Cell Phone United States
Resume:
Centerline Drivers, LLC.
Santa Ana, CA 92701
**-**-**** *:20:31PM CST
IntelliApp
Thank you for your interest in Centerline Drivers, LLC. 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.
If due to a disability, I am unable to complete the application process, I agree to notify the Company so that we may discuss options for a reasonable accommodation. Active Jobs
Job Name Jenn Hornsby
Job Title New Applicant - Assign to Jenn Hornsby
Personal Information
Referral Code: website
Name Jacques M Benavente
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 919 Conference Drive
City, State/Province Zip/Postal Goodlettsville, TN 37072 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 5337
Date of Birth
Primary Phone 925-***-****
Cell Phone 925-***-****
Preferred method of contact Cell Phone
Best time to contact you Morning
Email *******@*****.***
Cell Phone Provider Mint mobile
Yes, I agree to receive information
concerning future opportunities or
Yes
1
promotions from Centerline Drivers, LLC.
by email or other commercial electronic
communications.
Would you like to receive communication
from Centerline Drivers, LLC. 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
Centerline Drivers, LLC.'s service provider
receives in real time and logs your text
messages with Centerline Drivers, LLC..
No
Company Questions
Ad Number Recruiter
GENERAL INFORMATION
What location are you applying for? TN, Nashville
Type of Route you want Local Delivery
If hired, can you present evidence of your
right to work in the U.S.?
Yes
Are you currently employed? Yes
What date did your last employment end?
Are you able to perform the essential
functions of the job for which you are
applying, either with or without reasonable
accommodation?
Yes
Please describe the functions that cannot
be performed. (Note: We comply with the
ADA and consider reasonable
accommodation measures that may be
necessary for eligible
applicants/employees to perform essential
functions. Hire may be subject to passing a
medical examination, and skill and/or
agility tests.)
Have you ever worked for this company
before?
No
Enter start and end dates, location,
position, and reason for leaving:
Are you a veteran? Yes
2
Do you have a Hazmat Endorsement? No
Do you have a Tanker Endorsement? No
Do you have a Double Endorsement? No
Do you have a current TWIC card? No
Expiration date:
Have you ever been known by any other
name?
No
Enter name:
How did you hear about Centerline? Billboard
If you chose "Referral" or "Other", please
explain:
Na
DRIVING EXPERIENCE
How much driving experience do you
have?
5+ years
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 Box truck
Refer Box truck
Bulky heavy Box truck
Frieght Box truck
Tow truck " 2 car"
Tow truck " 4 car"
Tractor and Semi-Trailer Na
Tractor - Two Trailers Na
Other Tow truck
Flat bed roll back
EDUCATION
List highest grade completed: College - 1
List last school attended (name, city, and
state):
Tow school iraq/ kbr
EMERGENCY CONTACT
Name: Jeff Crayton
Phone Number: 1-479-***-****
Google Tracking
3
Licenses
List all driver licenses that you have held in the past License Number 219
Licensing Authority TN
Country US
License Class Class D
Original Issue Date
License Expiration Date 08-01-2030
DOT Medical Card Expiration Date 06-15-2025
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement No
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement Yes
Employment / Unemployment
Trillium Staffing
Company Trillium Staffing
Start Date 05-2024
End Date 11-2024
Address Vantage way
Address 2 M
City, State/Province Zip/Postal Mt Laurel, NJ 37211 Country United States
Phone 615-***-****
Position Held Box truck driver
Reason for leaving? No new jobs
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes
4
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 The state!
