Saia LTL Freight
Ste. 400
John Creek, GA 30097
**-**-**** *:11:31PM CDT
IntelliApp
In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
Position City State/Province
Class A CDL Driver Little Rock (LRK) AR
Personal Information
Referral Code: pulse_rec
Name Rl Bailey, Jr.
Residence 3 years or longer (If No,
previous addresses shown below)
No
Current Address 5901 John F Kennedy Boulevard
Address 2 304
City, State/Province Zip/Postal North Little Rock, AR 72116 Country United States
Addresses Over last 3 years Address 1
5901 John F Kennedy Boulevard
North Little Rock, AR 72116
United States
02-2021 to 04-2022
Address 2
3101 homer adkins blvd
Jacksonville, AR 72076
United States
03-2014 to 02-2021
SSN/SIN 3467
Date of Birth
Primary Phone 501-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email ********@*****.***
Yes
1
Yes, I agree to receive information
concerning future opportunities or
promotions from Saia LTL Freight by email
or other commercial electronic
communications.
Would you like to receive communication
from Saia LTL Freight 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 Saia LTL
Freight's service provider receives in real
time and logs your text messages with
Saia LTL Freight.
Yes
Company Questions
GENERAL INFORMATION
What position are you applying for? Local/City Driver If you selected "Team Driver" please enter
Team Partner
Can you provide legal documentation
establishing your identity and eligibility to
be legally employed in the United States?
Yes
Will you now or in the future require
sponsorship for employment visa status
(e.g., H-1B visa status)?
No
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 Saia, Westex,
Action Express, Clark Brothers Transfer,
Connection Company, Madison Freight,
Robart Transportation or LinkEx?
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:
No
2
Have you ever been known by any other
name?
Enter name:
How did you hear about us? Job Board
If "Job Board", please enter job board type. Pulse If "Social Media", please enter social
media source.
If "Recruiter Contacted", please enter
recruiter name.
If "Employee Referral", please enter the
employee's name
If "Other", please explain
DRIVING EXPERIENCE
Do you have at least 12 months of
tractor-trailer experience?
No
Do you have any tractor-trailer driving
experience with the last 24 months?
No
Select the type of equipment you have experience driving in the past 24 months
(answer yes for all that apply):
Van
Flat
Tank
Bulk
Reefer
Other
Select the amount of total experience you
have driving tractor-trailers:
Less Than 6 Months
Select the approximate number of miles
you have driven tractor-trailers:
Less than 50,000
Select the amount of total experience you
have driving tractor-double trailers:
Less Than 6 Months
Select the approximate number of miles
you have driven tractor-double trailers:
Less than 50,000
Select the amount of total experience you
have driving tractor-triple trailers:
Less Than 6 Months
Select the approximate number of miles
you have driven tractor-triple trailers:
Less than 50,000
Select the amount of total experience you
have driving tractor-Rocky Mountain
doubles:
Less Than 6 Months
3
Select the approximate number of miles
you have driven tractor-Rocky Mountain
doubles:
Less than 50,000
Please provide the type of driving experience you have (answer yes for all that apply): OTR No
Regional No
Local Yes
LTL No
Other No
Please explain
Which safe driving awards do you hold and
from whom?
DOT DRUG / ALCOHOL TEST HISTORY
In accordance with DOT regulation 49CFR Part 40.25, please respond to the following questions regarding any Drug/Alcohol Test results, Treatment Records, and Refusal to Test History within the last three (3) years:
Have you had any DOT required alcohol
tests with a result of 0.04 or higher alcohol
concentration?
No
Please explain:
Have you had any verified positive DOT
required drug test?
No
Please explain:
Have you refused to be tested (including
having a verified adulterated or substituted
drug test result)?
No
Please explain:
Have you had any other violation of DOT
agency drug or alcohol testing regulations?
No
Please explain:
If you violated a DOT drug and/or alcohol
regulation did you successfully complete
DOT return to duty requirements (including
all follow up tests)?
No
Please explain:
Were there any situations in which you
tested positive on a pre-employment test
for a DOT employer that did not hire you?
No
Please explain:
Were there any situations in which you
refused to submit (including positives by
No
4
adulteration or subsitution) to a
pre-employment test for a DOT employer
that did not hire you?
Please explain:
I certify that my responses to the above
questions are true.
