Trillium Driver Solutions
Corporate Office
Kalamazoo, MI 49048
**-**-**** *:52:17AM CDT
IntelliApp
Thank you for your interest in Trillium Driver Solutions. 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. We consider applicants for all positions without regard for race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status. All employees are subject to Form I-9 Employment Eligibility Verification and Social Security Number Verification upon hire. Personal Information
Referral Code: 548
Name Kerry Davis
Residence 3 years or longer (If No,
previous addresses shown below)
No
Current Address 903 Tracy Ct.
City, State/Province Zip/Postal Duncanville, TX 75137 Country United States
Addresses Over last 3 years Address 1
903 Tracy Ct.
Duncanville, TX 75137
United States
07-2021 to 05-2023
Address 2
1110 Janeil ln
Desoto, TX 75115
United States
05-2010 to 07-2021
SSN/SIN 6821
Date of Birth
Primary Phone 214-***-****
Cell Phone 214-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email *******@****.***
Yes, I agree to receive electronic
communications directly related to my
potential future, current, or past
employment with Trillium. Communications
Yes
may include but are not limited to:
information regarding W-2 mailings,
pertinent safety information,
communications regarding work
schedule/location changes and
documentation needed for employment.
You may opt out at any time from future
communications by responding STOP to
any electronic communication.
Yes, I agree to receive electronic
communications regarding future
opportunities, referral bonus incentives,
and other promotions from Trillium. You
may opt out at any time from future
communications by responding STOP to
any electronic communication.
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 Trillium
Driver Solutions's service provider
receives in real time and logs your text
messages with Trillium Driver Solutions.
Yes
Company Questions
GENERAL INFORMATION
What type of driving position are you
applying for?
Local
On what date will you be available for
work?
Any
What are your salary requirements? None
Are you familiar with Federal Motor Carrier
Safety Regulations?
Yes
Do you currently possess a CDL license? Yes
Do you have experience using an
Electronic Logging Device for Hours of
Service compliance?
Yes
Do you have reliable transportation? Yes
Distance willing to travel to a job site one
way: (Miles and/or Hours)
N/A
Are you prevented from lawfully becoming
employed in this country because of VISA
or Immigration status?
No
Are you currently legally authorized to
work in the United States for any employer
without restrictions and without requiring
immigration sponsorship?
Yes
Are you currently on layoff status and
subject to recall?
No
Are you currently employed? No
What date did your last employment end? 05/08/2023 Can you read, speak, and write English
sufficiently to converse with the general
public, understand highway traffic signs
and signals, respond to official inquiries,
and make entries on reports and records?
Yes
Is there any reason you might be unable to
perform the essential functions of the job
for which you are applying?
No
Have you ever applied for a position at
Trillium?
No
When did you apply?
Have you ever worked for Trillium before? No
Enter start and end dates, location,
position, and reason for leaving:
Do you have a current TWIC card? No
Expiration date:
Do you have a "Fast" pass? No
Do you currently possess a valid and
unexpired passport that would allow you to
drive between the U.S. and Canadian
borders (if required by the position being
applied for)?
No
Who referred you? Sap professional
Emergency Contact #1 (list name,
address, and phone):
Veronica Lynch-Davis
Emergency Contact #2 (list name,
address, and phone):
Veronica Lynch-Davis
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 N/A
Tractor and Semi-Trailer Van, refer,intermodel
Tractor - Two Trailers None
Other
Which safe driving awards do you hold and
from whom?
EDUCATION
List highest grade completed: College - 3
List last school attended (name, city, and
state):
Louisiana Tech University Ruston, LA
PROFESSIONAL REFERENCES FAMILIAR WITH YOUR WORK
List name, address, city, state, phone number, and title: First Reference: US foods
Second Reference: Hub Group trucking
Third Reference: Grocers Supply co.
