Start Date Commercial Motor

Location:

Harrisonburg, VA

Posted:

September 11, 2023

Contact this candidate

Resume:

Riverside Transportation Inc

**** *. ******* **

Rockport, IN 47635

913-***-****

**-**-**** *:45:26PM CDT

IntelliApp

Thank you for your interest in Riverside Transportation Inc. Riverside Transportation has many terminals across the Central United States. Orientation takes place in Kansas City, KS.

To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

Personal Information

Referral Code: AllTruckingAssistant

Name Samuel Rohrer Kato

Residence 3 years or longer (If No,

previous addresses shown below)

Yes

Current Address 5175 Briery Branch Rd

City, State/Province Zip/Postal Dayton, VA 22801

Country United States

Residence 3 years or longer (If No,

previous addresses shown below)

Yes

SSN/SIN 7843

Date of Birth

Primary Phone 540-***-****

Cell Phone 540-***-****

Best time to contact you Any

Email ******.**********@*****.***

Yes, I agree to receive information

concerning future opportunities or

promotions from Riverside Transportation

Inc by email or other commercial electronic

communications.

Yes

Would you like to receive communication

from Riverside Transportation Inc via text

message?

Yes

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 Riverside

Transportation Inc's service provider

receives in real time and logs your text

messages with Riverside Transportation

Inc.

Company Questions

GENERAL INFORMATION

What position are you applying for? Company Driver Driver Trainer's Name

Did you answer "Owner Operator" or "Fleet

Owner" above?

EQUIPMENT (OWNER/OPERATORS ONLY)

Equipment Description (Tractor):

Type:

Year:

Make:

Model:

Color:

VIN:

Unladen Weight:

Purchase Price:

Purchase Date:

Are you legally eligible for employment in

the United States?

Yes

Are you currently employed? No

What date did your last employment end? 09-07-2023 Do you read, write, and speak English? Yes

Have you ever worked for this company

before?

Enter start and end dates, location,

position, and reason for leaving:

Do you have a current Passport? Yes

Expiration date: 09-15-2028

Please enter the names of any relatives

employed here:

N/A

Have you ever been known by any other

name?

Enter name:

How did you hear about us? Online Craigslist

If "Driver Referral", please enter the

driver's name

N/A

If "Other", please explain N/A

In case of Emergency, notify (list name,

address, and phone):

Dad 540-***-****

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: No

Type of Equipment (van, reefer, tank, etc.):

Start Date:

End Date:

Approximate Number of Total Miles:

Tractor and Semi-Trailer: Yes

Type of Equipment (van, reefer, tank, etc.):

Start Date: 02-23-2020

End Date: 09-07-2023

Approximate Number of Total Miles: 500,000.00

Tractor - Two Trailers: No

Type of Equipment (van, reefer, tank, etc.):

Start Date:

End Date:

Approximate Number of Total Miles:

Other:

Which safe driving awards do you hold and

from whom?

EDUCATION

List highest grade completed: College - 5+

List last school attended (name, city, and

state):

UCU

Have you registered for the

Clearinghouse?

Licenses

License Number 340

Licensing Authority VA

Country US

License Class

License Expiration Date 09-15-2026

Physical Expiration Date

Current License Yes

Commercial Driver License No

Endorsements

Tanker Endorsement No

HAZMAT Endorsement No

X Endorsement No

Doubles Triples Endorsement No

Other Endorsement No

Employment / Unemployment

Sysco

Company Sysco

Start Date 06-2022

End Date 09-2023

Address 5081 S valley pike

City, State/Province Zip/Postal St Paul, MN 22801

Country United States

Phone 540-***-****

Position Held Driver

Reason for leaving? N/A

Were you terminated/discharged/laid off? Yes

Termination Explanation Three mistaken in same week 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 Virginia

Miles driven weekly 1000-1500

Hours Per Week 65

Most common truck driven Tractor-Trailer

Most common trailer Reefer Trailer

Trailer length 53 feet or more

CRST International, Inc.

Company CRST International, Inc.

Start Date 04-2022

End Date 06-2022

Address 3930 16th Avenue SW

City, State/Province Zip/Postal Cedar Rapids, IA 52404 Country United States

Phone 319-***-****

Position Held Drive

Reason for leaving? Better pay

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?

Did you perform any safety sensitive

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Yes

Areas Driven Mississippi Georgia Indiana Florida

Virginia Penns

Miles driven weekly

Hours Per Week

Most common truck driven Tractor-Trailer

Most common trailer Other

Trailer length

Unemployment

Start Date 02-2022

End Date 03-2022

Comment Volunteering at the church

VPGC LLC

Company VPGC LLC

Start Date 11-2021

End Date 01-2022

Address PO BOX 228

City, State/Province Zip/Postal Hinton, VA 22831

Country United States

Phone 866-***-****

Position Held wherehouse

Reason for leaving? I got my dreaming job

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?

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

Hours Per Week

Most common truck driven

Most common trailer

Trailer length

Unemployment

Start Date 10-2021

End Date 10-2021

Comment I was volunteer at church

Marco Metals

Company Marco Metals

Start Date 10-2020

End Date 09-2021

Address PO BOX 2245

City, State/Province Zip/Postal Harrisonburg, VA 22801 Country United States

Phone 877-***-****

Position Held Driver

Reason for leaving? To put on short pants

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?