Yes
EDUCATION
List highest grade completed: Some College
List last school attended (name, city, and
state):
Pulaski Tech North Little Rock Arkansas
Licenses
License Number 190
State/Province AR
Country US
License Class Class A
License Expiration Date 07-16-2027
Physical Expiration Date 07-16-2023
Current License Yes
Commercial Driver License Yes
Endorsements None
Employment / Unemployment
Uams
Company Uams
Start Date 08-2019
End Date 04-2022
Address
City, State/Province Zip/Postal Little Rock, AR
Country United States
Phone 501-***-****
Position Held Maintenance repair/skilled Tradesman Reason for leaving? Still employed
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
5
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
No
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 subject to drug and
alcohol testing?
Areas Driven
Miles driven weekly
Most common truck driven
Most common trailer
Trailer length
Arkansas Children's Hospital
Company Arkansas Children's Hospital
Start Date 09-2018
End Date 08-2019
Address
City, State/Province Zip/Postal Little Rock, AR
Country United States
Phone 501-***-****
Position Held Shipping and receiving
Reason for leaving? I had my children and needed more flexibility with the hours of operation
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?
No
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 subject to drug and
alcohol testing?
6
Areas Driven
Miles driven weekly
Most common truck driven
Most common trailer
Trailer length
FedEx Ground
Company FedEx Ground
Start Date 11-2016
End Date 08-2018
Address 8 Industrial Pkwy
City, State/Province Zip/Postal Mabelvale, AR
Country United States
Phone 501-***-****
Position Held Bulk truck delivery driver
Reason for leaving? I had no benefits while driving for a contractor
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 Little Rock
Miles driven weekly 0-500
Most common truck driven Straight Truck
Most common trailer Liftgate
Trailer length 31 feet or less
Fedex Ground
Company Fedex Ground
Start Date 05-2014
7
End Date 10-2016
Address 8 Industrial Pkwy
City, State/Province Zip/Postal Mabelvale, AR
Country United States
Phone
Position Held Bulk truck delivery driver
Reason for leaving? I had no benefits while driving for a contractor
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 Little Rock
Miles driven weekly 0-500
Most common truck driven Straight Truck
Most common trailer Liftgate
Trailer length 31 feet or less
UAMS
Company UAMS
Start Date 03-2008
End Date 04-2014
Address 8901 kanis rd
City, State/Province Zip/Postal Little Rock, AR 72206 Country United States
Phone 501-***-****
Position Held Maintenance repair/ skilled Tradesman Reason for leaving? Neede more money to support my family Were you terminated/discharged/laid off? No
8
Is this your current employer? Yes
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
No
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
Most common truck driven
Most common trailer
Trailer length
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. In the last 10 years, have you ever been
convicted of driving under the influence or
refusing an alcohol / drug test?
No
9
Please Explain
7. Have you ever been disqualified from
operating any motor vehicle by any
Federal, State, or local enforcement
agency?
No
Please Explain
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 Rl Bailey, Jr.
IP Address 174.53.51.52
Signature Date/Time 04-18-2022 8:11 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. By signing below I authorize Saia, Inc. and/or Saia Motor Freight Line, LLC (the
"Company") to act on my behalf to conduct a criminal background check. Further, I understand that my employment is at will and for no definite period and may, regardless of the date of payment of wages, be terminated at any time with or without previous notice and with or without cause. I also understand that as a condition of employment, I will be required to pass a controlled substance test involving a collection of my urine, that a post offer physical may be required and I must successfully complete an E-Verify check (subject to state law requirements). I understand that, as a continuing condition of employment, I may be required to submit a D.O.T. recertification physical (drivers only) and/or random controlled substance test(s), alcohol test(s), and other drug tests as outlined in Saia's Drug and Alcohol policy. All information gathered shall be held in strict confidence between the Company and the applicant / employee. Signing below also 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. 10
Signed Date: 04-18-2022 8:11 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
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
11
Clearinghouse Release
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
User Requested Copy
User requested a copy to be sent to this
email address ********@*****.***.
Yes
12
Authorization of Background Investigation
I have carefully read and understand this Disclosure and Authorization form 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 Driver iQ/Cisive, 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 (including independent contractor 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 obtain background reports, throughout my employment or contract period.
I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract 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 hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.
By my signature below, I also 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:
RL Bailey, Jr.
Social Security #:
3467
Signed Date: 04-18-2022
RL Bailey, Jr.
5901 John F Kennedy Boulevard
304
North Little Rock, AR 72116
Gender:
13
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Saia LTL Freight 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 Saia LTL Freight 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 Saia LTL Freight to conduct a limited query of the Clearinghouse, Saia LTL Freight 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 Saia LTL Freight indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Saia LTL Freight unless I give additional specific consent within the Clearinghouse. However, I understand that Saia LTL Freight 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. 04-18-2022
RL Bailey, Jr. Date
14
APPLICATION AGREEMENT
By checking I Agree below I authorize Saia, Inc. and/or Saia Motor Freight Line, LLC (the "Company") to act on my behalf to conduct a criminal background check. Under the provision of the Fair Credit Reporting Act 15 U.S.C 1681, et seq, notice is hereby given that an investigative consumer report may be made which may include information pertaining to your, character, general reputation, personal characteristics, and mode of living, which will be used for employment purposes. Also, you have the right to request the company to make a complete and accurate disclosure of the nature and scope of the investigation requested by the company, pursuant to FMCSR 391.23, driver applicants have the right to review information provided by the previous employers, the right to have errors in the information corrected by the previous employer and for that previous employer to resend the corrected information. Driver applicants also have the right to have a rebuttal statement attached to the erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. Your request must be in writing and submitted within a reasonable time period after your application. The company shall respond in writing, mailed or otherwise delivered, to you, not later than five days after the date on which the request for such disclosure was received from you or such report was first requested, whichever is later. I also authorize the investigation of all statements contained in the application. I understand that any misrepresentation or omission of facts called for on this application is cause for immediate dismissal. I hearby grant permission to verify employment with current and former employers to obtain information regarding my previous employment record. Further, I understand that my employment is at will and for no definite period and may, regardless of the date of payment of wages, be terminated at any time with or without previous notice and with or without cause. I also understand that as a condition of employment, I will be required to pass a controlled substance test involving a collection of my urine, that a post offer physical may be required and I must successfully complete an E-Verify check (subject to state law requirements). I understand that, as a continuing condition of employment, I may be required to submit a D.O.T. recertification physical (drivers only) and/or random controlled substance test(s), alcohol test(s), and other drug tests as outlined in Saia's Drug and Alcohol policy. All information gathered shall be held in strict confidence between the Company and the applicant / employee. By checking "I Agree" also 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.
Printed Name: RL Bailey, Jr.
Social Security #: 3467
Signed Date: 04-18-2022
Signed:
15
Authorization of Background Investigation
I have carefully read and understand this Disclosure and Authorization form 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 Driver iQ/Cisive, 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 (including independent contractor 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 obtain background reports, throughout my employment or contract period.
I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract 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 hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.
By my signature below, I also 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. Employer / Contractor / Educational Institution:
Uams
Printed Name:
RL Bailey, Jr.
Social Security #:
3467
Signed Date: 04-18-2022
RL Bailey, Jr.
5901 John F Kennedy
Boulevard
304
North Little Rock, AR 72116
Gender:
16
Authorization of Background Investigation
I have carefully read and understand this Disclosure and Authorization form 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 Driver iQ/Cisive, 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 (including independent contractor 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 obtain background reports, throughout my employment or contract period.
I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract 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 hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.
By my signature below, I also 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. Employer / Contractor / Educational Institution:
Arkansas Children's Hospital
Printed Name:
RL Bailey, Jr.
Social Security #:
3467
Signed Date: 04-18-2022
RL Bailey, Jr.
5901 John F Kennedy
Boulevard
304
North Little Rock, AR 72116
Gender:
17
Authorization of Background Investigation
I have carefully read and understand this Disclosure and Authorization form 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 Driver iQ/Cisive, 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 (including independent contractor 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 obtain background reports, throughout my employment or contract period.
I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract 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 hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the consumer reporting agency.
By my signature below, I also 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. Employer / Contractor / Educational Institution:
FedEx Ground
Printed Name:
RL Bailey, Jr.
Social Security #:
3467
Signed Date: 04-18-2022
RL Bailey, Jr.
5901 John F Kennedy
Boulevard
304
North Little Rock, AR 72116
Gender:
18
Authorization of Background Investigation
I have carefully read and understand this Disclosure and Authorization form 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 Driver iQ/Cisive, 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 (including independent contractor 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 obtain background reports, throughout my employment or contract period.
I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or contract 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 hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information service bureaus, credit bureaus, record/data repositories, courts (federal, state and local), motor vehicle records agencies, my past or