Benore Logistic Systems, Inc.
Erie, MI 48133
**-**-**** *:33:51PM CST
IntelliApp
Personal Information
Name James Cameron
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 226 Hickory Terrance
City, State/Province Zip/Postal Lagrange, GA 30241 Country United States
Residence 10 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 7597
Date of Birth
Primary Phone 706-***-****
Cell Phone 706-***-****
Preferred method of contact Primary Phone
Best time to contact you Any
Email adunnl@r.postjobfree.com
Yes, I agree to receive information
concerning future opportunities or
promotions from Benore Logistic Systems,
Inc. by email or other commercial
electronic communications.
Yes
Would you like to receive communication
from Benore Logistic Systems, Inc. via text
message?
By participating, you consent to receive
text messages sent by an automatic
telephone dialing system, which may
contain recruiting/advertising messages.
Consent to these terms is not a condition
of being hired, contracted, or leased. You
may opt out at any time by texting STOP to
unsubscribe. You also agree that Benore
Logistic Systems, Inc.'s service provider
receives in real time and logs your text
messages with Benore Logistic Systems,
Inc..
Yes
1
Company Questions
GENERAL INFORMATION
What position are you applying for? Local Driver
What type of work do you seek? Full-time
What location are you applying for? Hogansville, GA Please select the recruiter you've been
working with.
Amanda West
What is your desired compensation? $22 hour
What is the first date you are available to
work?
01-10-2023
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? No
What date did your last employment end? 09-28-2021 Do you read, write, and speak English? Yes
Have you ever submitted an application to
the Company before?
No
Please provide the date(s) you previously
applied.
Have you ever worked for this company
before?
No
Enter start and end dates, supervisor,
location, position, rate of pay, and reason
for leaving:
Do you have a current TWIC card? No
Expiration date:
Do you have a passport? Yes
Are you currently enrolled in the Free and
Secure Trade Program ("FAST")?
No
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? Employee Referral/Word of Mouth If you heard about us through a media
outlet, please list the name:
Tim Askew
Were you referred by an employee? Yes
Enter name: Tim Askew
2
DRIVING EXPERIENCE
Do you have experience driving a truck
with a manual transmission?
Yes
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 none
Tractor and Semi-Trailer none
Tractor - Two Trailers 1,000,000,000 miles or more Other none
Please list all noted restrictions with detail
as shown on the back of your license.
none
Please list the states you have operated in
during the past five years.
Tennessee, Florida, Alabama, Ga
Which safe driving awards do you hold and
from whom?
Kenco certificate of Achievement safe
driving award
Please list your professional trade/civic
activities:
EDUCATION
List highest grade completed: Grade 12
List last school attended (name, city, and
state):
Ethel W. Knight High School Lagrange Ga
Do you possess a high school diploma or
equivalent credential?
Yes
Do you have any special training, skills,
qualifications, or other experiences that
relate to the position applied for?
Driver workshop June 2,2014 GFA
Certificate of Achievement Pro-Trend
Speed Management
PERSONAL REFERENCES
List name, address, city, state and phone number for non-family members: First Reference: Tim Askew 678-***-****
Second Reference: Larry Cotton 678-***-****
115 Ware Street Hogansville
Third Reference: Derrick Ferrel 404-***-****
EMERGENCY CONTACT
List name, address, city, state, phone
number and relationship:
Leanntoinette Sims daughter
1304 Murphy Ave
Lagrange Ga 30240
3
Licenses
License Number 488
Licensing Authority GA
Country US
License Class Class A
License Expiration Date 11-03-2026
Physical Expiration Date 01-03-2024
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement No
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement No
Employment / Unemployment
Unemployment
Start Date 09-2021
End Date 01-2023
Comment Retired
Kenco Transportation
Company Kenco Transportation
Contact / Supervisor Name
Start Date 11-2016
End Date 09-2021
Address
City, State/Province Zip/Postal Chattanooga, TN
Country United States
Phone 800-***-****
Fax 423-***-****
Position Held
Reason for leaving? retired
Were you terminated/discharged/laid off? No
4
Is this your current employer? Yes
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven
Miles driven weekly 2500-3000
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Other
Trailer length 53 feet or more
U.S. Military
Branch of Service Air Force
Start Date 07-1971
End Date 10-1974
Can you obtain your DD214? Yes
Rank at discharge
Trucking School
Start Date 01-2013
End Date 10-2016
School West Georgia Tech
Address
Address 2
City, State/Province Lagrange, GA
Country US
Phone
Did you graduate? Yes
5
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 180
Border Crossing Yes
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
Trucking School
Start Date 07-1994
End Date 07-1994
School West Georgia Tech
Address
Address 2
City, State/Province Lagrange, GA
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?