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

Hours Per Week

Most common truck driven

Most common trailer

Trailer length

Unemployment

Start Date 08-2020

End Date 09-2020

Comment I wanted to spending time with my family

and also Xmas seasos

VPGC LLC

Company VPGC LLC

Start Date 08-2018

End Date 07-2020

Address PO BOX 228

City, State/Province Zip/Postal Hinton, VA 22831

Country United States

Phone 866-***-****

Position Held wherehouse

Reason for leaving? little pay

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?

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

Hours Per Week

Most common truck driven

Most common trailer

Trailer length

Unemployment

Start Date 12-2017

End Date 07-2018

Comment My parents are work on my paperwork of

adopt me in the time such that I be in USA

with them. that why I had nothing to do.

Trucking School

Start Date 04-2022

End Date 04-2022

School CDL Tennessee school

Address

Address 2

City, State/Province Louisville,tn 37777, TN

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?

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 170

Border Crossing No

Log Books No

Federal Motor Carrier Regulations No

Hazardous Materials No

Education

School Name Uganda Christian University

Start Date 08-2014

End Date 11-2017

City, State/Province Mukono, KA

Country UG

What did you study? Mechanical Engineering

Phone 631-***-****

Graduation Date 08-2018

FMCSR

Under FMCSR 391.15, are you currently

disqualified from driving a commercial

motor vehicle? [49 CFR 391.15]

Has your license, permit or privilege to

drive ever been suspended or revoked for

any reason? [49 CFR 391.21(b)(9)]

Have you ever been denied a license,

permit, or privilege to operate a motor

vehicle?[49 CFR 391.21(b)(9)]

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)]

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

Vehicle Accident Record

Were you involved in any accidents/incidents with any vehicle in the last 5 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 Samuel Rohrer Kato

IP Address 2607:fb91:14af:4

Signature Date/Time 09-07-2023 4:45 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: 09-07-2023 4:45 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

Yes

demonstrate my consent. An electronic

signature is as legally binding as an ink

signature.

PSP Disclosure and Authorization

By checking the box, I (a) acknowledge

that I have read and understand the PSP

Disclosure and Authorization and also

have been given the opportunity to

copy/print it, and (b) agree to use an

electronic signature to demonstrate my

consent. An electronic signature is as

legally binding as an ink signature.

Yes

FCRA Disclosure 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

Yes

User requested a copy to be sent to this

email address

******.**********@*****.***.

DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND

INVESTIGATION FOR EMPLOYMENT PURPOSES

Disclosure

Riverside Transport Inc., Riverside Transportation LLC, Riverside Transportation Inc., RTI Dedicated LLC, Mid American Specialized Trucking LLC (the "Company") and/or Asurint may request from a consumer reporting agency and for employment-related purposes, a

"consumer report(s)" (commonly known as "background reports") containing background information about you in connection with your employment or application for employment (including independent contractor or volunteer assignments, as applicable). Asurint, Inc. ("Asurint") will prepare or assemble the background reports for the Company. Asurint is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, 800-***-****, www.asurint.com. The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.

Authorization

I hereby authorize Company to obtain the consumer reports described above about me. Printed Name:

Samuel Rohrer Kato

Social Security #:

7843

Signed Date: 09-07-2023

Samuel Rohrer Kato

5175 Briery Branch Rd

Dayton, VA 22801

540-***-****

Gender:

IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Riverside Transport Inc., Riverside Transportation LLC, Riverside Transportation Inc., RTI Dedicated LLC, Mid American Specialized Trucking LLC ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization. AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Riverside Transport Inc., Riverside Transportation LLC, Riverside Transportation Inc., RTI Dedicated LLC, Mid American Specialized Trucking LLC ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above. Printed Name:

Samuel Rohrer Kato

Signed Date: 09-07-2023

Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

I hereby provide consent to Riverside Transportation 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 Riverside Transportation 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 Riverside Transportation Inc to conduct a limited query of the Clearinghouse, Riverside Transportation 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 Riverside Transportation Inc indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Riverside Transportation Inc unless I give additional specific consent within the Clearinghouse. However, I understand that Riverside Transportation 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.

09-07-2023

Samuel Rohrer Kato Date

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 09-07-2023

Date

X 7843

Social Security Number

Samuel Rohrer Kato

5175 Briery Branch Rd

Dayton, VA 22801

540-***-****

Gender:

X Samuel Rohrer Kato

Print Name (First, MI, Last)

Signature

I, the above mentioned signer, hereby authorize Sysco To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Riverside Transportation 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 carriers (company/school) listed above to Riverside Transport Inc, and/or Asurint for the sole purpose of transmitting such records to Riverside Transport Inc. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers (company/school) 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 Riverside Transport Inc., Riverside Transportation LLC, Riverside Transportation Inc., RTI Dedicated LLC, Mid American Specialized Trucking LLC or Asurint to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Riverside Transport Inc or Asurint with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years.

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 09-07-2023

Date

X 7843

Social Security Number

Samuel Rohrer Kato

5175 Briery Branch Rd

Dayton, VA 22801

540-***-****

Gender:

X Samuel Rohrer Kato

Print Name (First, MI, Last)

Signature

I, the above mentioned signer, hereby authorize CRST International, Inc. To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Riverside Transportation Inc DISCLOSURE AND RELEASE

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 09-07-2023

Date

X 7843

Social Security Number

Samuel Rohrer Kato

5175 Briery Branch Rd

Dayton, VA 22801

540-***-****

Gender:

X Samuel Rohrer Kato

Print Name (First, MI, Last)

Signature

I, the above mentioned signer, hereby authorize CDL Tennessee school To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Riverside Transportation Inc DISCLOSURE AND RELEASE

Contact this candidate