Cdl A United States
Resume:
Lazer Spot, Inc.
Suite ***
Alpharetta, GA 30005
**-**-**** *:57:09AM CDT
IntelliApp
Applicant opted out of D&A release authorization for the following individual employers / educational institutions.
Laser logistics
Thank you for your interest in Lazer Spot, Inc.. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted. 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
Yard Spotter / CDL A Driver Gainesville GA
Personal Information
Referral Code: referrer
Name Alexander Jr Brooks
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 645 Sw Troy Street
City, State/Province Zip/Postal Lake City, FL 32024 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 1289
Date of Birth
Primary Phone 386-***-****
Preferred method of contact Primary Phone
Best time to contact you Any
Email ***********@*****.***
Yes, I agree to receive information
concerning future opportunities or
promotions from Lazer Spot, Inc. by email
or other commercial electronic
Yes
1
communications.
Would you like to receive communication
from Lazer Spot, Inc. via text message?
By participating, you consent to receive
text messages sent by an automatic
telephone dialing system, which may
contain recruiting/advertising messages.
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 Lazer
Spot, Inc.'s service provider receives in
real time and logs your text messages with
Lazer Spot, Inc..
Yes
Company Questions
GENERAL INFORMATION
What position are you applying for? Company Driver What location are you applying for? FL, JACKSONVILLE Are you legally eligible for employment in
the United States?
Yes
How many years of relevant experience do
you have?
20 years
Do you have the relevant license/permit
required for this position?
Yes
Has your license/permit been denied,
suspended, or revoked for any reason?
No
Are you willing to submit to
pre-employment background screenings
including pre-employment drug
screenings?
Yes
Are you currently employed? Yes
What date did your last employment end?
Do you read, write, and speak English? Yes
Please select additional languages spoken
besides English:
None
If other selected above, please enter other
language below.
Have you ever worked for this company
before?
Yes
Enter start and end dates, location,
position, rate of pay, and reason for
leaving:
08/13/2023 until 02 21 2024
2
Do you have a current TWIC card? No
Expiration date:
Please enter the names of any relatives
employed here:
None
Have you ever been known by any other
name?
No
Enter name:
How did you hear about us? Other
If "Driver Referral", please enter the
driver's name
None
If "Other", please explain
In case of Emergency, notify (list name,
relation, and phone):
Erica Jeanette Cooks wife 368-***-****
DRIVING EXPERIENCE
For each class of equipment, enter type of equipment (van, reefer, tank, etc.), start and end dates, and approximate number of total miles. If no experience in a class, enter
"NONE".
Straight Truck None
Tractor and Semi-Trailer 20 years
Tractor - Two Trailers None
Other Tanker
Which safe driving awards do you hold and
from whom?
None
EDUCATION
List highest grade completed: GED
List last school attended (name, city, and
state):
Madison county high School
COVID-19
To mitigate the risk of potential COVID-19 exposures, Lazer Spot is requesting that all visitors complete the following acknowledgement form before visiting a site. Answering yes to any of these questions will not preclude employment. It may, however, be reason to postpone an applicant's interview, road test, or other on-site visit. Are you experiencing ANY of following
symptoms within the last 48 hours: fever,
sore throat, cough, shortness of breath,
fatigue, body aches, headache, loss of
taste/smell, congestion/runny nose,
nausea/vomiting and/or diarrhea?
No
Have you tested positive for COVID-19 in
the past 10 days?
No
No
3
Have you been in close contact with a
person who tested positive with COVID-19
in the past 10 days?
Are you currently awaiting results from a
COVID-19 test?
No
Are you willing to follow government and/or
customer mandates relating to masks,
testing and/or vaccination?
Yes
Recruiter
Licenses
License Number 160
Licensing Authority FL
Country US
License Class Class A
License Expiration Date 06-16-2027
DOT Medical Card Expiration Date 03-25-2025
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
C&t Trucking
PLEASE DO NOT CONTACT
Company C&t Trucking
Start Date 12-2022
End Date 05-2024
Address 3720Williams Dairy Road
City, State/Province Zip/Postal Charlotte, NC 27406 Country United States
4
Phone 704-***-****
Fax 704-***-****
Position Held Driver
Reason for leaving? Misunderstanding
Were you terminated/discharged/laid off? Yes
Termination Explanation Misunderstanding
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 Florida
Miles driven weekly 1500-2000
Pay Range (cents/mile) 53
Most common truck driven Tractor-Trailer
Most common trailer Tank Trailer
Trailer length 53 feet or more
Laser logistics
Company Laser logistics
Start Date 07-2023
End Date 03-2024
Address 65257 Shiloh Rd #900
City, State/Province Zip/Postal Alpharetta, GA 30005 Country United States
Phone
Position Held Driver
Reason for leaving? Will explain
Were you terminated/discharged/laid off? Yes
Termination Explanation We'll explain
Is this your current employer? No
5
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 Florida
Miles driven weekly 500-1000
Pay Range (cents/mile)
Most common truck driven Day Cab
Most common trailer Reefer Trailer
Trailer length 53 feet or more
Williams Dairy Trucking
Company Williams Dairy Trucking
Start Date 03-2013
End Date 05-2022
Address 409 Red Oak Rd
City, State/Province Zip/Postal Baxley, GA 31513
Country United States
Phone 912-***-****
Fax 912-***-****
Position Held Driver
Reason for leaving? Company went out of business
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
Yes
6
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven Florida
Miles driven weekly 1500-2000
Pay Range (cents/mile) 53
Most common truck driven Tractor-Trailer
Most common trailer Tank Trailer
Trailer length 53 feet or more
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
on any DOT-mandated drug or alcohol
test?
