Centerline Drivers, LLC.
Santa Ana, CA 92701
**-**-**** *:08:48PM 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 dissability, I am unable to complete the application process, I agree to notify the Company so that we may discuss options for a reasonable accomodation. Personal Information
Referral Code: website
Name David R Tigue
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 4654 Village Mill Way
City, State/Province Zip/Postal Rancho Cordova, CA 95742 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 3915
Date of Birth
Primary Phone 916-***-****
Cell Phone 916-***-****
Preferred method of contact Cell Phone
Best time to contact you Afternoon
Email adm6lo@r.postjobfree.com
Cell Phone Provider AT&T
Yes, I agree to receive information
concerning future opportunities or
promotions from Centerline Drivers, LLC.
by email or other commercial electronic
communications.
Yes
Would you like to receive communication
from Centerline Drivers, LLC. via text
Yes
1
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..
Company Questions
Ad Number Recruiter
GENERAL INFORMATION
What location are you applying for? CA, Sacramento If hired, can you present evidence of your
right to work in the U.S.?
Yes
Are you currently employed? No
What date did your last employment end? 06-26-2020 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:
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? Email
2
If you chose "Referral" or "Other", please
explain:
Not applicable
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 3/12/1918 to 6/3/1919
5000 miles
Tractor and Semi-Trailer 6/24/1920 to 6/26/2020
16,000,000 miles
Tractor - Two Trailers 5/2/88 seasonal
10,000 miles
Other Forklift 6 months
EDUCATION
List highest grade completed: College - 4
List last school attended (name, city, and
state):
Phil.college of criminology-Philippines
EMERGENCY CONTACT
Name: Madelyn tigue
Phone Number: 916-***-****
Google Tracking
Licenses
List all driver licenses that you have held in the past License Number 888
State/Province CA
Country United States
License Class Class A
License Expiration Date 02-03-2026
Physical Expiration Date 02-03-2022
Current License Yes
Commercial Driver License Yes
Endorsements None
3
Employment / Unemployment
Aramark Uniform Services
Company Aramark Uniform Services
Start Date 02-2011
End Date 02-2021
Address 7620 Wilbur way
City, State/Province Zip/Postal Sacramento, CA 95828 Country United States
Phone 818-***-****
Fax 818-***-****
Position Held Truck driver - shuttle
Reason for leaving? Retired
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?
No
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Local Northern California
Miles driven weekly 2000-2500
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Trucking School
Start Date 09-1919
End Date 12-1919
School Driving school academy
City, State/Province Sacramento, CA
4
Country US
Phone
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?
Yes
GPA 85
Hours of Instruction 160
Border Crossing Yes
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
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
•
No
5
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
•
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 David R Tigue
IP Address 2601:204:df00:bf
Signature Date/Time 02-23-2021 3:08 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. 6
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
•
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: 02-23-2021 3:08 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 DISCLOSURE REGARDING BACKGROUND CHECKS 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
California Consumer Copy Request
If you live or work in California, Minnesota,
or Oklahoma, please check this box if
you'd like to receive a copy of a consumer
report if one is obtained.
Yes
7
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
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 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
8
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
User Requested Copy
User requested a copy to be sent to this
email address adm6lo@r.postjobfree.com.
Yes
9
Centerline (the "Company") may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports"). 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. These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your employment or your contract period, as allowed by law.
Asurint, or another consumer reporting agency, will prepare or assemble the background reports for the Company. Asurint is located and can be contacted by mail at P.O. Box 14730, Cleveland, OH, 44145, and Asurint can be contacted by phone at 800-***-****. Information about Asurint's privacy practices is available at https://www.asurint.com/#compliance.
The background report may contain information concerning your character, general reputation, personal characteristics, and mode of living. The types of information that may be obtained include, but are not limited to: employment history
(e.g., dates of employment, final salary information, performance-related information, reasons for departure, etc.); personal and professional reference checks; and other information bearing on your character, general reputation, personal characteristics, and mode of living.
This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; and, for investigative consumer reports, personal interviews with sources such as neighbors, friends, former employers and associates; and other information sources provided as references. The Company is not intending to collect, and will not be requesting, any information bearing on your credit worthiness, credit standing, or credit capacity, unless it otherwise notifies you prior thereto in writing. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.
