TMS Logistics, Inc.
Cedar Grove, WI 53013
**-**-**** *:12:36PM CDT
IntelliApp
Thank you for your interest in TMS Logistics, 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 Phillip Augustus Williams
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 119 Cherokee Dr
Address 2 119 Cherokee Dr
City, State/Province Zip/Postal Auburndale, FL 33823 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 0623
Date of Birth
Primary Phone 863-***-****
Cell Phone 863-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email adcvtl@r.postjobfree.com
Company Questions
GENERAL INFORMATION
What position are you applying for? Local
What type of position are you applying for? WALKING FLOORS What location are you applying for? Lakeland, FL
Are you legally eligible for employment in
the United States?
Yes
1
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 valid DOT Medical
Examiner's Certificate
Yes
Expiration date: 05 08 2020
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? Indeed
If you chose Referral or Other above
Please explain:
In case of Emergency, notify (list name,
address, and phone):
Carron Williams 119 cherokee dr 646 479
0732
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 9 years 250.000 miles
Tractor and Semi-Trailer 24 years 1000.000 dry van & tanknone Tractor - Two Trailers none
Other none
Which safe driving awards do you hold and
from whom?
none
EDUCATION
List highest grade completed: Grade 8
List last school attended (name, city, and
state):
the the usan
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship: 2
First Reference: Norris Allentown pa 610-***-**** co worker
Second Reference: keith nj 908-***-****
Licenses
License Number 200
State/Province PA
Country United States
License Class Class A
License Expiration Date 08-14-2022
Physical Expiration Date 05-05-2020
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement No
Employment / Unemployment
H&H transport inc
Company H&H transport inc
Start Date 03-2019
End Date 03-2020
Address 847 King George rd
Address 2 847 king george rd
City, State/Province Zip/Postal Fords, NJ 08863
Country United States
Phone 800-***-****
Position Held Driver
Reason for leaving? Relocate to florida
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
3
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 North East
Miles driven weekly 2500-3000
Pay Range (cents/mile) 52
Most common truck driven Day Cab
Most common trailer Van
Trailer length 53 feet or more
Builders First Source Plant City
Company Builders First Source Plant City
Start Date 06-2015
End Date 03-2019
Address Industrial dr
Address 2 Industrial dr
City, State/Province Zip/Postal Plant City, FL
Country United States
Phone 813-***-****
Fax 214-***-****
Position Held Driver
Reason for leaving? Locate to Pa
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
4
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Centeral Fl
Miles driven weekly 500-1000
Pay Range (cents/mile) 19 hr
Most common truck driven Day Cab Conventional
Most common trailer Flatbed
Trailer length 53 feet or more
Trucking School
Start Date 08-1995
End Date 02-1996
School Smith soloman
City, State/Province Ny Ny, NY
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 160
Border Crossing No
Log Books Yes
Federal Motor Carrier Regulations No
Hazardous Materials No
5
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
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
6
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 Phillip Augustus Williams
IP Address 72.187.56.123
Signature Date/Time 03-09-2020 4:12 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.
Signed Date: 03-09-2020 4:12 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
Yes
7
signature.
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 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
User Requested Copy
User requested a copy to be sent to this
email address
adcvtl@r.postjobfree.com.
Yes
8
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) through TMS Logistics, Inc., consumer reports
(Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services). 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 HireRight 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 HireRight, 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 HireRight has previously furnished within the past two year period preceding your request (3 years in California). HireRight may be contacted by mail at P.O. Box 33181, Tulsa, OK 74153 or by telephone at 800-***-****. You may also bring a third party with you to view the information at the HireRight offices if this person provides proper identification. Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx.
I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY HIRERIGHT 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 HireRight, and I agree that such information which HireRight 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 HireRight to other companies which subscribe to HireRight. 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:
Phillip Augustus Williams
Social Security #:
0623
Signed Date: 03-09-2020
Phillip Augustus Williams
119 Cherokee Dr
119 Cherokee Dr
Auburndale, FL 33823
Gender:
9
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with TMS Logistics, 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 TMS Logistics, 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:
Phillip Augustus Williams
Signed Date: 03-09-2020
10
DISCLOSURE AND RELEASE
I, the undersigned, do hereby authorize TMS Logistics and Alert Background Checks, to conduct a pre-employment screening/ background check on myself, for the purpose of determining my suitability for employment with TMS Logistics. This authorization is for the release of any and all information pertaining to me, including but not limited to the following: Educational institutions concerning my educational record, conduct, skills, habits, character, grade point average and degree obtained.
1.
Law enforcement agencies, military authorities, motor vehicle bureaus, hospitals, institutions, physicians, worker's compensation agencies, insurance companies and courts of law. 2.
3. Credit bureau reports from reporting agencies, including information from financial institutions. Previous or current employer(s) concerning my dates of employment, positions/titles, work habits, skills, general character, wages/salary/commissions/bonuses, disciplinary actions, and reasons for leaving. 4.
5. Previous or current employer(s) concerning information about drug screen results and/or accidents. HOLD HARMLESS RELEASE
I hereby release and hold harmless the TMS Logistics and Alert, their employees/agents, law enforcement agencies, credit reporting agencies, state and federal agencies, educational institutions, present and/or past employer, landlords, and all officers and employees that shall provide information to TMS Logistics and/or Alert, upon request, for and against any and all claims, suits or expenses arising from or related to the content, validity or handling of said reports.
Printed Name: Phillip Augustus Williams
Social Security #: 0623
Signed Date: 03-09-2020
Signed:
11
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 03-09-2020
Date
X 0623
Social Security Number
Phillip Augustus Williams
119 Cherokee Dr
119 Cherokee Dr
Auburndale, FL 33823
Gender:
X Phillip Augustus Williams
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize H&H transport inc To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to TMS Logistics, Inc.
DISCLOSURE AND RELEASE
In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed above to TMS Logistics, Inc., or to HireRight for the sole purpose of transmitting such records to TMS Logistics, Inc.. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers (company/school) listed above to release information about names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and other information. The information that I have authorized TMS Logistics, Inc. or HireRight to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes TMS Logistics, Inc. or HireRight with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years.
12
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 03-09-2020
Date
X 0623
Social Security Number
Phillip Augustus Williams
119 Cherokee Dr
119 Cherokee Dr
Auburndale, FL 33823
Gender:
X Phillip Augustus Williams
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Builders First Source Plant City To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to TMS Logistics, Inc.
DISCLOSURE AND RELEASE
In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed above to TMS Logistics, Inc., or to HireRight for the sole purpose of transmitting such records to TMS Logistics, Inc.. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers (company/school) listed above to release information about names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and other information. The information that I have authorized TMS Logistics, Inc. or HireRight to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes TMS Logistics, Inc. or HireRight with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years.
13
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) through TMS Logistics, Inc., consumer reports
(Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services). 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 HireRight 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 HireRight, 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 HireRight has previously furnished within the past two year period preceding your request (3 years in California). HireRight may be contacted by mail at P.O. Box 33181, Tulsa, OK 74153 or by telephone at 800-***-****. You may also bring a third party with you to view the information at the HireRight offices if this person provides proper identification. Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx.
I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY HIRERIGHT 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 HireRight, and I agree that such information which HireRight 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 HireRight to other companies which subscribe to HireRight. 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.
Employer / Contractor / Educational Institution:
Smith soloman
Printed Name:
Phillip Augustus Williams
Social Security #:
0623
Signed Date: 03-09-2020
Phillip Augustus Williams
119 Cherokee Dr
119 Cherokee Dr
Auburndale, FL 33823
Gender:
14
A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or