No
7
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 5 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
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
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 Alexander Jr Brooks
IP Address 2601:348:601:1e1
Signature Date/Time 05-30-2024 4:57 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. 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.
8
Signed Date: 05-30-2024 4:57 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
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
PSP Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the PSP
Disclosure and Authorization 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
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
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
9
FCRA 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
10
DISCLOSURE FOR CONSUMER REPORTS
In connection with my application for employment (including contract) with Lazer Spot, Inc., I understand consumer reports will be requested by Lazer Spot, Inc. ("Company"). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, education, accidents, licensure, credit, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, CDLIS, workers' compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies that maintain such records.
In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained. If I am hired (or contracted), I understand that Company can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment or contract period. Printed Name:
Alexander Jr Brooks
Social Security #:
1289
Signed Date: 05-30-2024
Alexander Jr Brooks
645 Sw Troy Street
Lake City, FL 32024
11
AUTHORIZATION FOR CONSUMER REPORTS
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment or contract period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information. This authorization is conditioned upon the following representations of my rights: I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request
(California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 6525 Shiloh Rd Suite 900, Alpharetta, GA, 678-***-**** to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.
Agency Contact Information:
HireRight
Attn: Consumers Department
14002 E. 21st Street, Suite 1200
Tulsa, OK 74134
http://www.hireright.com/applicants
iiX
1716 Briarcrest Drive
Suite 200
Bryan, TX 77802
Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
Email: **********@*******.***
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
*******@*********.***
DriverIQ
4500 S 129th E Ave, Suite 127
Tulsa, OK 74134
********@******.***
12
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, 206-***-****. Printed Name:
Alexander Jr Brooks
Social Security #:
1289
Signed Date: 05-30-2024
Alexander Jr Brooks
645 Sw Troy Street
Lake City, FL 32024
13
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Lazer Spot, Inc. ("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 Lazer Spot, Inc. ("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:
Alexander Jr Brooks
Signed Date: 05-30-2024
14
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Lazer Spot, Inc. 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 Lazer Spot, Inc. 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 Lazer Spot, Inc. to conduct a limited query of the Clearinghouse, Lazer Spot, Inc. 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 Lazer Spot, Inc. indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Lazer Spot, Inc. unless I give additional specific consent within the Clearinghouse. However, I understand that Lazer Spot, Inc. 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. 05-30-2024
Alexander Jr Brooks Date
15
Pre-Employment Drug Testing Consent And Release Form I hereby consent to submit to urinalysis and/or other tests as shall be determined by Lazer Spot in the selection process of applicants for employment, for the purpose of determining the drug content thereof. I agree that the local lab assigned by Lazer Spot may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the Company for analysis. I further agree to and hereby authorize the release of results of said test to the Company. I understand that it is the current use of illegal drugs that would prohibit me from being employed at this Company. In addition, a negative and dilute sample constitutes an immediate retest. I further agree to hold harmless Lazer Spot, Inc. and its agents (including the above-named physician or clinic) from any liability arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with the Companys consideration of my application for employment.
I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original.
I have carefully read the foregoing and fully understand its contents. I acknowledge that my signing of this consent and release form is a voluntary act on my part, and that I have not been coerced into signing this document by anyone. It is also my understanding that if I am not employed by Lazer Spot for more than 90 days, the total cost of the drug screen will be deducted from my last pay check. This includes situations where I falsely lead my employer into believing I had a drug screen when in reality I did not. I will still be charged as though I had one. Printed Name: Alexander Jr Brooks
Social Security #: 1289
Signed Date: 05-30-2024
Signed:
16
17
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 05-30-2024
Date
X 1289
Social Security Number
Alexander Jr Brooks
645 Sw Troy Street
Lake City, FL 32024
X Alexander Jr Brooks
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize C&t Trucking To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Lazer Spot, Inc.
EMPLOYMENT / CONTRACTOR VERIFICATION ACKNOWLEDGEMENT AND RELEASE
I hereby authorize my previous employers and trucking schools for the past three years to release and forward to Lazer Spot, Inc.
("Company") all information regarding my:
1. Record of Alcohol and Controlled Substance Testing/Training, in accordance with Parts 382 and 40 of the Federal Motor Carrier Safety Regulations (49 CFR Part 382 and 49 CFR Part 40, Section 40.25.). I understand that information to be released by my previous employer(s) is limited to the following DOT-regulated testing items: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested; (iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation. 2. Record of safety performance history, including employment dates, work history and accidents, in accordance with Part 391 of the Federal Motor Carrier Safety Regulations (49 CFR Part 391). To Be Read And Signed By Applicant For Independent Contractor or Driver Qualification It is understood that the information in this Authorization to Release Information form will be used and that prior employers and trucking schools will be contacted for purposes of investigation as required by Section 391.23 of the Motor Carrier Safety Regulations. It is agreed and understood that Company may investigate the applicant's background to
Contact this candidate