Exxact Transport, Inc.
PO Box *****
Lakeland, FL 33804
**-**-**** *:26:40AM CDT
IntelliApp
Thank you for your interest in Exxact Transport, 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.
Personal Information
Name Cynthia Andrea Cornelius
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 1328 Josephine Ct
City, State/Province Zip/Postal Sebring, FL 33875
Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 2037
Date of Birth
Primary Phone 561-***-****
Cell Phone 561-***-****
Preferred method of contact Primary Phone
Best time to contact you Any
Email *********@*****.***
Yes, I want to receive information and
communications from Exxact Transport,
Inc. concerning future opportunities or
promotions.
Yes
Would you like to receive communication
from Exxact Transport, 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
Yes
1
may opt out at any time by texting STOP to
unsubscribe. You also agree that Exxact
Transport, Inc.'s service provider receives
in real time and logs your text messages
with Exxact Transport, Inc..
Company Questions
GENERAL INFORMATION
What position are you applying for? Driver for Owner Operator If you answered "Owner Operator", select
yes.
No
EQUIPMENT (OWNER/OPERATORS ONLY)
Equipment Description (Tractor):
Type:
Year:
Make:
Model:
VIN:
Weight
Mileage
What location are you applying for? Lakeland, FL
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? Yes
What date did your last employment end?
Do you read, write, and speak English? Yes
Have you ever worked for this company
before?
No
Enter start and end dates, location,
position, and reason for leaving:
Do you have a current TWIC card? No
Expiration date:
Please enter the names of any relatives
employed here:
Have you ever been known by any other
name?
No
Enter name:
Were you referred by a driver? Yes
2
Please enter driver's name: Leonard Faison
How did you hear about us? Other
If "Other", please explain: Leonard Faison
In case of Emergency, notify (list name,
address, and phone):
Brenda Wilson 1328 Josephine Court,
Sebring, FL 33875
DRIVING EXPERIENCE
Please select your amount of Tractor and
Semi-Trailer experience:
1 - 3 years
If you have other driving experience,
please list the type of equipment and
approximate length of driving time for each
type:
Which safe driving awards do you hold and
from whom?
EDUCATION
List highest grade completed: High School Diploma
List last school attended (name, city, and
state):
South Florida state college
Licenses
License Number 520
State/Province FL
Country United States
License Class Class A
License Expiration Date 02-12-2027
Physical Expiration Date 02-26-2020
Current License Yes
Commercial Driver License Yes
Endorsements None
Employment / Unemployment
DVL Express Inc
Company DVL Express Inc
Start Date 02-2020
End Date 03-2020
Address 2064 West 167th St.
3
City, State/Province Zip/Postal Markham, IL 60428
Country United States
Phone 630-***-****
Position Held Temp team driver with boyfriend
Reason for leaving? Looking for permanent work
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 48 states
Miles driven weekly 2500-3000
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Turf care - sunshine staffing
Company Turf care - sunshine staffing
Start Date 07-2019
End Date 01-2020
Address 4200 Webster turner dr
City, State/Province Zip/Postal Sebring, FL 33875 Country United States
Phone 863-***-****
Position Held Local Driver
Reason for leaving? Temporary assignment
Were you terminated/discharged/laid off? No
Is this your current employer? No
Yes
4
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 Local
Miles driven weekly 0-500
Pay Range (cents/mile)
Most common truck driven Yard Horse
Most common trailer Van
Trailer length 53 feet or more
John Christner Trucking
Company John Christner Trucking
Start Date 10-2018
End Date 06-2019
Address 19007 W HIGHWAY 33
City, State/Province Zip/Postal Sapulpa, OK 74066
Country United States
Phone 918-***-****
Fax 918-***-****
Position Held OTR driver
Reason for leaving? Need to get local job
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
5
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Reefer Trailer
Trailer length 53 feet or more
Western Express
Company Western Express
Start Date 06-2018
End Date 10-2018
Address 7135 Centennial Place
City, State/Province Zip/Postal Nashville, TN 37209 Country United States
Phone 615-***-****
Fax 615-***-****
Position Held OTR driver
Reason for leaving? Better job
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 All 48
Miles driven weekly 2500-3000
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
6
Most common trailer Van
Trailer length 53 feet or more
Unemployment
Start Date 05-2018
End Date 05-2018
Comment
Unemployment
Start Date 12-2016
End Date 02-2018
Comment Drove over the road with Andrew riding in
the truck and assisted with all paperwork,
coupling and uncoupling trailers, Gps
directions, etc.
Unemployment
Start Date 02-2016
End Date 01-2018
Comment Drove over the road as a passenger
Unemployment
Start Date 02-2016
End Date 12-2016
Comment
Southeast claims service
Company Southeast claims service
Start Date 01-2004
End Date 02-2016
Address 2 Au Soleil
City, State/Province Zip/Postal Boynton Beach, FL 33435 Country United States
Phone 561-***-****
Position Held Admin asst
Reason for leaving? Owner retired
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
No
7
Did you operate a commercial motor
vehicle?
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
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?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Trucking School
Start Date 02-2018
End Date 04-2018
School South Florida State College
City, State/Province Avon Park, FL
Country United States
Phone 863-***-****
Did you graduate? Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while attending this truck
school?
No
Did you perform any safety sensitive
functions at this truck school, regulated by
DOT, and subject to drug and alcohol
testing?
No
GPA 4.0
Hours of Instruction 200
Border Crossing No
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
8
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
9
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?
Type of Accident / Incident Non-Injury
Date of Accident / Incident 01-2020
Hazmat Accident / Incident No
Was the vehicle towed away? No
City Versailles
State/Province KY
Were you in a commercial vehicle? Yes
If yes, was this a Department of
Transportation recordable accident?
No
Were you at fault? No
Were you ticketed? No
Description another Driver in personal vehicle hit the rear corner back of my trailer. Caused no
damage to the trailer. little damage to there
car. Received no ticket.
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? Yes
Comment 2004 for drug parafanalia
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 No
10
"guilty" to, been convicted of, had
prosecution deferred in connection with, or
pled "no contest" to a misdemeanor?
Signature
Full Name Cynthia Andrea Cornelius
IP Address 71.215.35.183
Signature Date/Time 03-18-2020 9:26 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.
Signed Date: 03-18-2020 9:26 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
11
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
Summary of Rights Under 15 U.S.C. Section 1681m(a) By checking the box, I (a) acknowledge
that I have read and understand the
Summary of Rights Under 15 U.S.C.
Section 1681m(a) and have been given
the opportunity to copy/print the 1681m
Summary of Rights and (b) agree to use
an electronic signature to demonstrate my
consent. An electronic signature is as
Yes
12
legally binding as an ink signature.
User Requested Copy
User requested a copy to be sent to this
email address *********@*****.***.
Yes
13
DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND
INVESTIGATION FOR EMPLOYMENT PURPOSES
Disclosures
Exxact Transport, Inc. (the "Company") may request from a consumer reporting agency and for employment-related purposes, a
"consumer report(s)" (commonly known as "background reports") containing background information about you in connection with your employment, or application for employment, or engagement for services (including independent contractor or volunteer assignments, as applicable).
HireRight, LLC ("HireRight") will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, 800-***-****, www.hireright.com. The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information. Authorization
I hereby authorize Company to obtain the consumer reports described above about me. Printed Name:
Cynthia Andrea Cornelius
Social Security #:
2037
Signed Date: 03-18-2020
Cynthia Andrea Cornelius
1328 Josephine Ct
Sebring, FL 33875
Gender:
14
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Exxact Transport, 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 Exxact Transport, 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:
Cynthia Andrea Cornelius
Signed Date: 03-18-2020
15
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Exxact Transport, 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 Exxact Transport, 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 Exxact Transport, Inc. to conduct a limited query of the Clearinghouse, Exxact Transport, 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 Exxact Transport, Inc. indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Exxact Transport, Inc. unless I give additional specific consent within the Clearinghouse. However, I understand that Exxact Transport, 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.
03-18-2020
Cynthia Andrea Cornelius Date
16
OTHER DISCLOSURES, ACKNOWLEDGMENTS & AUTHORIZATIONS REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES Disclosures
Investigative Consumer Report:
Exxact Transport, Inc. (the "Company") may request an investigative consumer report about you from HireRight, LLC ("HireRight"), a consumer reporting agency, in connection with your employment, or application for employment, or engagement for services
(including independent contractor or volunteer assignments, as applicable). An "investigative consumer report" is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews), the most common form of which is checking personal or professional references through personal interviews with sources such as your former employers and associates, and other information sources. The investigative consumer report may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.
Ongoing Authorization:
If the Company hires you or contracts for your services, the Company may obtain additional consumer reports and investigative consumer reports about you without asking for your authorization again, throughout your employment or your contract period, as allowed by law.
Additional State Law Notices:
Please see the "Additional State Law Notices" for California, Massachusetts, Minnesota, New Jersey, New York, and Washington that are provided below, as applicable. A California disclosure and summary of your rights under California Civil Code Section 1786.22, and a copy of New York Article 23-A, are being provided to you separately. Summary of Rights under the Fair Credit Reporting Act: A summary of your rights under the Fair Credit Reporting Act is being provided to you separately. San Francisco Fair Chance Ordinance Official Notice: A copy of the San Francisco Fair Chance Ordinance Official Notice is being provided to you separately. HireRight Privacy Policy:
Information about HireRights privacy practices is available at www.hireright.com/Privacy-Policy.aspx. Acknowledgments & Authorization
I acknowledge that I have received and carefully read and understand the separate "Disclosure and Authorization Regarding Background Investigation for Employment Purposes"; and the separate "Summary of Rights under the Fair Credit Reporting Act" that have been provided to me by the Company. I also acknowledge receipt of and that I have carefully read and understand (as applicable), the separate California Disclosure and Summary of Rights under California Civil Code Section 1786.22; the separate New 17
York Article 23-A; and the separate San Francisco Fair Chance Ordinance Official Notice that have been provided to me. By my signature below, I authorize the preparation of background reports about me, including background reports that are
"investigative consumer reports" by HireRight, and to the furnishing 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 or engagement for services (including independent contractor or volunteer 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, as allowed by law, obtain from HireRight (or from a consumer reporting agency other than HireRight) additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period. I understand that if the Company obtains a credit report about me, then it will only do so where such information is substantially related to the duties and responsibilities of the position in which I am engaged or for which I am being evaluated. I understand that information contained in my employment (or contractor or volunteer) application, or otherwise disclosed by me before or during my employment (or contract or volunteer 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 understand that the information included in the background reports may be obtained from private and public record sources, including without limitation and as appropriate: government agencies and courthouses; educational institutions; and employers. Accordingly, I hereby authorize all of the following, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local government agencies and courts; educational institutions (public or private); testing agencies; information service bureaus; credit bureaus and other consumer reporting agencies; other public and private record/data repositories; motor vehicle records agencies; my employers; the military; and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer reporting agency and its agents includes, but is not limited to, information concerning my: employment and earnings history; education, credit, motor vehicle and accident history; drug/alcohol testing results and history; criminal history; litigation history;