Applicant Name: Frederick Cyril Novotny Jr

Company Name: Seattle Choice Transport

Company Address: 2800 Bluff Road, Indianapolis, Indiana 46225 Submitted Date/Time: October 09, 2023 03:10 PM (CDT) 1.PERSONAL INFORMATION

Applicant Details

Last Name: Novotny Jr

First Name: Frederick

Middle Name: Cyril

Birth Date: October 20, 1963

Identification Country USA

SSN/SIN/Other Identification Number: ***-**-****

Phone Number: 470-***-****

Email Address: ad10b3@r.postjobfree.com

Current Residency Details

Current Address: 10095 Highway 334

Country: USA

State/Province: Georgia

County: Jackson

City/Municipality: Nicholson

Zip Code/Postal Code: 305653614

Residence From: Feb 2012 to Oct 2023

2. EMPLOYMENT HISTORY

This position is CDL; you will be required to provide 10 years of employment history below. Current or Most Recent Employer /Company Name /Truck Driving School /Self Employment Are you currently employed? No

Account for period if not employed:

From: Oct 2022 to Oct 2023

Employment Status: Medical Leave

Employer 1

Employer/Company Name: WaterJet Cutting of Indiana Phone Number: 317-***-****

Address: 10760 E US Hwy 136

Country: USA

State/Province: Indiana

City: Indianapolis

Zip/Postal Code: 46234

Position Held: Omax WaterJet operator

From: Feb 2019 to Oct 2022

Reason for Leaving: Resigned

Were you subject to the FMCSRs while employed? No

Was your job designated as a safety-sensitive

function in any DOT-regulated mode subject to the

drug and alcohol testing requirements of 49 CFR

Part 40?

No

Employer 2

Employer/Company Name: Utec Construction

Phone Number: 770-***-****

Address: Atlanta

Country: USA

State/Province: Georgia

City: Atlanta

Zip/Postal Code: 30549

Position Held: CDL-A Truck driver and Vermeer Utility drill operator From: Sep 2017 to Feb 2019

Reason for Leaving: Took Different Job

Were you subject to the FMCSRs while employed? Yes Was your job designated as a safety-sensitive

function in any DOT-regulated mode subject to the

drug and alcohol testing requirements of 49 CFR

Part 40?

Yes

Employer 3

Employer/Company Name: Knight transportation

Phone Number: 404-***-****

Address: 4275 Shirley Dr

Country: USA

State/Province: Georgia

City: Atlanta

Zip/Postal Code: 30336

Position Held: Dry Van CDL-A truck driver

From: Aug 2017 to Sep 2017

Reason for Leaving: Took Different Job

Were you subject to the FMCSRs while employed? Yes Was your job designated as a safety-sensitive

function in any DOT-regulated mode subject to the

drug and alcohol testing requirements of 49 CFR

Part 40?

Yes

Employer 4

Employer/Company Name: Cook Residential Construction Phone Number: 678-***-****

Address: 3120 Frontage Rd

Country: USA

State/Province: Georgia

City: Gainesville

Zip/Postal Code: 30504

Position Held: CDL-A Mac Dump Truck driver

From: Jul 2017 to Aug 2017

Reason for Leaving: Took Different Job

Were you subject to the FMCSRs while employed? Yes Was your job designated as a safety-sensitive

function in any DOT-regulated mode subject to the

drug and alcohol testing requirements of 49 CFR

Part 40?

Yes

Employer 5

Employer/Company Name: CDL-A of GA truck driving school Phone Number: 770-***-****

Address: 846 Jefferson Hwy

Country: USA

State/Province: Georgia

City: Winder

Zip/Postal Code: 30680

Position Held: Class -A classroom and manual daycab with dry van school

From: Apr 2017 to Jun 2017

Reason for Leaving: Completed Truck Driving School Were you subject to the FMCSRs while employed? Yes Was your job designated as a safety-sensitive

function in any DOT-regulated mode subject to the

drug and alcohol testing requirements of 49 CFR

Part 40?

Yes

Employer 6

Employer/Company Name: Steffl Machine and Tool

Phone Number: 706-***-****

Address: McCarty Rd

Country: USA

State/Province: Georgia

City: Bethlehem

Zip/Postal Code: 30620

Position Held: Manual and CNC mill and lathe machine operator From: Feb 2012 to Apr 2017

Reason for Leaving: Took Different Job

Were you subject to the FMCSRs while employed? No

Was your job designated as a safety-sensitive

function in any DOT-regulated mode subject to the

drug and alcohol testing requirements of 49 CFR

Part 40?

No

Employer 7

Employer/Company Name: Ohana Health Care

Phone Number: 808-***-****

Address: 911053 Kai Kukuma

Country: USA

State/Province: Hawaii

City: Ewa Beach

Zip/Postal Code: 96706

Position Held: Care giver for Elderly

From: Feb 2009 to Feb 2012

Reason for Leaving: Took Different Job

Were you subject to the FMCSRs while employed? No

Was your job designated as a safety-sensitive

function in any DOT-regulated mode subject to the

drug and alcohol testing requirements of 49 CFR

Part 40?

No

3. EXPERIENCE AND QUALIFICATIONS

Driving Experience

Commercial Driving experience in the last 3 years: No Accident Details

In the last 3 years, have you been in an Accident? No Traffic Conviction and/or Forfeitures Details

In the last 3 years, have you had any traffic

convictions and/or forfeitures?:

No

Current License Information

Current State/Province of Residence: Georgia

Current License Number: 058017083

License Class: CDL - A

Expiration Date: 10/20/2025

Other Information

Have you ever been denied a license, permit, or

privilege to operate a motor vehicle? No More

Information:

No

More Information:

Has any license, permit or privilege ever been

suspended or revoked?

No

More Information:

CDL Endorsements: None

More Information:

CDL Restrictions: None

More Information:

4. UPLOAD RELATED DOCUMENTS

Below are the documents that have been uploaded

Document Type Document Title

Driver’s License (Front) image.jpg

Driver’s License (Back) image.jpg

Medical Certificate image.jpg

5. FORMS

Below are the disclosure documents that have been uploaded Document Section Document Name

Disclosures & Authorizations Disclosure Regarding Investigative Background Investigation

Disclosures & Authorizations Summary of Rights Under the Fair Credit Reporting Act

Disclosures & Authorizations Acknowledgement and Authorization for Background Check

Disclosures & Authorizations Disclosure Regarding Background Investigation Custom disclosures Seattle Choice Transport - CDAPS_Receipt DOT Documents Previous Pre-Employment Alcohol & Drug Test Statement

DOT Documents Consent to Conduct Queries of The FMCSA CDL D

& A Clearinghouse

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23 (d) and (e). I understand that I have the right to:

* Review information provided by current previous employers;

* Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and

* Have a rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree on the accuracy of the information.

Applicant Certification

By clicking this box, I certify 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. This application is being completed for: Seattle Choice Transport 2800 Bluff Road, Indianapolis, Indiana 46225

ACKNOWLEDGEMENT FOR ELECTRONIC SIGNATURE

Your Name: Frederick Cyril Novotny Jr

Your SSN's Last Four Numbers: 2042

* I acknowledge that my name and my (SSN/Last four SSN) which is displayed above, is accurate, and by checking the Acceptance Box, and by clicking on the “Next Document” Button below, I am electronically signing the above document.

* I understand that my electronic signature will be binding as though I had physically signed this document by hand. I agree that a printout of this authorization may be accepted with the same authority as the original. Signature:

Date: 10/9/2023

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