Miles driven weekly 1000-1500
Most common truck driven Other
Most common trailer Flatbed
Trailer length 31 feet or less
Trillium staff drivers
Company Trillium staff drivers
Start Date 01-2008
End Date 11-2024
Address 919 conference drive, " suite
Address 2 717 Sam Houston drive
City, State/Province Zip/Postal Houston, TX
Country United States
Phone 713-***-****
Position Held Heavy truck driver
Reason for leaving? Demobed
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 IRAQ
5
Miles driven weekly 0-500
Most common truck driven Straight Truck
Most common trailer Other
Trailer length 31 feet or less
Lansing build products
Company Lansing build products
Start Date 11-2023
End Date 02-2024
Address 281 brick church pike
City, State/Province Zip/Postal Nashville, TN 37211 Country United States
Phone 615-***-****
Position Held Box truck driver
Reason for leaving? I resigned
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 Tenn
Miles driven weekly 0-500
Most common truck driven Other
Most common trailer Other
Trailer length 31 feet or less
Capstone Logistics LLC
Company Capstone Logistics LLC
Start Date 01-2022
End Date 11-2023
Address 30 Technology Pkwy S #200
6
City, State/Province Zip/Postal Peachtree Corners, GA 30092 Country United States
Phone 770-***-****
Position Held B lisence driver
Reason for leaving? Resigned
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 Tenn/ Georgia/ Atlanta
Miles driven weekly 0-500
Most common truck driven Straight Truck
Most common trailer Flatbed
Trailer length 31 feet or less
Absolute Rush Delivery
Company Absolute Rush Delivery
Start Date 05-2020
End Date 07-2021
Address 4648 old hickory blvd
Address 2 Old hickory
City, State/Province Zip/Postal Nashville, TN 37211 Country United States
Phone 800-***-****
Position Held Box truck driver refer
Reason for leaving? Resigned
Were you terminated/discharged/laid off? No
Is this your current employer? No
Yes
7
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 Usa
Miles driven weekly 1000-1500
Most common truck driven Other
Most common trailer Other
Trailer length 31 feet or less
Sls grading
Company Sls grading
Start Date 11-2020
End Date 04-2021
Address 141 spence lane
City, State/Province Zip/Postal Nashville, TN 37211 Country United States
Phone 615-***-****
Position Held B lisence driver
Reason for leaving? The black truck " was Junk"
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
8
Areas Driven Tenn
Miles driven weekly 0-500
Most common truck driven Class B Vehicle
Most common trailer Other
Trailer length 32 to 44 feet
AB collier tow recovery
Company AB collier tow recovery
Start Date 01-2018
End Date 02-2019
Address 190 polk ave
City, State/Province Zip/Postal Nashville, TN 37211 Country United States
Phone 615-***-****
Position Held Roll back driver
Reason for leaving? Left for 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 Largest area operated by a tow company Miles driven weekly 500-1000
Most common truck driven Other
Most common trailer Other
Trailer length Other
9
Military
Country United States
Branch of Service U.S. Navy
Start Date 08-1976
End Date 02-1978
Can you obtain your DD214? Yes
Rank at discharge E3
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
·
No
10
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
·
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 Jacques M Benavente
IP Address 172.58.242.36
Signature Date/Time 11-07-2024 1:20 PM
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. 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 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
·
11
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.
·
Signed Date: 11-07-2024 1:20 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
CALIFORNIA INVESTIGATIVE CONSUMER REPORT DISCLOSURE DOCUMENT By checking the box, I 1) agree to use an
electronic signature to demonstrate my
consent, 2) agree that an electronic
signature is as legally binding as an ink
signature, and 3) acknowledge that I have
read and understood this California
Disclosure Regarding Background Checks
document.
Yes
Massachusetts Criminal Policy and Record Correction Acknowledgment By checking the box, I (a) acknowledge
that I have read and understand the
Company's Massachusetts Criminal
Record Policy and Information Concerning
the Process in Correcting a Criminal
record and have also been given the
opportunity copy/print both, and (b) agree
to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Yes
NEW JERSEY DISCLOSURE REGARDING BACKGROUND CHECKS DOCUMENT Yes
12
By checking the box, I (a) acknowledge
that I have read and understand the
Summary of Rights Under New Jersey's
Fair Credit Reporting Act and also have
been given the opportunity to copy/print
the Summary of Rights, and (b) agree to
use an electronic signature to demonstrate
my acknowledgment. An electronic
signature is as legally binding as an ink
signature.
New York State Article 23-A Notice
By checking the box, I (a) acknowledge
that I have read and understand the New
York State Correction Law Article 23-A and
have been given the opportunity to
copy/print it and (b) agree to use an
electronic signature to demonstrate my
acknowledgment. An electronic signature
is as legally binding as an ink signature.
Yes
Washington Summary of Rights Acknowledgment
By checking the box, I (a) acknowledge
that I have read and understand the
Summary of Rights Under Washington's
Fair Credit Reporting Act and have been
given the opportunity to copy/print the
Summary of Rights and (b) agree to use
an electronic signature to demonstrate my
acknowledgment. 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
FCRA Disclosure
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
Yes
13
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.
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
Summary of Rights Under 15 U.S.C. Section 1681m(a) By checking this box, I represent that I
understand and agree to the above
language.
Yes
NEVADA SUMMARY OF RIGHTS
By checking this box, I represent that I
understand and agree to the above
language.
Yes
14
CALIFORNIA INVESTIGATIVE CONSUMER REPORT DISCLOSURE DOCUMENT By checking this box, I represent that I
understand and agree to the above
language.
Yes
INVESTIGATIVE CONSUMER REPORT DISCLOSURE DOCUMENT
By checking this box, I represent that I
understand and agree to the above
language.
Yes
ADDITIONAL MASSACHUSETTS DISCLOSURE DOCUMENT
I have received, reviewed and understood
this Additional Disclosure Document for
Massachusetts.
Yes
ADDITIONAL NEW YORK DISCLOSURE DOCUMENT
I have received, reviewed and understood
this Additional Disclosure Document for
New York
Yes
ADDITIONAL WASHINGTON DISCLOSURE DOCUMENT
I have received, reviewed and understood
this Additional Disclosure Document for
Washington.
Yes
User Requested Copy
User requested a copy to be sent to this
email address *******@*****.***.
Yes
15
Printed Name:
Jacques M Benavente
Social Security #:
5337
Signed Date: 11-07-2024
Jacques M Benavente
919 Conference Drive
Goodlettsville, TN 37072
CONSUMER REPORT DISCLOSURE DOCUMENT 16
BACKGROUND SCREENING AUTHORIZATION DOCUMENT
By signing below, I authorize Centerline Drivers, LLC, ("the Company") to order consumer reports and investigative consumer reports for employment purposes from a consumer reporting agency ("CRA") solely to the extent allowed by law.
I understand that, to the extent allowed by law, the Company may rely on this authorization to order additional consumer reports and investigative consumer reports from a CRA for employment purposes during my employment without asking me for my authorization again.
For the specific purpose of preparing consumer reports and investigative consumer reports for the Company, and subject to all laws protecting my privacy, I authorize the following to disclose to the CRA the information needed to compile the reports: law enforcement and all other federal, state, and local agencies; all courts; my past or present employers; learning institutions, including colleges and universities; data vendors; drug and alcohol testing vendors or laboratories; and motor vehicle records agencies. I authorize the CRA to prepare the consumer reports and investigative consumer reports on me utilizing this information, and authorize the provision of my personally identifying information to the sources of information that require it to produce the information needed for the reports. Printed Name:
Jacques M Benavente
Social Security #:
5337
Signed Date: 11-07-2024
Jacques M Benavente
919 Conference Drive
Goodlettsville, TN 37072
Centerline Drivers, LLC, (the "Company") may order consumer report(s) on you from a consumer reporting agency 17 ("C IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Centerline Drivers, LLC. ("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 Centerline Drivers, LLC. ("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:
Jacques M Benavente
Signed Date: 11-07-2024
Centerline Drivers, LLC, (the "Company") may order consumer report(s) on you from a consumer reporting agency 18 ("C Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Centerline Drivers, LLC. 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 Centerline Drivers, LLC. 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 Centerline Drivers, LLC. to conduct a limited query of the Clearinghouse, Centerline Drivers, LLC. 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 Centerline Drivers, LLC. indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Centerline Drivers, LLC. unless I give additional specific consent within the Clearinghouse. However, I understand that Centerline Drivers, LLC. 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.
11-07-2024
Jacques M Benavente Date
Centerline Drivers, LLC, (the "Company") may order consumer report(s) on you from a consumer reporting agency 19 ("C Request/Consent for Information from Previous Employer(s)/Carrier(s) For Safety Performance History pursuant to 49 CFR Section 391.23 of the FMCSA regulations X 11-07-2024
Date
X 5337
Social Security Number
Jacques M Benavente
919 Conference Drive
Goodlettsville, TN 37072
X Jacques M Benavente
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Trillium staff drivers To release and forward in accordance with the following regulation, all known information pertaining to my Safety Performance History to Centerline Drivers, LLC.
DOT DRUG AND ALCOHOL RELEASE
I authorize, per 49 CFR Part 40, the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed to Asurint or other designated provider for the sole purpose of transmitting such records to Centerline Drivers, LLC or directly to Centerline Drivers LLC. 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
Contact this candidate