Delivery Driver Compensation Claims
Resume:
Centerline Drivers, LLC. (ND)
Santa Ana, CA 92701
**-**-**** *:16:08AM CST
IntelliApp (ND)
Thank you for your interest in Centerline Drivers, LLC.. To apply for a 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
Referral Code: indeed
Name Richard Lee Heitman
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 19240 Lorain Road #102
Address 2 102
City, State/Province Zip/Postal Fairview Park, OH 44126 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 5516
Date of Birth
Primary Phone 440-***-****
Cell Phone 440-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email adu9c7@r.postjobfree.com
Cell Phone Provider 440-***-****
Yes, I agree to receive information
concerning future opportunities or
promotions from Centerline Drivers, LLC.
(ND) by email or other commercial
electronic communications.
Yes
Would you like to receive communication
from Centerline Drivers, LLC. (ND) via text
message?
Yes
1
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. (ND)'s service
provider receives in real time and logs your
text messages with Centerline Drivers,
LLC. (ND).
Company Questions
GENERAL INFORMATION
What position are you applying for? Driver
What location are you applying for? OH, Cleveland
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? No
What date did your last employment end? 12-22-2022 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:
Please enter the names of any relatives
employed here:
Have you ever been known by any other
name?
No
Enter name:
How did you hear about us? internet
In case of Emergency, notify (list name,
address, and phone):
EDUCATION
List highest grade completed: College - 1
List last school attended (name, city, and
state):
University of Phoenix, Phoenix, Arizona
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship: First Reference:
2
Connie Coleman
Dearborn, Michigan
Second Reference:
Licenses
List all driver licenses that you have held in the past License Number 192
Licensing Authority OH
Country US
License Class
License Expiration Date 09-15-2023
Physical Expiration Date 10-20-2023
Current License Yes
Commercial Driver License No
Endorsements None
Employment / Unemployment
Unemployment
Start Date 06-2022
End Date 01-2023
Comment
Beardown Logistics
PLEASE DO NOT CONTACT
Company Beardown Logistics
Start Date 05-2012
End Date 05-2022
Address 23371 Aurora Road
City, State/Province Zip/Postal Bedford Heights, OH 44128 Country United States
Phone
Position Held Delivery Driver
Reason for leaving? Lack of hours
Were you terminated/discharged/laid off? No
3
Is this your current employer? Yes
May we contact this employer at this time? No
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
Signature
Full Name Richard Lee Heitman
IP Address 2600:8806:909d:4
Signature Date/Time 01-24-2023 9:16 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: 01-24-2023 9:16 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
Yes
4
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.
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
Massachusetts Criminal Policy and Record Correction Acknowledgment By checking the box, I (a) acknowledge
that I have read and understand the
Company?s Massachusetts Criminal
Record Policy and Information Concerning
the Process in Correcting a Criminal
record and have also been given the
opportunity copy/print both, and (b) agree
to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Yes
New Jersey Summary of Rights Acknowledgment
By checking the box, I (a) acknowledge
that I have read and understand the
Summary of Rights Under New Jersey's
Fair Credit Reporting Act and also have
been given the opportunity to copy/print
the Summary of Rights, and (b) agree to
use an electronic signature to demonstrate
my acknowledgment. An electronic
signature is as legally binding as an ink
signature.
Yes
New York State Article 23-A Notice
By checking the box, I (a) acknowledge
that I have read and understand the New
York State Correction Law Article 23-A and
have been given the opportunity to
Yes
5
copy/print it and (b) agree to use an
electronic signature to demonstrate my
acknowledgment. An electronic signature
is as legally binding as an ink signature.
Washington Summary of Rights Acknowledgment
By checking the box, I (a) acknowledge
that I have read and understand the
Summary of Rights Under Washington's
Fair Credit Reporting Act and have been
given the opportunity to copy/print the
Summary of Rights and (b) agree to use
an electronic signature to demonstrate my
acknowledgment. An electronic signature
is as legally binding as an ink signature.
Yes
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
NYC Authorization
By checking this box, I represent that I
understand and agree to the above
language.
Yes
NV Background Disclosure-Authorization
By checking this box, I represent that I
understand and agree to the above
language.
Yes
MD Background Disclosure-Authorization
By checking this box, I represent that I
understand and agree to the above
language.
Yes
6
NH Background Disclosure-Authorization
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 adu9c7@r.postjobfree.com.
Yes
7
DISCLOSURE AND AUTHORIZATION FOR CONSUMER REPORTS
In connection with my application for employment with Centerline Drivers, LLC., I understand consumer reports will be requested by Centerline Drivers, LLC. ("Company"). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, education, accidents, licensure, credit, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, CDLIS, workers' compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies that maintain such records. In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained. If I am hired, I understand that Company can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment or contract period.
Authorization
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired, this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information.
This authorization is conditioned upon the following representations of my rights: I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 1600 E. Fourth St, Suite 340, Santa Ana, CA, 714-***-**** to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency. Agency Contact Information:
HireRight
Attn: Consumers Department
14002 E. 21st Street, Suite 1200
Tulsa, OK 74134
http://www.hireright.com/applicants
iiX
1716 Briarcrest Drive
Suite 200
Bryan, TX 77802
Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
Email: adu9c7@r.postjobfree.com
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
adu9c7@r.postjobfree.com
8
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, 206-***-****. Printed Name:
Richard Lee Heitman
Social Security #:
5516
Signed Date: 01-24-2023
Richard Lee Heitman
19240 Lorain Road #102
102
Fairview Park, OH 44126
Gender:
9
NYC Authorization
AUTHORIZATION
By signing this authorization, I acknowledge that I have received and read multiple stand-alone documents in the e-mail sent to me with the links to this system or otherwise provided to me, including DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand these documents. I hereby authorize the obtaining of "consumer reports" and/or
"investigative consumer reports" by Centerline Drivers at any time after receipt of this authorization and throughout my employment, as allowable by applicable law. To this end, I hereby authorize, without reservation, any administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Asurint, P.O. Box 14730, Cleveland, OH 44114, 800-***-****, https://www.asurint.com/privacy-policy and/or Centerline Drivers. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original and I agree to receive any notices, relating to my background check, electronically. New York applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report.
New York City applicants only: By signing the Authorization, you further authorize the Company to provide you with a copy of your consumer report and any other documents, to the extent required by law, at the mailing address and/or email address you provide to the Company
Printed Name:
Richard Lee Heitman
Social Security #:
5516
Signed Date: 01-24-2023
Richard Lee Heitman
19240 Lorain Road #102
102
Fairview Park, OH 44126
10
NV Background Disclosure-Authorization
ADDITIONAL SUMMARY OF RIGHTS
For Nevada Residents:
Under the Fair Credit Reporting Act (FCRA), all consumers are entitled to one free annual file disclosure in any twelve month period. You may be charged a reasonable fee, not exceeding nine dollars, for each additional disclosure within any 12-month period. However, there is no fee if (1) you have been notified of an adverse action taken towards you based upon information appearing in your consumer file within the preceding 60 days, (2) you suspect that your file may contain fraud or you have been the victim of identity theft, or (3) you are unemployed or are currently receiving financial assistance.
"Consumer report" means any communication, written or oral, by a reporting agency regarding the payment history of a particular consumer, including information regarding credit worthiness, credit standing, or credit capacity, which is intended for present or future use in whole or in part to serve as a factor in determining the consumer's eligibility for credit or insurance to be used primarily for personal, family or household purposes, purposes relating to employment, or any other purpose authorized pursuant to the Fair Credit Reporting Act.
A reporting agency may furnish a consumer report concerning you for an extension of credit which you did not initiate only if the contemplated transaction represents a firm offer of credit to you and you meet specific criteria determined by the user, or you have not requested that your name and address be excluded from any list to be provided for such a purpose. A person shall not procure a consumer report to resell or disclose the report or the information contained in the report unless the person discloses to the reporting agency which originally furnished the report the identity of the intended ultimate user of the report or information, and the only purposes for which the information will be used. A reporting agency shall not include medical information in its files. If a person takes adverse action against you based on a consumer report from a reporting agency, the person shall notify you of the action taken; furnish you with the name and address of the reporting agency; and inform you of your right to obtain a copy of the consumer report from the agency.
Upon receiving your request for disclosure, and information sufficient to identify you, a reporting agency shall clearly and accurately disclose to you the nature and substance of information in its files which relates to you at the time of the request, and disclose the names of the institutional sources of information. If you request, the reporting agency shall provide a readable copy of the consumer report, disclose the name of each person who has received from the reporting agency information concerning you within the preceding 2 years for purposes of employment, promotion, reassignment or retention as an employee; or within the preceding 6 months for any other purpose.
A reporting agency shall periodically purge from its files and after purging shall not disclose bankruptcies whose dates of adjudication precede the report by more than 10 years. A report of adjudication must include, if known, the chapter of Title 11 of the United States Code under which the case arose. Except as otherwise provided by a specific statute, any other civil judgment, report of criminal proceedings, or other adverse information which precedes the report by more than 7 years. You have a right to bring civil action against anyone who willfully or negligently fails to comply with any requirement imposed under the subtitle of Nevada state law outlined above.
Nevada Consumers Security Freeze Rights
You have a right to place a security freeze in your file which will prohibit a reporting agency from releasing any information in your file without your express authorization. A security freeze must be requested in writing by certified mail. The security freeze is designed to prevent a reporting agency from releasing your consumer report without your consent. However, you should be aware that using a security freeze to take control over who is allowed access to the personal and financial information in your file may delay, interfere with or prohibit the timely approval of any subsequent request or application you make regarding a new loan, credit, mortgage, insurance, government services or payments, rental housing, employment, investment, license, cellular telephone, utilities, digital signature, Internet credit card transaction or other services, including an extension of credit at point of sale. When you place a security freeze in your file, you will be provided a personal identification number or password to use if you choose to remove the security freeze from your file or to authorize the temporary release of your consumer report for a specific person or period after the security freeze is in place. To provide that authorization, you must contact the reporting agency and provide all the following: 1. Sufficient identification to verify your identity. 2. Your personal identification number or password provided by the reporting A statement that you choose to remove the security freeze from your file or that you authorize the reporting agency to temporarily release your consumer report. If you authorize the temporary release of your consumer report, you must name the person who is to receiveyourconsumerreportortheperiodforwhichyour consumerreportmustbe available. 3.
11
A reporting agency must remove the security freeze from your file or authorize the temporary release of your consumer report not later than 3 business days after receiving the above information. A security freeze does not apply to certain persons, including a person, or collection agencies acting on behalf of a person, with whom you have an existing account that requests information in your consumer report for the purposes of reviewing or collecting the account.
Printed Name:
Richard Lee Heitman
Social Security #:
5516
Signed Date: 01-24-2023
Richard Lee Heitman
19240 Lorain Road #102
102
Fairview Park, OH 44126
12
MD Background Disclosure-Authorization
STATE OF MARYLAND
CONSUMER CREDIT REPORTING AGENCIES ACT
Annotated Code of Maryland Commercial Law Article
14-1201, ET SEQ.
Statement of Rights of the Consumer
As a resident of the State of Maryland, you have the following rights as a consumer under the laws of the State of Maryland relating to consumer credit information.
You have the right to request, in writing, that a consumer reporting agency restrict the sale or other transfer of information in your credit file to:
• A mail-service organization;
• A marketing firm; or
• Any other similar organization that obtains information about a consumer for marketing purposes. You have a right, upon request and proper identification, to receive from a consumer reporting agency an exact copy of any consumer file on you, including a written explanation of codes or trade language used in the report. You have a right to receive disclosure of information in your consumer file during normal business hours: In person, upon furnishing proper identification.
You may be accompanied by one other person of your choosing, who must furnish reasonable identification, and the consumer reporting agency may require a written statement from you granting permission to discuss your consumer information in this person's presence.
•
• By telephone, if you make written request with proper identification, and toll charges, if any, are charged to you.
• In writing, if you make written request and furnish proper identification. You have a right to dispute the completeness or accuracy of any item of information contained in your consumer file, and if you convey the dispute in writing, the consumer reporting agency will, within 30 days, reinvestigate and record the current status of that information, unless it has reasonable grounds to believe that the dispute is frivolous or irrelevant. If, after reinvestigation, the information you disputed is found to be inaccurate or cannot be verified, the consumer reporting agency will delete the information and mail you a written notice of the correction and will also mail to each person to whom erroneous information was furnished written notice of the correction. You will also be sent a written notice if the information you disputed is found to be accurate or is not verified.
You have 60 days after receiving notice of correction or other findings to request in writing that the consumer reporting agency furnish you with the name, address, telephone number of each creditor contacted during its reinvestigation, and it will provide this information to you within 30 days after receiving your request. If the reinvestigation does not resolve your dispute, you may file with the consumer reporting agency a brief statement of not more than 100 words, setting forth the nature of your dispute. This statement will be placed on your consumer file, and in any subsequent report containing the information you dispute, it will be clearly noted that the information has been disputed by you, and your statement or a clear and accurate summary of it will be provided with that report. Following deletion of any information you disputed that is found to be inaccurate or could not be verified, at your request, the consumer reporting agency will furnish notification of the information deleted or your statement, or statement summary, to any person you designate who has received your report within the past two years for employment purposes, or within the past one year for any other purpose.
Under the law, you will not be charged for any of the information requested nor for our handling of the information you dispute, nor for the corrected reports resulting from our handling. Under the law, you may be charged a fee not exceed $5 for a second or subsequent report requested by you during a 12-month period.
You have a right to file a complaint with the Commissioner of Financial Regulation, State of Maryland, if you have reason to believe that this law or any other law regulating consumer credit reporting has been violated, and the Commissioner will thoroughly inspect and investigate your complaint.
Under the law, effective October 1, 2017, you may not be charged a fee by a consumer reporting agency to place a security freeze on your account if you have not previously requested the placement of a freeze by that same consumer reporting agency. The name, address, and telephone number of the Commissioner of Financial Regulation is: Antonio Salazar, Commissioner of Financial Regulation Maryland Department of Labor, Licensing & Regulation 500 N. Calvert St.
Baltimore, Maryland 21202
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NOTICE
You have a right, under section 14-1212.1 of the Commercial Law Article of the Annotated Code of Maryland, to place a security freeze on your credit report. The security freeze will prohibit a consumer reporting agency from releasing your credit report or any information derived from your credit report without your express authorization. The purpose of a security freeze is to prevent credit, loans, and services from being approved in your name without your consent. You may elect to have a consumer reporting agency place a security freeze on your credit report by written request sent by certified mail, or by electronic mail or the internet if the consumer reporting agency provides a secure electronic connection. The consumer reporting agency must place a security freeze on your credit report within 5 business days after your request is received, or within 3 business days starting July 1, 2008. Within 5 business days after a security freeze is placed on your credit report, you will be provided with a unique personal identification number or password to use if you want to remove the security freeze or temporarily lift the security freeze to release your credit report to a specific person or for a specific period of time. You also will receive information on the procedures for removing or temporarily lifting a security freeze. If you want to temporarily lift the security freeze on your credit report, you must contact the consumer reporting agency and provide all of the following:
1. the unique personal identification number or password provided by the consumer reporting agency; 2. the proper identifying information to verify your identity; and the proper information regarding the person who is to receive the credit report or the period of time for which the credit report is to be available to users of the credit report.
3.
A consumer reporting agency must comply with a request to temporarily lift a security freeze on a credit report within 3 business days after the request is received, or within 15 minutes starting January 31, 2009, for certain requests. A consumer reporting agency must comply with a request to remove a security freeze on a credit report within 3 business days after the request is received. If you are actively seeking credit, you should be aware that the procedures involved in lifting a security freeze may slow your own applications for credit. You should plan ahead and lift a security freeze, either completely if you are seeking credit from a number of sources, or just for a specific creditor if you are applying only to that creditor, a few days before actually applying for new credit. A consumer reporting agency may charge a reasonable fee not exceeding $5 for each placement, temporary lift, or removal of a security freeze. However, a consumer reporting agency may not charge any fee to a consumer who, at the time of a request to place, temporarily lift, or remove a security freeze, presents to the consumer reporting agency a police report of alleged identity fraud against the consumer or an identity theft passport.
A security freeze does not apply if you have an existing account relationship and a copy of your credit report is requested by your existing creditor or its agents or affiliates for certain types of account review, collection, fraud control, or similar activities. Printed Name:
Richard Lee Heitman
Social Security #:
5516
Signed Date: 01-24-2023
Richard Lee Heitman
19240 Lorain Road #102
102
Fairview Park, OH 44126
14
NH Background Disclosure-Authorization
STATE OF NEW HAMPSHIRE STATEMENT OF RIGHTS OF THE CONSUMER As a resident of the State of New Hampshire, you have the following rights as a consumer under the laws of the State of New Hampshire relating to consumer credit information: After receiving notice of correction or other findings, you have the right to request that the consumer
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