Licenses
License Number 960
Licensing Authority TX
Country United States
License Class Class A
License Expiration Date 07-03-2016
Physical Expiration Date 01-27-2017
Current License Yes
Commercial Driver License Yes
Endorsements None
Employment / Unemployment
Us Foods (all Former/current Employees)
Company Us Foods (all Former/current Employees)
Start Date 04-2017
End Date 05-2023
Address 9399 West Higgins Road
City, State/Province Zip/Postal Rosemont, IL 60018 Country United States
Phone 847-***-****
Fax 866-***-****
Position Held Delivery Driver
Reason for leaving? CBD use Terminate
Were you terminated/discharged/laid off? Yes
Termination Explanation CBD use
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Local
Miles driven weekly 500-1000
Most common truck driven Tractor-Trailer
Most common trailer Reefer
Trailer length 40 feet or more
Hub Group Trucking
Company Hub Group Trucking
Start Date 02-2015
End Date 03-2017
Address 5660 Universal Drive
Address 2 8575 S. Central Expressway
City, State/Province Zip/Postal Memphis, TX 38118
Country United States
Phone 866-***-****
Position Held Driver
Reason for leaving? Currently employed
Were you terminated/discharged/laid off? No
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 Regional
Miles driven weekly 2000-2500
Most common truck driven Tractor-Trailer
Most common trailer Container
Trailer length 53 feet or more
Hub Group Trucking
Company Hub Group Trucking
Start Date 03-2015
End Date 07-2016
Address S. central expwy
City, State/Province Zip/Postal Dallas, TX 75241
Country United States
Phone 214-***-****
Position Held Regional Driver
Reason for leaving? Still employed
Were you terminated/discharged/laid off? No
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 LA,OK,AR,TX
Miles driven weekly 1500-2000
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
PJ Food Service
Company PJ Food Service
Start Date 02-2015
End Date 02-2015
Address 2002 PAPA JOHNS BLVD
Address 2 highway 360 Grand Prairie, TX
City, State/Province Zip/Postal Louisville, KY 40299 Country United States
Phone 919-***-****
Fax 919-***-****
Position Held Driver
Reason for leaving? currently employed
Were you terminated/discharged/laid off? No
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 TX
Miles driven weekly 0-500
Most common truck driven Tractor-Trailer
Most common trailer Reefer Trailer
Trailer length 45 to 52 feet
Unemployment
Start Date 08-2014
End Date 01-2015
Comment Took time off to take care of spouse and
kids. Spouse bad asthma. Now under
control.
Grocers Supply Co
Company Grocers Supply Co
Start Date 05-2006
End Date 08-2014
Address POBox 14200
City, State/Province Zip/Postal Houston, TX 77221
Country United States
Phone 800-***-****
Fax 713-***-****
Position Held Driver
Reason for leaving? spouse had midical issue took time off take care of family
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven TX,LA,OK,AR
Miles driven weekly 3500+
Most common truck driven Tractor-Trailer
Most common trailer Reefer Trailer
Trailer length 53 feet or more
Cardinal Health
Company Cardinal Health
Start Date 06-2005
End Date 05-2006
Address interstate 20
City, State/Province Zip/Postal Grand Prairie, TX 75052 Country United States
Phone 972-***-****
Position Held Driver
Reason for leaving? looking for better pay
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Yes
Did you operate a commercial motor
vehicle?
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 TX,
Miles driven weekly 1500-2000
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 45 to 52 feet
J.B. Hunt transportation
Company J.B. Hunt transportation
Start Date 01-2005
End Date 05-2005
Address 5701 W. Kiest Blvd
City, State/Province Zip/Postal Dallas, TX 76071
Country United States
Phone 214-***-****
Position Held Driver
Reason for leaving? looking for local job
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven OTR
Miles driven weekly 2500-3000
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Trucking School
Start Date 08-2004
End Date 09-2004
School Arkansas State University truck Driving
School
Address
Address 2
City, State/Province Newport, AR
Country United States
Phone
Did you graduate? Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while attending this truck
school?
Yes
Did you perform any safety sensitive
functions at this truck school, regulated by
DOT, and subject to drug and alcohol
testing?
Yes
GPA 98
Hours of Instruction 200
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]
Yes
Please provide additional detail:
Need RTD drug test
Has your license, permit or privilege to
drive ever been suspended or revoked for
any reason? [49 CFR 391.21(b)(9)]
Yes
Please provide additional detail, including the dates of the suspension(s)/revocation(s): Tested positive after use of CBD product
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)]
Yes
Please provide additional detail about what happened: CBD use
Date of last positive or refusal: 04-10-2023
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
·
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
·
No
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?
Type of Accident / Incident Non-Injury
Date of Accident / Incident 03-2013
Hazmat Accident / Incident No
Was the vehicle towed away? Yes
City Balch Springs
State/Province TX
Were you in a commercial vehicle? No
If yes, was this a Department of
Transportation recordable accident?