A summary of your rights under the Fair Credit Reporting Act is also being provided to you. Printed Name:
David R Tigue
Social Security #:
3915
Signed Date: 02-23-2021
David R Tigue
4654 Village Mill Way
Rancho Cordova, CA 95742
Gender:
DISCLOSURE REGARDING BACKGROUND INVESTIGATION 10
ACKNOWLEDGMENT AND AUTHORIZATION
I have carefully read and understand the Disclosure Regarding Background Investigation and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as Asurint, and to the release 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, promotion, retention or for other lawful employment purposes. I understand that if the Company hires me, my consent will apply, and the Company may, as allowed by law, obtain additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period from Asurint and/or other consumer reporting agencies. I also understand that nothing herein shall be construed as an offer of employment.
By my signature below, I certify the information I provided on and in connection with this form is true, accurate, and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background reports that may be requested by or on behalf of the Company. Printed Name:
David R Tigue
Social Security #:
3915
Signed Date: 02-23-2021
David R Tigue
4654 Village Mill Way
Rancho Cordova, CA 95742
Gender:
DISCLOSURE REGARDING BACKGROUND INVESTIGATION 11
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:
David R Tigue
Signed Date: 02-23-2021
DISCLOSURE REGARDING BACKGROUND INVESTIGATION 12
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.
02-23-2021
David R Tigue Date
DISCLOSURE REGARDING BACKGROUND INVESTIGATION 13
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 02-23-2021
Date
X 3915
Social Security Number
David R Tigue
4654 Village Mill Way
Rancho Cordova, CA 95742
Gender:
X David R Tigue
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Aramark Uniform Services To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records 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 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. Additionally, 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). DISCLOSURE REGARDING BACKGROUND INVESTIGATION 14
Summary of Rights Under 15 U.S.C. Section 1681m(a) You are hereby provided a summary of the following provisions of the Fair Credit Reporting Act, 15 U.S.C. 1681m(a): The following consumer reporting agencies will prepare the background report / consumer report for Centerline Drivers, LLC.
('Company'):
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
Phone: 877-***-****
Email: adm6lo@r.postjobfree.com
Web: http://www.tenstreet.com/drivers/
For Clearinghouse:
U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SE
Washington, DC 20590
Phone: 800-***-****, TTY 800-***-****
https://dataqs.fmcsa.dot.gov/Default.aspx
Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
Phone: 800-***-****
Email: adm6lo@r.postjobfree.com
Web: https://www.asurint.com/candidates
Workforce QA
1430 S. Main St
Salt Lake City, UT 84115
http://www.wfqa.com
•
No consumer reporting agency utilized by the Company makes adverse decisions relating to your employment or contract relationship and no consumer reporting agency utilized by the Company is able to provide any specific reasons to you why an adverse decision relating to your employment or contract relationship may be taken or was taken based on a consumer report.
•
15 U.S.C. 1681j provides for the right to obtain a free copy of a consumer report on you from the consumer reporting agency which prepared your background report, under various circumstances, including but not limited to where you receive notice that an adverse action has been taken toward you based on the consumer report. In that instance, Section 1681j provides a right to a free copy of the report provided that you make the request within 60 days of the date that you received notice of the adverse action.
•
15 U.S.C. 1681i provides for the right to dispute, with a consumer reporting agency the accuracy or completeness of any information in a consumer report furnished by the agency.
•
Printed Name:
David R Tigue
Social Security #:
3915
Signed Date: 02-23-2021
David R Tigue
4654 Village Mill Way
Rancho Cordova, CA 95742
DISCLOSURE REGARDING BACKGROUND INVESTIGATION 15
Centerline (the "Company") may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports"). 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. These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your employment or your contract period, as allowed by law.
Asurint, or another consumer reporting agency, will prepare or assemble the background reports for the Company. Asurint is located and can be contacted by mail at P.O. Box 14730, Cleveland, OH, 44145, and Asurint can be contacted by phone at 800-***-****. Information about Asurint's privacy practices is available at https://www.asurint.com/#compliance.
The background report may contain information concerning your character, general reputation, personal characteristics, and mode of living. The types of information that may be obtained include, but are not limited to: employment history
(e.g., dates of employment, final salary information, performance-related information, reasons for departure, etc.); personal and professional reference checks; and other information bearing on your character, general reputation, personal characteristics, and mode of living.
This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; and, for investigative consumer reports, personal interviews with sources such as neighbors, friends, former employers and associates; and other information sources provided as references. The Company is not intending to collect, and will not be requesting, any information bearing on your credit worthiness, credit standing, or credit capacity, unless it otherwise notifies you prior thereto in writing. You may request more information about the