Saia LTL Freight
Ste. 400
John Creek, GA 30097
**-**-**** *:54:59AM CST
IntelliApp
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.
Position City State/Province
Class A CDL Driver Memphis (MPS) TN
Personal Information
Name Derick G Parker, Sr.
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 7575 Havensville Rd
Address 2 Apt C
City, State/Province Zip/Postal Southaven, MS 38671 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 0618
Date of Birth
Primary Phone 901-***-****
Cell Phone 901-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email **************@*****.***
Yes, I agree to receive information
concerning future opportunities or
promotions from Saia LTL Freight by email
or other commercial electronic
communications.
Yes
Would you like to receive communication
from Saia LTL Freight via text message?
By participating, you consent to receive
text messages sent by an automatic
telephone dialing system, which may
contain recruiting/advertising messages.
Yes
1
Consent to these terms is not a condition
of being hired, contracted, or leased. You
may opt out at any time by texting STOP to
unsubscribe. You also agree that Saia LTL
Freight's service provider receives in real
time and logs your text messages with
Saia LTL Freight.
Company Questions
GENERAL INFORMATION
What position are you applying for? Local/City Driver If you selected "Team Driver" please enter
Team Partner
Can you provide legal documentation
establishing your identity and eligibility to
be legally employed in the United States?
Yes
Will you now or in the future require
sponsorship for employment visa status
(e.g., H-1B visa status)?
No
Are you currently employed? No
What date did your last employment end? 01-13-2024 Do you read, write, and speak English? Yes
Have you ever worked for Saia, Westex,
Action Express, Clark Brothers Transfer,
Connection Company, Madison Freight,
Robart Transportation or LinkEx?
No
Enter start and end dates, location,
position, and reason for leaving:
Do you have a current TWIC card? Yes
Expiration date: 12-31-2024
Please enter the names of any relatives
employed here:
Have you ever been known by any other
name?
No
Enter name:
How did you hear about us? Other
If "Job Board", please enter job board type.
If "Social Media", please enter social
media source.
Indeed
If "Recruiter Contacted", please enter
recruiter name.
2
If "Employee Referral", please enter the
employee's name
If "Other", please explain Driving by
DRIVING EXPERIENCE
Do you have at least 12 months of
tractor-trailer experience?
Yes
Do you have any tractor-trailer driving
experience with the last 24 months?
Yes
Select the type of equipment you have experience driving in the past 24 months
(answer yes for all that apply):
Van Yes
Flat No
Tank No
Bulk No
Reefer Yes
Other Yes
Select the amount of total experience you
have driving tractor-trailers:
3+ Years
Select the approximate number of miles
you have driven tractor-trailers:
50,000 to 100,000
Select the amount of total experience you
have driving tractor-double trailers:
3+ Years
Select the approximate number of miles
you have driven tractor-double trailers:
50,000 to 100,000
Select the amount of total experience you
have driving tractor-triple trailers:
3+ Years
Select the approximate number of miles
you have driven tractor-triple trailers:
Less than 50,000
Select the amount of total experience you
have driving tractor-Rocky Mountain
doubles:
Select the approximate number of miles
you have driven tractor-Rocky Mountain
doubles:
Please provide the type of driving experience you have (answer yes for all that apply): OTR No
Regional No
Local Yes
LTL Yes
3
Other No
Please explain
Which safe driving awards do you hold and
from whom?
DOT DRUG / ALCOHOL TEST HISTORY
In accordance with DOT regulation 49CFR Part 40.25, please respond to the following questions regarding any Drug/Alcohol Test results, Treatment Records, and Refusal to Test History within the last five (5) years:
Have you had any DOT required alcohol
tests with a result of 0.04 or higher alcohol
concentration?
No
Please explain:
Have you had any verified positive DOT
required drug test?
No
Please explain:
Have you refused to be tested (including
having a verified adulterated or substituted
drug test result)?
No
Please explain:
Have you had any other violation of DOT
agency drug or alcohol testing regulations?
No
Please explain:
If you violated a DOT drug and/or alcohol
regulation did you successfully complete
DOT return to duty requirements (including
all follow up tests)?
No
Please explain:
Were there any situations in which you
tested positive on a pre-employment test
for a DOT employer that did not hire you?