Were you at fault? No
Were you ticketed? No
Description Another vehicle turn in front of me
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 3 years? No Violations
Criminal Record
READ THIS SECTION CAREFULLY BEFORE ANSWERING THE NEXT QUESTIONS: CRIMINAL BACKGROUND - STATE, CITY, AND COUNTY-SPECIFIC NOTICES: Do not answer the question below unless: (1) you are applying for a position for which a state or local agency is otherwise required by state or federal law to conduct a conviction history background check; (2) you are applying for a position with a criminal justice agency, as defined by Section 13101 of the California Penal Code; (3) you are applying for position as a Farm Labor Contractor, as described in Section 1685 of the California Labor Code; or (4) you are apply for a position where an employer or an agent thereof is required by any state, federal, or local law to conduct criminal background checks for employment purposes or to restrict employment based on criminal history. For purposes of this paragraph, federal law shall include rules or regulations promulgated by a self-regulatory organization as defined in Section 3(a)(26) of the Securities Exchange Act of 1934, as amended by the 124 Stat. 1652 (Public Law 111-203), pursuant to the authority in section 19(b) of the Securities Exchange Act of 1934, as amended by 124 Sta. 1652 (Public Law 111-203). California Applicants: Do not Identify convictions under California Health & Safety Code Section 11357(b) or (c), 11360(b) (formerly subdivision (c) of section 11360), 11364, 11365, or 11550, related to marijuana offenses that occurred two (2) or more years before the date of this application. Also, do not identify any conviction for which the record has been judicially ordered sealed, expunged or statutorily eradicated, any misdemeanor conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, or any referral to or participation in a pre-trial or post-trial diversion program. California - San Francisco, CA Applicants: Do not answer the question below unless it is required by federal or state law. Do not disclose a conviction that has been expunged or made inoperative, any juvenile justice conviction, or a conviction more than seven years old unless required to do so by state or federal law. California - Los Angeles, CA Applicants: Do not answer the question below. Connecticut Applicants: Applicants for employment are not required to disclose the existence of any arrest, criminal charge, or conviction for which the records have been erased in accordance with the provisions of Connecticut State Law. Records subject to erasure are records pertaining to a finding of delinquency or that a child was a member of a family with service needs, an adjudication as a youthful offender, a criminal charge that has been dismissed or nulled (not prosecuted), a criminal charge for which a person has been found guilty, or a conviction for which a person received an absolute pardon. Any person whose criminal records have been erased in accordance with the provisions of Connecticut State Law shall be deemed to have never been arrested within the meaning or Connecticut General Statutes and may so swear by oath. Do not answer the question below unless (1) the employer is required to ask about your criminal record by state or federal law; or (2) a security or fidelity bond is required for the position for which you are applying.
Georgia Applicants: Do not identify records of crimes for which you were a "first offender" and were exonerated and discharged without a court adjudication or guilt. Hawaii Applicants: You are NOT required to respond to questions about your conviction records until after the Company has made you a conditional offer of employment. At that time, the Company may and will inquire about and consider your conviction records from the previous 10 years that bear a rational relationship to job(s) for which you are applying.
Illinois Applicants: Do not answer the question below unless (1) you are applying for a position for which the employer is required by state or federal law to exclude from employment applicants with criminal convictions; (2) you are applying for a position for which a standard fidelity bond or equivalent is required and you have been convicted of a specified offense that would disqualify you from obtaining such a bond; or (3) you are applying for a position that requires you to be licensed under the Emergency Medical Services (EMS) Systems Act.
Illinois - Cook County, IL Applicants: Do not answer the question below unless: (1) you are applying for a position for which the employer is required by state or federal law to exclude from employment applicants with criminal convictions; (2) you are applying for a position for which a standard fidelity bond or equivalent is required and you have been convicted of a specified offense that would disqualify you from obtaining such a bond;
Illinois - Chicago, IL Applicants: Do not answer the question below unless (1) you are applying for a position for which the employer is required by state or federal law to exclude from employment applicants with criminal convictions; (2) you are applying for a position for which a standard fidelity bond or equivalent is required and you have been convicted of a specified offense that would disqualify you from obtaining such a bond; or (3) you are applying for a position that requires you to be licensed under the Emergency Medical Services (EMS) Systems Act.
Kentucky Applicants: Do not identify misdemeanor convictions more than five (5) years old as of the date of this application.
Maryland Applicants: UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUlLTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
Maryland - Baltimore, MD Applicants: Do not answer the question below unless (1) you are applying for a position for which the employer is required by state or federal law to inquire about your criminal history; or (2) you are applying for a position at a facility or with an employer that provides programs, services, or direct care to minors or vulnerable adults.
Maryland - Montgomery County, MD Applicants: Do not answer the question below unless (1) the question is expressly authorized by federal, state, or county law or regulation; or (2) you are applying for a position with an employer that provides programs, services, or direct care to minors or vulnerable adults; or (3) you are applying for a position that requires a federal government security clearance. Maryland - Prince George's County, MD Applicants: Do not answer the question below unless (1) you are applying for a position for which the employer is authorized by state or federal law to exclude from employment those applicants with criminal convictions; (2) you are applying for a position with any County public safety agency, or to positions, in the judgement of the County, have access to confidential or proprietary or personal information, money or items of value, or involve emergency management;
(3) you are applying to a position that provides programs, services or direct care to minors or vulnerable adults.
