United States Cell Phone
Resume:
Personal Information
Referral Code: pulse_app
Name Roger W Scott
Current Address **** ******** **
Address * ************
City, State/Province Zip/Postal San Antonio, TX 78228-3740 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 5822
Date of Birth
Primary Phone 210-***-****
Cell Phone 210-***-****
Email *************@*****.***
Yes, I agree to receive information
concerning future
email or other commercial
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
real time and logs your text messages with
Yes
1
Company Questions
GENERAL INFORMATION
What position are you applying for? Company Driver If you answered "Owner Operator" or
"Fleet Owner", select yes.
No
EQUIPMENT (OWNER/OPERATORS ONLY)
Equipment Description (Tractor):
Type:
Year:
Make:
Model:
Color:
VIN:
Weight
Mileage
Fifth Wheel Height
What location are you applying for? Texas
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? Yes
What date did your last employment end?
Do you read, write, and speak English? Yes
Have you ever worked for this company
before?
No
Enter start and end dates, location,
position, and reason for leaving:
Do you have a current TWIC card? No
Expiration date:
Have you ever been known by any other
name?
No
Enter name:
How did you hear about us? Web
If "Driver Referral", please enter the
driver's name
Na
If "Other", please explain Na
DRIVING EXPERIENCE
2
For each class of equipment, select years of experience. If no experience in a class, select "None".
Straight Truck 10+ years
Tractor and Semi-Trailer 10+ years
Tractor - Two Trailers 10+ years
Other 40yrs
Licenses
License Number 584
Licensing Authority TX
Country US
License Class Class A
License Expiration Date 05-03-2032
DOT Medical Card Expiration Date 03-11-2027
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement Yes
Other Endorsement No
Employment / Unemployment
Core transport
Company Core transport
Start Date 05-2023
End Date 08-2025
Address 4938 Driskill St
City, State/Province Zip/Postal San Antonio, TX 78228- Country United States
Phone 210-***-****
Position Held Associate
Reason for leaving? Part-time.
3
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?
No
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
No
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
No
Areas Driven na
Miles driven weekly 0-500
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length Other
Southern Mail Service, Inc.
Company Southern Mail Service, Inc.
Start Date 06-1988
End Date 04-2023
Address 2505 N FRAZIER
Address 2 3928
City, State/Province Zip/Postal Houston, TX 77303
Country United States
Phone 936-***-****
Position Held Class A Driver
Reason for leaving? Lay off
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
Yes
4
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 OTR
Miles driven weekly 3500+
Pay Range (cents/mile) 30hrs
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 45 feet or longer
FMCSR
Under FMCSR 391.15, are you currently
disqualified from driving a commercial
motor vehicle? [49 CFR 391.15]
No
Has your license, permit or privilege to
drive ever been suspended or revoked for
any reason? [49 CFR 391.21(b)(9)]
No
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)]
No
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
·
No
5
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
Criminal Record
Have you ever been convicted of a crime? No
Do you have any deferred prosecutions? No
Do you have criminal charges pending? No
Have you ever pled "guilty" to, been
convicted of, or pled "no contest" to a
felony?
No
If you have any felony convictions, do you
currently hold a minister's permit to enter
or exit Canada?
No
Have you, within the last five years, pled
"guilty" to, been convicted of, had
prosecution deferred in connection with, or
pled "no contest" to a misdemeanor?
No
6
Signature
Full Name Roger W Scott
IP Address 172.71.170.169
Signature Date/Time 08-08-2025 2:59 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: 08-08-2025 2:59 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
FCRA Disclosure
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
7
FCRA 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
Summary of Rights Under 15 U.S.C. Section 1681m(a) By checking this box, I represent that I
understand and agree to the above
language.
Yes
INVESTIGATIVE CONSUMER REPORT DISCLOSURE
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 *************@*****.***.
Yes
8
DISCLOSURE FOR CONSUMER REPORTS
In connection with your employment or owner-operator (independent contractor) application, Balkan Express LLC/TCS may order one or more consumer report(s) (commonly known as "background reports" or "background checks") about you from one or more consumer reporting agencies. If you are hired or engaged as an owner-operator (independent contractor), additional consumer reports may be obtained in connection with and throughout your employment for employment purposes or for the legitimate business purpose of evaluating you as an owner-operator.
