United States Motor Carrier
Resume:
Forward Intermodal
Joliet, IL 60436
**-**-**** *:53:30PM CDT
IntelliApp - CST (OO)
Thank you for your interest in Forward Intermodal.. To apply for a driving position, please complete our online questionnaire. Incomplete information will delay the processing of your questionnaire or prevent it from being submitted. Personal Information
Referral Code: CC_IML_ORDOTR
Name Luis Anibal Martinez
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 217 Central Lake Cir
City, State/Province Zip/Postal Griffin, GA 30224
Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 5689
Date of Birth
Primary Phone 770-***-****
Cell Phone 470-***-****
Email ***********@*****.***
Company Questions
Set WL from URL 5
GENERAL INFORMATION
What service division are you applying for? Intermodal What position are you applying for? Company Driver What location are you applying for? GA, Atlanta - International What type of run do you prefer? Local
How much intermodal experience do you
have?
2 year +
Do you need to (Are you interested in)
participate(ing) in Central States Owner
Operator Plates Program?
Yes
Yes
1
Are you legally eligible to contract with a
Motor Carrier in the United States?
Are you currently employed or contracted
to another Motor Carrier?
Yes
What date did your last employment or
contract date end?
Do you read, write, and speak English? Yes
Have you ever worked or been contracted
to this company before?
No
Enter start and end dates, location,
position, and reason for leaving:
Do you have a current TWIC card? Yes
Expiration date: 2028
Have you served in the U.S. Armed Forces
or are you a family member eligible for
derived preference?
No
Please enter the names of any relatives
employed or contracted here:
Have you ever been known by any other
name?
No
Enter name:
How were you referred to this company? Other
If "Newspaper Ad", please enter the name
of the paper
If "Contractor", please enter the name of
the contractor
If "Flyer", please tell us where you picked it
up
If "Central States Trucking Co. Driver",
please enter their name
If "Other" please describe
In case of Emergency, notify (list name,
address, and phone):
DRIVING EXPERIENCE
Please summarize driving experience you
have had. List the class, type of
equiptment, and with start and end dates.
30 yrs CDL A
Which safe driving awards do you hold and
from whom?
EQUIPMENT (OWNER/OPERATORS ONLY)
Equipment Description (Tractor):
2
Type:
Year:
Make:
Model:
VIN:
EDUCATION
List highest grade completed: College - 2
List last school attended (name, city, and
state):
IST ACADEMY MIAMI FLA
Licenses
License Number 802
Licensing Authority GA
Country US
License Class Class A
License Expiration Date 06-14-2030
DOT Medical Card Expiration Date 04-21-2024
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement No
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement No
Licenses
License Number 802
Licensing Authority GA
Country US
License Class Class A
License Expiration Date 06-14-2030
DOT Medical Card Expiration Date 05-06-2024
Current License Yes
3
Commercial Driver License Yes
Endorsements
Tanker Endorsement No
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement No
Licenses
License Number 155
Licensing Authority TN
Country US
License Class Class A
License Expiration Date 08-13-2027
DOT Medical Card Expiration Date 01-12-2021
Current License No
Commercial Driver License Yes
Endorsements
Tanker Endorsement No
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement No
Employment / Unemployment
FirstFleet
Company FirstFleet
Start Date 06-2023
End Date 04-2024
Address 217 central lake circle
City, State/Province Zip/Postal Griffin, TN 30223
Country United States
Phone 678-***-****
Position Held OTR Driver
4
Reason for leaving? Still here. JB Hunt just got are bid. 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
Areas Driven
Miles driven weekly 1500-2000
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer Reefer Trailer
Trailer length 53 feet or more
RoadOne IntermodaLogistics
Company RoadOne IntermodaLogistics
Start Date 05-2020
End Date 06-2023
Address 4201 W. 36th St.
City, State/Province Zip/Postal Randolph, MA 60632 Country United States
Phone 815-***-****
Fax 708-***-****
Position Held 0/0
Reason for leaving? Still here.