Massachusetts Applicants: You are NOT required to provide information regarding your conviction records until the interview stage of the hiring process. At that time, the Company may and will inquire about and consider your conviction records in accordance with Massachusetts state law. By law this inquiry cannot include: First conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray, or disturbance or the peace;
·
Conviction of a misdemeanor where the date or such conviction or the completion of any period of incarceration resulting therefrom, whichever date is later, occurred five (5) or more years prior to the date of such application for employment or such request for information, unless such person has been convicted or any offense within five (5) years immediately preceding the date or such application for employment or such request for information; or
·
· Sealed records or juvenile offenses.
An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. An applicant for employment with a sealed record on file with the commissioner of probation may answer 'no record' to an inquiry herein relative to prior arrests or criminal court appearances. In addition, any applicant for employment may answer 'no record' with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases or delinquency or as a child in need of services which did not result in a complaint transferred to the superior court for criminal prosecution.
It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liabilities. Missouri - Columbia, MO Applicants: Do not answer the question below unless (1) you are applying for a position for which the employer is required by local, state or federal law to exclude from employment any applicants with certain criminal convictions; (2) you are applying for a position for which a standard fidelity bond or equivalent is required and you have been convicted of a specified offense that would disqualify you from obtaining such a bond; or (3) you are applying for a position that requires you to be licensed under the Emergency Medical Services (EMS) Systems Act. Missouri - Kansas City, MO Applicants: Do not answer the question below unless you are applying for a position for which the employer is required to exclude applicants with certain criminal convictions from employment due to local, state, or federal law or regulation.
Missouri - St. Louis, MO Applicants: Do not answer the question below unless you are applying for a position for which the employer is required by federal or state laws and regulations, or city ordinance to exclude applicants with certain criminal convictions from employment due to local, state, or federal law or regulation. Minnesota Applicants: Do not answer the question below unless you are applying for a position as to which the employer is required by a statute to conduct a criminal background check or otherwise must take into consideration a potential employee's criminal history during the hiring process.
New Jersey Applicants: Do not answer the question below unless you are applying for a position (1) where a criminal history record background check is required by law, rule or regulation; (2) where your arrest or conviction for one or more crimes or offenses would or may preclude you from holding that position under any law, rule or regulation; or (3) where any law, rule, or regulation restricts an employer's ability to engage in specified business activities based on the criminal records of its employees. New York - Buffalo, NY Applicants: Do not answer the question below (1) unless you are applying for a position that requires a license and the trade or licensing body asks the same question; (2) except to disclose any convictions or violations that would bar your employment in the position for which you are applying under state or federal law; or (3) unless you are applying to a position with a school or other facility that provides care or supervision to children, young adults, senior citizens, or the physically or mentally disabled.
Rhode Island Applicants: Do not answer the following question unless (i) state or federal law disqualifies an applicant from employment due to certain criminal histories; or (ii) a standard fidelity bond is required for the position, and the applicants criminal convictions would disqualify him or her from obtaining the bond. New York - New York City, NY Applicants: Do not answer the question below unless you are applying for a position for which federal, state or local law requires a criminal background check to be obtained or which bars employment in a particular industry based on criminal history.
New York - Rochester, NY Applicants: Do not answer the question below (1) unless you are applying for a licensed position for which employers are required to inquire about applicants' criminal histories by the licensing authority or state or federal law; (2) except to disclose any convictions or violations that would bar your employment in the position for which you are applying under state or federal law. Do not disclose any conviction that was sealed unless the inquiry is specifically required or permitted by state or federal law.
Ohio Applicants: Convictions for certain minor misdemeanor marijuana violations do not constitute a criminal record and need not be reported in response to employer inquiries. Please consult Ohio Rev. Code Section 2925.04 to see If this provision applies to you before responding.
Oregon Applicants: Do not answer the question below unless (1) you are applying for a position where federal, state or local law, including corresponding rules and regulations, requires the consideration of an applicant's criminal history; (2) you are applying for a position with a law enforcement agency; (3) you are applying to a position in the criminal justice system; or (4) are applying for a non-employee volunteer position. Oregon - Portland, OR Applicants: Do not answer the question below unless (1) you are applying for a position with a law enforcement agency; (2) you are applying for a position with direct access to children, the elderly, or the disabled; or (3) you are applying for a positon which presents public safety concerns. Pennsylvania - Philadelphia, PA Applicants: The Fair Criminal Record Screening Standards Ordinance prohibits an employer from making any inquiry or requiring any person to disclose or reveal any Criminal convictions during the application process, which begins when the applicant inquires about the employment being sought and ends when an employer makes a conditional offer of employment. An employer may not make any inquiries regarding or require any person to disclose or reveal any criminal convictions or ask if the applicant is willing to submit to a criminal records check until a conditional offer of employment has been made (9 Phil Code Section 9-3500,et seq.). Rhode Island Applicants: Do not answer the following question unless (i)