To the extent allowed by law, the consumer reports may include information concerning your character, general reputation, personal characteristics, mode of living, drug and alcohol test results, motor vehicle records, driving records, criminal history, public court records, employment history (including names and dates of previous employers, reason for termination of employment, work experience, and accidents), social security number validation, education, licensure, or verification of other information supplied by you. Such reports may be obtained from private and public record sources, including sanctions databases, CDLIS (including but not limited to CDLIS Central Site, CDLIS Master Pointer Record data and your driver record from the jurisdiction identified in the CDLIS data, in accordance with applicable state law and the Driver Privacy Protection Act), former employers, public court records, and federal, state, and other government agencies that maintain such records. Printed Name:
Roger W Scott
Social Security #:
5822
Signed Date: 08-08-2025
Roger W Scott
4938 Driskill St
4938driskill
San Antonio, TX 78228-3740
9
AUTHORIZATION FOR CONSUMER REPORTS
I authorize Balkan Express LLC/TCS to obtain one or more consumer report(s) or investigative consumer report(s) about me. If hired or engaged as an owner-operator (independent contractor), I understand this authorization shall remain on file and shall serve as ongoing authorization for additional consumer reports or investigative consumer reports to be obtained from any consumer reporting agency at any time during my employment or contract period without asking me for authorization again. Printed Name:
Roger W Scott
Social Security #:
5822
Signed Date: 08-08-2025
Roger W Scott
4938 Driskill St
4938driskill
San Antonio, TX 78228-3740
10
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Balkan Express 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 Balkan Express 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:
Roger W Scott
Signed Date: 08-08-2025
11
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Balkan Express LLC 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 Balkan Express LLC 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 Balkan Express LLC to conduct a limited query of the Clearinghouse, Balkan Express LLC 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 Balkan Express LLC indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Balkan Express LLC unless I give additional specific consent within the Clearinghouse. However, I understand that Balkan Express LLC 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.
08-08-2025
Roger W Scott Date
12
Request/Consent for Information from Previous Employer(s)/Carrier(s) For Safety Performance History pursuant to 49 CFR Section 391.23 of the FMCSA regulations X 08-08-2025
Date
X 5822
Social Security Number
Roger W Scott
4938 Driskill St
4938driskill
San Antonio, TX
78228-3740
X Roger W Scott
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Southern Mail Service, Inc. To release and forward in accordance with the following regulation, all known information pertaining to my Safety Performance History to Balkan Express LLC
DISCLOSURE AND AUTHORIZATION UNDER 49 C.F.R. PART 391.23 INCLUDING DOT DRUG AND ALCOHOL INFORMATION
For purposes of an investigation in accordance with 49 C.F.R. Part 391.23, I authorize my previous employers, contractors (if owner-operator), and trucking schools, as applicable, to release and forward to Balkan Express LLC/TCS ("Company") the following information for the past three (3) years:
1. DOT alcohol and controlled substance information in accordance with Parts 382 and 40 of the Federal Motor Carrier Safety Regulations (49 CFR Part 382 and 49 CFR Part 40, Section 40.25) limited to the following DOT regulated testing items, including pre-employment testing results: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested;
(iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation. 2. Safety performance history information in accordance with 49 CFR Part 391.23, which includes: employment dates, work history
(which may include position held, reason for leaving, any termination information, whether subject to the Federal Motor Carrier Safety Administration regulations, equipment experience, area driven, and other information as applicable) and accident information
(including accident date, nature of accident, whether it was preventable, whether there were injuries, fatalities, or hazardous materials involved, and copies of any accident report).
Pursuant to Section 391.23(i) of the Federal Motor Carrier Safety Regulations, you have the following rights with regard to the information released:
1. You have the right to make a written request at any time to review the information provided by previous employers, contractors (if owner-operator), or trucking schools, as applicable. 2. You have the right to have errors in the information corrected by the previous employer, contractor (if owner-operator), or trucking school, as applicable and for that employer, contractor (if owner-operator), or trucking school to re-send the corrected information. 3. You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer, contractor (if owner-operator), or trucking school and you cannot agree on the accuracy of the information. 13
Summary of Rights Under 15 U.S.C. Section 1681m(a) You are hereby provided a summary of the following provisions of the Fair Credit Reporting Act, 15 U.S.C. 1681m(a): The following consumer reporting agencies will prepare the background report / consumer report for Balkan Express LLC
('Company'):
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
Phone: 877-***-****
Email: *******@*********.***
Web: http://www.tenstreet.com/drivers/
·
No consumer reporting agency utilized by the Company makes adverse decisions relating to your employment or contract relationship and no consumer reporting agency utilized by the Company is able to provide any specific reasons to you why an adverse decision relating to your employment or contract relationship may be taken or was taken based on a consumer report.
·
15 U.S.C. 1681j provides for the right to obtain a free copy of a consumer report on you from the consumer reporting agency which prepared your background report, under various circumstances, including but not limited to where you receive notice that an adverse action has been taken toward you based on the consumer report. In that instance, Section 1681j provides a right to a free copy of the report provided that you make the request within 60 days of the date that you received notice of the adverse action.
·
15 U.S.C. 1681i provides for the right to dispute, with a consumer reporting agency the accuracy or completeness of any information in a consumer report furnished by the agency.
·
Printed Name:
Roger W Scott
Social Security #:
5822
Signed Date: 08-08-2025
Roger W Scott
4938 Driskill St
4938driskill
San Antonio, TX 78228-3740
14
INVESTIGATIVE CONSUMER REPORT DISCLOSURE
Balkan Express LLC ("Company") will order an 'investigative consumer report' concerning you for employment purposes or, if you are an owner-operator (independent contractor), for the legitimate business purpose of evaluating your suitability for an independent contractor engagement pursuant to your written instructions. An 'investigative consumer report' is defined as a consumer report or portion thereof in which information on a consumer's character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with neighbors, friends, or associates of the consumer reported on or with others with whom he is acquainted or who may have knowledge concerning any such items of information.
The investigative consumer report the Company will order concerning you will contain information concerning your character, general reputation, personal characteristics, and mode of living, obtained through personal interviews. You have the right to request the additional disclosures provided for under the Fair Credit Reporting Act, 15 U.S.C. 1681d(b), which reads as follows:
Any person who procures or causes to be prepared an investigative consumer report on any consumer shall, upon written request made by the consumer within a reasonable period of time after the receipt by him of the disclosure required by subsection (a)(1) of this section, make a complete and accurate disclosure of the nature and scope of the investigation requested. This disclosure shall be made in a writing mailed, or otherwise delivered, to the consumer not later than five days after the date on which the request for such disclosure was received from the consumer or such report was first requested, whichever is the later. At present, the specific 'nature and scope' of the investigative consumer report the Company may request is as follows: Employment Verifications, Motor Vehicle Reports, CDLIS, Criminal Records, and PSP. The report(s) will be requested from the following: Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
Phone: 877-***-****
Email: *******@*********.***
Web: http://www.tenstreet.com/drivers/
You have the right to request whether an investigative consumer report was ordered. You can also make a written request for a complete and accurate disclosure of the nature and scope of the investigation that was requested, request a copy of the report, a copy of any federal or state local notices of rights that may apply to you, or request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries of each consumer reporting agency issuing an investigative consumer report about you, by sending a letter or email to the Company. You may also request and promptly receive from all such consumer reporting agencies free copies of any such investigative consumer reports. MARYLAND: You have the right to request additional disclosures from the Company regarding the nature and scope of the requested investigation.
MASSACHUSETTS: If you contact the Company, you have the right to know whether the Company ordered an investigative consumer report about you. You also have the right to ask the CRA for a copy of any such report. MINNESOTA: You have the right in most circumstances to submit a written request to the CRA for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The CRA must provide you with this disclosure within five business days after its receipt of your request or the report was requested by the Company, whichever date is later. NEW JERSEY: You have the right to submit a request to the CRA for a copy of any investigative consumer report the Company ordered about you.
NEW YORK: If you contact the Company, you have the right to know whether the Company ordered a consumer report or investigative consumer report about you. Shown above is the CRA's address and telephone number. You have the right to contact the CRA to inspect or receive a copy of any such report. A copy of Article 23-A of the Correction Law is provided in connection herewith. WASHINGTON STATE: If you submit a written request to the Company, you have the right to a complete and accurate disclosure of the nature and scope of any investigative consumer report the Company ordered about you. You are entitled to this disclosure within five business days after the date your request is received or we ordered the report, whichever is later. You also have the right to request a written summary of your rights under the Washington Fair Credit Reporting Act. 15
Printed Name:
Roger W Scott
Social Security #:
5822
Signed Date: 08-08-2025
Roger W Scott
4938 Driskill St
4938driskill
San Antonio, TX 78228-3740
16
DISCLOSURE FOR CONSUMER REPORTS
In connection with your employment or owner-operator (independent contractor) application, Balkan Express LLC/TCS may order one or more consumer report(s) (commonly known as "background reports" or "background checks") about you from one or more consumer reporting agencies. If you are hired or engaged as an owner-operator (independent contractor), additional consumer reports may be obtained in connection with and throughout your employment for employment purposes or for the legitimate business purpose of evaluating you as an owner-operator.
To the extent allowed by law, the consumer reports may include information concerning your character,
Contact this candidate