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
Border Crossing No
Log Books No
Federal Motor Carrier Regulations No
6
Hazardous Materials No
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 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
7
Criminal Record
Have you ever pled guilty to, been
convicted of, or pled no contest to a crime?
No
For each crime, please provide the date of
disposition, description of the crime and
whether it was a felony or misdemeanor.
Signature
Full Name James Cameron
IP Address 2600:6c5a:4f00:f
Signature Date/Time 01-02-2023 2:33 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: 01-02-2023 2:33 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
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
8
Additional Consent or Certification
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
FCRA Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Employment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Clearinghouse Release
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
User Requested Copy
User requested a copy to be sent to this
email address adunnl@r.postjobfree.com.
Yes
9
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) and for other employment purposes, Benore Logistic Systems, Inc. may seek background information about you from consumer reporting agencies, including, but not limited to, IIX and Asurint . The information will be in the form of consumer reports (Investigative Consumer Reports in California). Consumer reports include any written, oral or other communication of information by a consumer reporting agency bearing on your credit standing, character, general reputation and other characteristics that is expected to be used for employment purposes, and 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, and criminal records from federal, state and other agencies that maintain such records, as well as information from IIX or Asurint 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 request information from Benore Logistic Systems, Inc., upon proper identification, about the nature, substance and scope of any consumer report on you that is requested by Benore Logistic Systems, Inc., by the time of your request. The request must be made in writing and within a reasonable time after you have received this disclosure., I AUTHORIZE, WITHOUT RESERVATION, IIX, Phoenix Services Inc and/or Asurint, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY IIX Phoenix Services Inc. and/or Asurint TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I I hereby consent to Benore Logistic Systems, Inc. obtaining the above information from IIX, Phoenix Services Inc and/or Asurint, and I agree that such information which IIX, Phoenix Services Inc and/or Asurint has or obtains in my employment history (not DOT drug and alcohol information without a specific consent by me) with Benore Logistic Systems, Inc. if I am hired, will be supplied by IIX, Phoenix Services Inc and/or Asurint to other companies which subscribe to IIX, Phoenix Services Inc and/or Asurint. I hereby authorize procurement of consumer reports as set forth above. I understand that if I am hired or contracted, this authorization for reports covered by this release shall remain on file and shall serve as an ongoing authorization for Benore Logistic Systems, Inc. to procure consumer reports at any time during my employment or contract period.
I consent to Benore Logistic Systems, Inc. obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and Benore Logistic Systems, Inc. cannot change or alter such information. I understand that 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:
James Cameron
Social Security #:
7597
Signed Date: 01-02-2023
James Cameron
226 Hickory Terrance
Lagrange, GA 30241
Gender:
10
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Benore Logistic Systems, 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 Benore Logistic Systems, 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:
James Cameron
Signed Date: 01-02-2023
11
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Benore Logistic Systems, Inc. to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for Benore Logistic Systems, Inc. to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent. I understand that if I refuse to provide consent for Benore Logistic Systems, Inc. to conduct a limited query of the Clearinghouse, Benore Logistic Systems, Inc. is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle.
I understand that if the limited query conducted by Benore Logistic Systems, Inc. indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Benore Logistic Systems, Inc. unless I give additional specific consent within the Clearinghouse. However, I understand that Benore Logistic Systems, Inc. will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle.