No
Please explain:
Were there any situations in which you
refused to submit (including positives by
adulteration or subsitution) to a
pre-employment test for a DOT employer
that did not hire you?
No
Please explain:
I certify that my responses to the above
questions are true.
Yes
EDUCATION
List highest grade completed: Some College
4
List last school attended (name, city, and
state):
Forest city Arkansas
Licenses
License Number 956
Licensing Authority MS
Country US
License Class Class A
License Expiration Date 05-25-2025
DOT Medical Card Expiration Date 05-25-2025
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement No
HAZMAT Endorsement Yes
Hazmat Expiration Date 05-25-2025
X Endorsement No
Doubles Triples Endorsement Yes
Other Endorsement No
Employment / Unemployment
ARMSTRONG LOGISTICS LLC
Company ARMSTRONG LOGISTICS LLC
Start Date 10-2021
End Date 01-2024
Address 3141 Fairview Rd
City, State/Province Zip/Postal Salt Lake City, UT 38116 Country United States
Phone 901-***-****
Position Held Truck Driver local
Reason for leaving? Need more money
Were you terminated/discharged/laid off? No
Is this your current employer? No
Yes
5
May we contact this employer at this time?
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 Memphis Arkansas Mississippi
Miles driven weekly 3500+
Most common truck driven Day Cab
Most common trailer Doubles
Trailer length 53 feet or more
POWER TRANSPORTATION
Company POWER TRANSPORTATION
Start Date 05-2020
End Date 09-2021
Address 3124 DIRECTORS ROW
City, State/Province Zip/Postal Memphis, TN 38131
Country United States
Phone 901-***-****
Position Held LOCAL CITY DRIVER
Reason for leaving? RESIGN NEED MORE MONEY
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?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
6
Areas Driven
Miles driven weekly 3500+
Most common truck driven Day Cab
Most common trailer Doubles
Trailer length 53 feet or more
JNJ Express, Inc
Company JNJ Express, Inc
Start Date 01-1999
End Date 05-2020
Address 3800 homewood
City, State/Province Zip/Postal Memphis, TN 38118
Country United States
Phone 901-***-****
Position Held Local truck driver
Reason for leaving? I decided I needed better pay
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?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Local Driver TN, MS,COVINGTON,
ARKANSAS
Miles driven weekly 3500+
Most common truck driven Day Cab
Most common trailer Doubles
Trailer length 53 feet or more
7
FMCSR
Under FMCSR 391.15, are you currently
disqualified from driving a commercial
motor vehicle? [49 CFR 391.15]
No
Has your license, permit or privilege to
drive ever been suspended or revoked for
any reason? [49 CFR 391.21(b)(9)]
No
Have you ever been denied a license,
permit, or privilege to operate a motor
vehicle?[49 CFR 391.21(b)(9)]
No
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)]
No
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
·
No
8
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
Signature
Full Name Derick G Parker, Sr.
IP Address 2601:3cb:600:9aa
Signature Date/Time 01-15-2024 9:54 AM
By signing my application below, I agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature. By signing below I authorize Saia, Inc. and/or Saia Motor Freight Line, LLC (the
"Company") to act on my behalf to conduct a criminal background check. Further, I understand that my employment is at will and for no definite period and may, regardless of the date of payment of wages, be terminated at any time with or without previous notice and with or without cause. I also understand that as a condition of employment, I will be required to pass a controlled substance test involving a collection of my urine, that a post offer physical may be required and I must successfully complete an E-Verify check (subject to state law requirements). I understand that, as a continuing condition of employment, I may be required to submit a D.O.T. recertification physical (drivers only) and/or random controlled substance test(s), alcohol test(s), and other drug tests as outlined in Saia's Drug and Alcohol policy. All information gathered shall be held in strict confidence between the Company and the applicant / employee. Signing below also 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: 01-15-2024 9:54 AM
Signed:
Federal FCRA Summary of Rights Acknowledgment
By checking this box, I (a) acknowledge
that I have read and understand the
federal FCRA Summary of Rights and
Yes
9
have been given the opportunity to
copy/print the Summary of Rights and (b)
agree to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Additional Consent or Certification
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
FCRA Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Employment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Clearinghouse Release
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
10
User Requested Copy
User requested a copy to be sent to this
email address **************@*****.***.
Yes
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 Driver iQ/Cisive, 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:
Derick G Parker, Sr.