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
5
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer
Trailer length
Falcon Transportation
Company Falcon Transportation
Start Date 06-2019
End Date 06-2020
Address
City, State/Province Zip/Postal Landcaster, PA
Country United States
Phone 817-***-****
Position Held Driver
Reason for leaving? Current employer
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
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
6
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Kllm Transport Services, Llc
Company Kllm Transport Services, Llc
Start Date 02-2019
End Date 06-2019
Address 135 Riverview Dr.
City, State/Province Zip/Postal Jackson, MS 39218
Country United States
Phone 800-***-****
Fax 601-***-****
Position Held L/P Driver
Reason for leaving? Company asked me to edit my logs 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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
First Fleet
Company First Fleet
Start Date 02-2017
End Date 02-2019
7
Address 202 Heritage Park Drive
City, State/Province Zip/Postal Murfreesboro, TN 37129 Country United States
Phone 800-***-****
Fax 888-***-****
Position Held Driver
Reason for leaving? wanting lease purchase
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
TransForce, Inc.
Company TransForce, Inc.
Start Date 06-2016
End Date 01-2017
Address 5520 Cherokee Avenue
Address 2 Suite 200
City, State/Province Zip/Postal Alexandria, VA 22312 Country United States
Phone 800-***-****
Fax 866-***-****
Position Held Driver
8
Reason for leaving? Temp work only
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor - Trailer
Most common trailer
Trailer length
Longistics
Company Longistics
Start Date 05-2016
End Date 05-2016
Address
City, State/Province Zip/Postal X, TN
Country United States
Phone
Position Held
Reason for leaving? x
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
Yes
9
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Team One Logistics
Company Team One Logistics
Start Date 10-2015
End Date 05-2016
Address
City, State/Province Zip/Postal Alpharetta, GA
Country United States
Phone 770-***-****
Fax 770-***-****
Position Held Driver
Reason for leaving? had topped out of there pay and needed to make more money
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
Miles driven weekly
10
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Evans Delivery Company, Inc.
Company Evans Delivery Company, Inc.
Start Date 08-2015
End Date 10-2015
Address 100-110 WEST COLUMBIA AVE
City, State/Province Zip/Postal Schuylkill Haven, PA 17972 Country United States
Phone 570-***-****
Position Held Driver
Reason for leaving? needed to make more money
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Covenant Transport
Company Covenant Transport
Start Date 06-2015
End Date 08-2015
11
Address 400 Birmingham
City, State/Province Zip/Postal Chattanooga, TN 37419 Country United States
Phone 423-***-****
Fax 423-***-****
Position Held Driver
Reason for leaving? x
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Road One Intermoda Logistics
Company Road One Intermoda Logistics
Start Date 03-2015
End Date 05-2015
Address 4201 W. 36th St.
City, State/Province Zip/Postal Atlanta, GA 60632
Country United States
Phone 815-***-****
Position Held Driver
Reason for leaving? Bad equipment
Were you terminated/discharged/laid off? No
12
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Huddle House Inc
Company Huddle House Inc
Start Date 02-2012
End Date 03-2015
Address
City, State/Province Zip/Postal Atlanta, GA
Country United States
Phone
Fax 888-***-****
Position Held Driver
Reason for leaving? Conflict of interest
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
13
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
J B Hunt Transport, Inc.
Company J B Hunt Transport, Inc.
Start Date 01-2012
End Date 02-2012
Address 615 J B Hunt Corporate Dr
City, State/Province Zip/Postal Lowell, AR 72745
Country United States
Phone
Position Held Driver
Reason for leaving? better opportunity
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
14
Trailer length
Unemployment
Start Date 12-2011
End Date 01-2012
Comment took a month vacation
Pilgrim Pride
Company Pilgrim Pride
Start Date 08-2007
End Date 12-2011
Address
City, State/Province Zip/Postal Douglas, GA
Country United States
Phone 912-***-****
Fax 912-***-****
Position Held Driver
Reason for leaving? Got bought out by other company 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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Unemployment
Start Date 01-2007
15
End Date 02-2007
Comment Finding a nursing home for my dad
Trucking School
Start Date 01-1994
End Date 02-1994
School All State Career School
Address
Address 2
City, State/Province Chester, PA
Country United States
Phone
Did you graduate? Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while attending this truck
school?