01-02-2023
James Cameron Date
12
Upon the signing of this application, I represent that all of the information now or hereafter given by me in support of my application is true and complete. I authorize you to verify any of the information concerning my background, including but not limited to, my employment, driving record, education, criminal history, or medical history (post-offer only), with the appropriate individuals, companies, institutions or agencies, and I authorize them to release such information as you require, including my prior disciplinary employment record, without any obligation to give me written notice of such disclosure. I also authorize you to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure. I hereby release you and them from any liability whatsoever as a result of any such inquiries and disclosures and this release from liability does not waive or prohibit an individual from filing a charge of discrimination under the laws enforced by the EEOC. I agree that any false information in support of my application may subject me to discharge at any time during the period of my employment. I agree that either party may terminate the employment relationship, with or without cause, at any time, and I further agree that this arrangement may only be altered in writing directed to me personally and signed by the president of the firm. I agree that I shall be bound by the other rules, policies, regulations and terms and conditions of employment of the firm as they are from time to time changed, and no additional obligations can be imposed on the firm except those which have been acknowledged in writing, by the president or his designated representatives. I agree that any action or suit against the firm, its agents or employees, arising out of my employment or termination of employment, including, but not limited to, claims arising under State and Federal law, but not Federal civil rights statutes containing a separate limitations period, must be brought within 180 days of the event giving rise to the claims or be forever barred unless the applicable statute of limitations period is shorter than 180 days in which case I will continue to be bound by that shorter limitations period. I waive any limitation periods to the contrary. I further agree that if I should bring any non-statutory action or claim arising out of my employment against the firm, in which the firm prevails, I will pay to the firm any and all such costs incurred by the firm in defense of said claims or actions, including attorney fees. I further agree that my employment is conditional until such time as the results of my post-offer physical (if such physical is required) are known.
Printed Name: James Cameron
Social Security #: 7597
Signed Date: 01-02-2023
Signed:
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 01-02-2023
Date
X 7597
Social Security Number
James Cameron
226 Hickory Terrance
Lagrange, GA 30241
Gender:
X James Cameron
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Kenco Transportation To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Benore Logistic Systems, 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 carrier(s) listed above to Benore Logistic Systems, Inc., or to IIX, Phoenix Services Inc or Asurint for the sole purpose of transmitting such records to Benore Logistic Systems, Inc. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past ten 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 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 carrier(s) 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 Benore Logistic Systems, Inc., IIX, Phoenix Services Inc or Asurint to review involves tests required by DOT. If any carrier(s) listed above furnishes Benore Logistic Systems, Inc. with information concerning items (i) through
(vi) above, I also authorize that carrier(s) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the previous ten-year period and the name and phone number of any substance abuse professional who evaluated me during the past ten years.
14
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) and for other employment purposes, Benore Logistic Systems, Inc. may seek background information about you from consumer reporting agencies, including, but not limited to, IIX and Asurint . The information will be in the form of consumer reports (Investigative Consumer Reports in California). Consumer reports include any written, oral or other communication of information by a consumer reporting agency bearing on your credit standing, character, general reputation and other characteristics that is expected to be used for employment purposes, and 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, and criminal records from federal, state and other agencies that maintain such records, as well as information from IIX or Asurint 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 request information from Benore Logistic Systems, Inc., upon proper identification, about the nature, substance and scope of any consumer report on you that is requested by Benore Logistic Systems, Inc., by the time of your request. The request must be made in writing and within a reasonable time after you have received this disclosure., I AUTHORIZE, WITHOUT RESERVATION, IIX, Phoenix Services Inc and/or Asurint, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY IIX Phoenix Services Inc. and/or Asurint TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I I hereby consent to Benore Logistic Systems, Inc. obtaining the above information from IIX, Phoenix Services Inc and/or Asurint, and I agree that such information which IIX, Phoenix Services Inc and/or Asurint has or obtains in my employment history (not DOT drug and alcohol information without a specific consent by me) with Benore Logistic Systems, Inc. if I am hired, will be supplied by IIX, Phoenix Services Inc and/or Asurint to other