Social Security #:
0618
Signed Date: 01-15-2024
Derick G Parker, Sr.
7575 Havensville Rd
Apt C
Southaven, MS 38671
Gender:
12
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Saia LTL Freight to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for Saia LTL Freight to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent. I understand that if I refuse to provide consent for Saia LTL Freight to conduct a limited query of the Clearinghouse, Saia LTL Freight is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle. I understand that if the limited query conducted by Saia LTL Freight indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Saia LTL Freight unless I give additional specific consent within the Clearinghouse. However, I understand that Saia LTL Freight will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle. 01-15-2024
Derick G Parker, Sr. Date
13
APPLICATION AGREEMENT
By checking I Agree below I authorize Saia, Inc. and/or Saia Motor Freight Line, LLC (the "Company") to act on my behalf to conduct a criminal background check. Under the provision of the Fair Credit Reporting Act 15 U.S.C 1681, et seq, notice is hereby given that an investigative consumer report may be made which may include information pertaining to your, character, general reputation, personal characteristics, and mode of living, which will be used for employment purposes. Also, you have the right to request the company to make a complete and accurate disclosure of the nature and scope of the investigation requested by the company, pursuant to FMCSR 391.23, driver applicants have the right to review information provided by the previous employers, the right to have errors in the information corrected by the previous employer and for that previous employer to resend the corrected information. Driver applicants also have the right to have a rebuttal statement attached to the erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. Your request must be in writing and submitted within a reasonable time period after your application. The company shall respond in writing, mailed or otherwise delivered, to you, not later than five days after the date on which the request for such disclosure was received from you or such report was first requested, whichever is later. I also authorize the investigation of all statements contained in the application. I understand that any misrepresentation or omission of facts called for on this application is cause for immediate dismissal. I hearby grant permission to verify employment with current and former employers to obtain information regarding my previous employment record. Further, I understand that my employment is at will and for no definite period and may, regardless of the date of payment of wages, be terminated at any time with or without previous notice and with or without cause. I also understand that as a condition of employment, I will be required to pass a controlled substance test involving a collection of my urine, that a post offer physical may be required and I must successfully complete an E-Verify check (subject to state law requirements). I understand that, as a continuing condition of employment, I may be required to submit a D.O.T. recertification physical (drivers only) and/or random controlled substance test(s), alcohol test(s), and other drug tests as outlined in Saia's Drug and Alcohol policy. All information gathered shall be held in strict confidence between the Company and the applicant / employee. By checking "I Agree" also 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.
Printed Name: Derick G Parker, Sr.
Social Security #: 0618
Signed Date: 01-15-2024
Signed:
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 01-15-2024
Date
X 0618
Social Security Number
Derick G Parker, Sr.
7575 Havensville Rd
Apt C
Southaven, MS 38671
Gender:
X Derick G Parker, Sr.
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize ARMSTRONG LOGISTICS LLC To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Saia LTL Freight
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 Saia LTL Freight, or to Driver iQ/Cisive for the sole purpose of transmitting such records to Saia LTL Freight. 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 Saia LTL Freight or Driver iQ/Cisive to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes Saia LTL Freight or Driver iQ/Cisive 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.
15
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 01-15-2024
Date
X 0618
Social Security Number
Derick G Parker, Sr.
7575 Havensville Rd
Apt C
Southaven, MS 38671
Gender:
X Derick G Parker, Sr.
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize POWER TRANSPORTATION To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Saia LTL Freight
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 Saia LTL Freight, or to Driver iQ/Cisive for the sole purpose of transmitting such records to Saia LTL Freight. 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 Saia LTL Freight or Driver iQ/Cisive to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes Saia LTL Freight or Driver iQ/Cisive 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.
16
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 Driver iQ/Cisive, 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. Employer / Contractor / Educational Institution:
JNJ Express, Inc
Printed Name:
Derick G Parker, Sr.
Social Security #:
0618
Signed Date: 01-15-2024
Derick G Parker, Sr.
7575 Havensville Rd
Apt C
Southaven, MS 38671
Gender:
17
A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information.
·
You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
a person has taken adverse action against you because of information in your credit report;
you are the victim of identity theft and place a fraud alert in your file;
your file contains inaccurate information as a result of fraud;
you are on public assistance;
you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit