SECTION 2 – Notice To Driver Applicants on Controlled Substances Testing Requirement
NevCal Trucking has a vital interest in maintaining safe, healthful, and efficient working conditions for our customers, the public, and our drivers. Using or being under the influence of alcohol and/or controlled substances on the job may pose serious safety and health risks not only for the user, but to all those who work with the user. The possession, use, or sale of alcohol or an illegal controlled substance poses unacceptable risks to safe, healthful, and efficient operations.
To meet this compelling interest, and in compliance with the Department of Transportation’s Alcohol and Controlled Substance Testing Requirements (49 CFR Part 382) drivers who wish to be considered for employment must agree to SUBMIT TO PRE-EMPLOYMENT CONTROLLED SUBSTANCE TESTING.
By completing and signing this Notice and the attached Application of Employment, the driver applicant understands and agrees to submit to pre-employment controlled substances testing as provided for in NevCal Trucking’s Alcohol and Controlled Substances Policy.
ANY DRIVER APPLICANT WHO IS UNWILLING TO AGREE TO THESE CONDITIONS SHOULD NOT APPLY FOR EMPLOYMENT WITH NEVCAL TRUCKING. Refusal of a driver applicant to agree to controlled substances testing at this time does not preclude applying for employment with NevCal Trucking at some future date.
Printing your First Name + Middle Initial + Last Name will act as your digital signature for fully understanding and accepting Section 3.
SECTION 4 Acknowledgement
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. {Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connections with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
“I understand that information I provide regarding current and/or previous employers may be used, and those employees) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:
Printing your First Name + Middle Initial + Last Name will act as your digital signature for fully understanding and accepting the Section 4 Acknowledgement.
*Class of Equipment (ie Straight Truck, Tractor & Semi-Trailer, Tractor-2 Trailers, Tractor-3 Trailers, Motor Coach-School Bus with more than 8 passengers, Motor Coach-School Bus with More than 15 Passengers, Other),
**Type of Equipment (ie Van, Reefer, Tank, Flat, N/A)
MANDATORY USE FOR ALL ACCOUNT HOLDERS IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service
1. In connection with your application for employment with (“Fundis Company d.b.a NEVCAL Trucking”), 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.
The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing.
If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:
2. I authorize (“Fundis Company d.b.a NEVCAL Trucking”) 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 consenting to 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.
3. 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 am challenging 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.
4. Please note: 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 FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.
NOTICE: This form is made available to monthly account holders by NICT on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language provided in paragraphs 1 -4 of this document to obtain an Applicant’s consent. The language must be used in whole, exactly as provided. The language may be included with other consent forms or language at the discretion of the account holder, provided the four paragraphs remain intact and the language is unchanged.
LAST UPDATED 10/29/2012
Printing your First Name + Middle Initial + Last Name will act as your digital signature certifies that this entire application was completed by me, and that all entries on it and information in it are true, agreed upon and complete to the best of my knowledge