Yes
Did you perform any safety sensitive
functions at this truck school, regulated by
DOT, and subject to drug and alcohol
testing?
Yes
GPA
Hours of Instruction 180
Border Crossing Yes
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
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
No
16
offense while operating a motor vehicle, or
are any charges pending?
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
on any DOT-mandated drug or alcohol
test?
No
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?
Type of Accident / Incident Injury
Date of Accident / Incident 08-2018
Hazmat Accident / Incident No
Was the vehicle towed away? No
City
State/Province TN
Were you in a commercial vehicle? Yes
If yes, was this a Department of
Transportation recordable accident?
Yes
Were you at fault? No
Were you ticketed? No
Description Was in stop traffic. And 2 or 3 cars hit each other and one hit my landing gear..
17
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 5 years? Violation Date 05-2018
Charge / Description Failure to Obey Signal
Violation State/Province GA
In Commercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Community Service?
Other Penalty?
Fine Amount (if any):
Comments: Failure to obey traffic control device
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 5 years? Violation Date 05-2017
Charge / Description Speeding
MPH Over Limit: 11
Violation State/Province GA
In Commercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Community Service?
Other Penalty?
Fine Amount (if any):
Comments:
Criminal Record
Have you ever been convicted of a crime? No
Do you have any deferred prosecutions? No
Do you have criminal charges pending? No
18
Have you ever pled "guilty" to, been
convicted of, or pled "no contest" to a
felony?
No
If you have any felony convictions, do you
currently hold a minister's permit to enter
or exit Canada?
No
Have you, within the last five years, pled
"guilty" to, been convicted of, had
prosecution deferred in connection with, or
pled "no contest" to a misdemeanor?
No
Signature
Full Name Luis Anibal Martinez
IP Address 161.188.172.97
Signature Date/Time 04-09-2024 2:53 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: 04-09-2024 2:53 PM
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
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.
Yes
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
Yes
19
legally binding as an ink signature.
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
User Requested Copy
User requested a copy to be sent to this
email address ***********@*****.***.
Yes
20
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) through Forward Intermodal, consumer reports
(Investigative Consumer Reports in California) may be requested from Asurint. These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and drug/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 that maintain such records; as well as information from Asurint concerning previous driving record requests made by others from such state agencies and state provided driving records. We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA"). You have the right to make a request to Asurint, 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 explaining of any coded information, the sources of information and the recipients of any reports on you that Asurint has previously furnished within the past two year period preceding your request (3 years in California). I AUTHORIZE, WITHOUT RESERVATION, ASURINT, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY ASURINT TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I.
I hereby consent to your obtaining the above information from Asurint, and I agree that such information which Asurint has or obtains in 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 Asurint to other companies which subscribe to Asurint. I hereby authorize procurement of consumer reports as set forth above. If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you to procure consumer reports at any time during my employment or contract period. I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs System at: https://dataqs.fmcsa.dot.gov.
Printed Name:
Luis Anibal Martinez
Social Security #:
5689
Signed Date: 04-09-2024
Luis Anibal Martinez
217 Central Lake Cir
Griffin, GA 30224
Gender:
21
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Forward Intermodal 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 Forward Intermodal 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 Forward Intermodal to conduct a limited query of the Clearinghouse, Forward Intermodal 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 Forward Intermodal indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Forward Intermodal unless I give additional specific consent within the Clearinghouse. However, I understand that Forward Intermodal 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. 04-09-2024
Luis Anibal Martinez Date
22
TO BE READ AND SIGNED BY APPLICANT
This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge.
Printed Name: Luis Anibal Martinez
Social Security #: 5689
Signed Date: 04-09-2024
Signed:
END OF APPLICATION
23
IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
1. In connection with your application for employment with Forward Intermodal ("Prospective Employer"), it 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. 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 Forward Intermodal 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
Contact this candidate