Driver Application

Driver Application for Shoreline Transfer

 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.
TO BE READ AND SIGNED BY APPLICANT

I understand that information I provide regarding current and/or previous employers may be used, and those
employer(s) will be contacted, for the purpose of investigating my safety performance history as required by
CFR 391.23(d) and (e). I understand that I have the right to: 

• Review information provided by previous employers;
• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if
  the previous employer(s)
  cannot agree on the accuracy of the information.

EMPLOYMENT HISTORY

All driver applicants to drive in interstate commerce must provide the following information on all employers
during the preceding 3 years. List complete mailing address, street number, city, state and zip code.
Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 years' information on those employers for whom the applicant operated such vehicle.
(NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

Employers:

*Includes vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 16 or more passengers
(including the driver), or any size vehicle used to transport hazardous materials in
a quantity requiring placarding.
+The Federal Motor Carrier Safety Regulations (FMCSRs) apply to
anyone operating a motor vehicle on a highway in
interstate commerce to transport passengers or property when the vehicle: (1)
weighs or has a GVWR of
10,001 pounds
or more, (2) is designed or used to transport more than 8 passengers (including the driver), OR (3)
is of
any size and is
used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

Experience and Qualifications - Driver

Drivers Licenses or permits in the past 3 years:

DRIVING EXPERIENCE

Class Of Equipment

Experience and Qualifications - Other

Education

Request For Information From Previous Employer

To release and forward the controlled substance and alcohol testing records within the previous 3 years from the date of my application noted above

Prospective Employer: Shoreline Transfer Express

Phone: 770-297-0235

Attention: Safety/HR

Address 195 Pearl Nix Parkway Gainesville Georgia

Fax: 770-297-8132

In compliance with 40.25(g) and 391.23(h), release of this information must be made inwritten form that ensures confidentiality such as fax, email, or letter.

DRIVER'S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23

Motor carriers have the responsibility to
make the following investigations and inquiries with respect to each driver
employed, other than a person who has been a regularly employed driver of
the motor carrier for a continuous
period, which began before January 1,
1971.
(a)(1) An inquiry into the driver's driving record during the preceding three years to
the appropriate agency
of every State in which the driver held a motor vehicle operator's license or permit during those three
years; and
(a)(2) An investigation of the driver's employment record during the preceding three years.
(b) A copy of the driver record(s) obtained in response to the inquiry or inquiries to each State driver
record agency as required must be placed in
the Driver Qualification File within 30 days of the date the driver's employment begins and be retained in compliance with 391.51.
(c) Replies to the investigations of the driver's safety performance history must be placed in the Driver
Investigation History File within 30 days of the date the driver's employment begins. This goes into effect
after October 29, 2004.
(d) Prospective motor carrier must investigate the information from all previous employers of the applicant
the employed the driver to operate a CMV within the previous three years. This information must cover
general driver identification and employment verification and employment verification information, data
elements as specified in 390.15 for accident involving the driver that occurred in the three-year period
preceding the date of the employment application and any accidents the previous employer may wish to
provide.
(e) Prospective motor carrier must investigate the information from all previous DOT regulated employers
that employed the driver within the previous three years from the date of the employment application in a safety-sensitive function that required alcohol and controlled substance testing specified by 49 CFR Part
40.
Drivers have the following rights:
The right to review information provided by previous employers.
The right to have errors in the information corrected by the previous employer and for that
previous employer to re-send the corrected information to the prospective employer.
The right to have a rebuttal statement attached to
the alleged erroneous information, if the previous
employer and the driver cannot agree on the accuracy of the information.
Drivers who wish to review previous employer-provided investigative information must submit a written request to the previous employer when applying or as late as 30 days after employed or being notified of
denial of employment. The prospective employer must provide this information to the applicant within five business days of receiving the written request. If
the driver has not arranged to pick up or receive the requested records within 30 days of the prospective employer making them available, the prospective employer may consider the driver to have
waived his/her request to review the records.
Drivers wishing to request correction of erroneous information in records must send the request for the correction to the previous employer that provided the records. After October 29, 2004, the previous employer must either correct and forward the information to the prospective motor carrier employer or notify the driver within 15 days of receiving the driyer's request to correct the data that it
does not agree to correct the data. Drivers wishing to rebut information in records must send the rebuttal to the previous employer with instruction to include the rebuttal in the driver's safety performance history.
I acknowledge that I have read and understand the contents of this document

HireRight.
DAC Trucking
Trucking Industry
DOT D/A Disclosure and Authorization
Send to Fax Number 800.257.8069

Part 1- Disclosure and Authorization for Release of Information  for Employment Purposes - 49 CFR Part 391.23, DOT Drug and Alcohol Testing:

In 'accordance with DOT Regulation 49 CFR Part 391.23, I hereby authorize release of my DOT-regulated drug and
alcohol testing records by the DOT-regulated employer(s) listed below to HireRight for the purpose of HireRight transmitting such records to the HireRight customer listed above. I understand that information/documents released
pursuant to this Part I is limited to the following DOT-regulated testing items, including pre-employment testing results,
occurring during the previous three (3) years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests;
(iii) refusals to be tested (including adulterated and/or substituted tests); (iv) other violations of DOT drug and alcohol
testing regulations (i.e., violations of 49 CFR 382 Subpart B); (v) information obtained from previous employers of a drug
and alcohol rule violation; and (vi) any documentation of completion of the return-to-duty process following a rule violation.
If any company listed below furnishes HireRight with information concerning items (i) through (vi) above, I also authorize such
company to furnish the following information to, HireRight, if applicable: (i) dates of my negative drug and/or alcohol tests and/
or tests with results below 0.04 during the previous three (3) years; and (ii) the name and telephone number of any substance
abuse professional who evaluated me during the previous three (3) years.

List allDOT-regulated employers you have applied with and/or worked for in a safety-sensitive function during
the previous three (3) years. If necessary, attach additional pages, including the date, your name, Social
Security number and signature.

By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully
understand this Part I disclosure and authorization for release as well as the attached FMCSA Notification of Driver Rights
and any applicable state law notices; (iii) prior to signing I was given an opportunity to ask questions and to have those
questions answered to my satisfaction; (iv) I execute this authorization voluntarily and with the knowledge that the
information obtained pursuant to this authorization could affect my eligibility for employment, promotion, retention or other
lawful purpose; (v) I understand I may review this document with legal counsel prior to signing; and (vi) facsimile or
photographic copies of this authorization are as valid as an original.

Motor Carrier Safety Administration (FMCSA)
Drug and Alcohol Clearinghouse

I, (applicant), hereby give my consent to Shoreline Transfer Express, LLC to inquire a background check from FMCSA Commercial Driver's
License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation
information about me exists in the Clearinghouse.
Iunderstand that if the limited query conducted by Shoreline Transfer Express, LLC
indicates that drug or alcohol violation information about me exists in the Clearinghouse,
FMCSA will not disclose that information to Shoreline Transfer Express, LLC without first
obtaining additional specific consent from me.
I further understand that if I refuse to provide consent for Shoreline Transfer Express, LLC to conduct a limited query of the Clearinghouse, Shoreline Transfer Express, LLC must
prohibit me from performing safety-sensitive functions, including driving a commercial
motor vehicle, as required by FMCSA's drug and alcohol program regulations