19-2016
Signed:
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 09-19-2016
Date
X 3571
Social Security Number
Scott Bandeen
Po Box 581
Cocolalla, ID 83813
Gender:
X Scott Bandeen
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Petroleum Services To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Sherman Brothers Trucking DOT DRUG AND ALCOHOL RELEASE
I authorize, per 49 CFR Part 40, the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed to USIS for the sole purpose of transmitting such records to Sherman Brothers Trucking, or directly to Sherman Brothers Trucking. 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. The information that I have authorized USIS to review involves tests required by DOT. If any carrier (company/school) listed above furnishes USIS 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. CONSUMER REPORT DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) with Sherman Brothers Trucking, consumer reports may be requested from USIS Commercial Services (USIS). These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, academic history, professional credentials, and drugs/alcohol use. Such reports may contain public record information concerning your driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from USIS concerning previous driving record requests made by others from such state agencies and state provided driving records. You have the right to make a request to USIS, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that USIS has previously furnished within the three-year period preceding your request. USIS may be contacted by mail at P.O. Box 33181, Tulsa, Oklahoma, 74153, or by phone at 800-***-****.
I AUTHORIZE, WITHOUT RESERVATION, USIS, AND ANY PARTY OR AGENCY CONTACTED BY USIS, TO FURNISH THE ABOVE-MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION OBTAINED UNDER PART I. I hereby consent to your obtaining the above information from USIS, and I agree that such information which USIS has or obtains, and my employment history (not DOT Drug and Alcohol information without a specific consent by me) with you if I am hired, will be supplied by USIS to other companies which subscribe to USIS. I hereby authorize procurement of consumer report(s). If hired or contracted, this authorization, for reports covered by this release only, shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment or contract period.
Notice to California Applicants
Under California law, the consumer reports we order on you for employment purposes within the State of California are defined as investigative consumer reports. These reports may contain information on your character, general reputation, personal characteristics and mode of living. Under section 1786.22 of the California Civil Code, you may view the file maintained on you by USIS during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services, by appearing at USIS in person or by mail. The agency is required to have personnel available to explain your file to you and the agency must explain to you any coded information appearing in your file. If you appear in person, a person of your choice may accompany you, provided that this person furnishes proper identification. Employer / Contractor / Educational Institution:
DTS
Printed Name:
Scott Bandeen
Social Security #:
3571
Signed Date: 09-19-2016
Scott Bandeen
Po Box 581
Cocolalla, ID 83813
Gender:
Contact this candidate