- Maiden Name (If Any)
- Last Name*
Previous Three Years Residency
License Information
Section 383.21 FMCSR states “No person who operates a commercial motor vehicle shall at any time have more than one driver’s license”. I certify that I do not have more than one motor vehicle license, the information for which is listed below.
Driving Experience
Straight Truck
Tractor & Semi-Trailer
Tractor-Two Trailers
Other
Accident Record For Past 3 Years Or More
Traffic Convictions and Forfeitures For the Past 3 Years (Other than parking violations)
Employee Record
Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record).
Must list the complete mailing address: street number and name, city, state and zip code.
Last Employer
Second Employer
Third Employer
TO BE READ AND SIGNED BY APPLICANT
I authorize you to make sure investigations and inquiries to 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 connection 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 employer(s) 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:
- Review information provided by current/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) and I cannot agree on the accuracy of the
information.”
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This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.
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Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations.
An Equal Opportunity Employer – Pre-Employment Application
Answer every question fully and accurately.
Educational Background
READ THE FOLLOWING CONDITIONS CAREFULLY AND SIGN TO INDICATE YOUR AGREEMENT
- I hereby certify that the information on this application is accurate. I understand that any false answers or statements or misrepresentations or omissions, made by me on the application or any related document, will be sufficient for rejection of my application or for my immediate discharge should such falsifications or misrepresentations be discovered at anytime after I am employed.
- I hereby agree that, if so requested by the Company, I will undergo a pre-employment physical examination (which may, at the discretion of the Company, include drug and alcohol testing) to determine whether I am physically qualified to perform my assigned job. If hired, I agree to undergo physical examinations, drug screens and random drug screens as may be requested by the Company, in accordance with applicable law. I understand that successful completion of all physical examinations (including, at the discretion of the Company, drug and alcohol testing) will be a condition of my employment and/or continued employment, in accordance with applicable law. I consent to the physician, testing agency and/or medical/facility releasing to the Company the results of all of these physical examinations and drug and alcohol testing.
- This application does not constitute an express or implied contract. If an employment relationship is established, the Company has the right to terminate my employment at any time with or without cause and I understand that I have a right to terminate my employment at any time with or without cause, and that these rights cannot be altered except by express written agreement signed by myself and an officer of the Company.
- If hired: 1) I agree to report anyone in the Company’s employ whose conduct is contrary to the best interests of the Company. 2) I agree to report any work related injury to my Manager or Supervisor within 24 hours of occurrence. 3) I agree to obey the rules and regulations of the Company at all times.
- I attest that the information provided herein is true and complete to the best of my knowledge. I hereby knowingly and voluntarily authorize the Company to investigate my past record as may be necessary, including verification of my social security number, and I release my former and current employers and all persons whomsoever from any and all liability from damage on account of furnishing said information.
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ONLY MARYLAND APPLICANTS NEED SIGN:
- “UNDER MARYLAND LAW AN EMPLOYER MAY NOT REQUIRE OR DEMAND ANY APPLICANT FOR EMPLOYMENT OR PROSPECTIVE EMPLOYMENT OR ANY EMPLOYEE TO SUBMIT TO OR TAKE A POLYGRAPH, LIE DETECTOR OR SIMILAR TEST OR EXAMINATION AS A CONDITION OF EMPLOYMENT OR CONTINUED EMPLOYMENT. ANY EMPLOYER WHO VIOLATES THIS PROVISION IS GULITY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT TO EXCEED $100.”
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DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND FOR
EMPLOYMENT PURPOSES
- Disclosure
- Class Produce Group, LLC (the "Company") 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, or engagement for services (including independent contractor or volunteer assignments, as applicable).
- HireRight, LLC ("HireRight") will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireriqht.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.
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Completion of this form is strictly voluntary and is confidential.
- The Class Produce Group, LLC, CFC Trucking Co. Inc. & TGD Cuts Inc. provides equal employment opportunity to all qualified applicants and employees by prohibiting discrimination against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, veteran status or disability.
- This information will be used solely to assist us in complying with Federal and State Equal Employment Opportunity and Affirmative Action record keeping requirements. Refusal to provide this information will not adversely affect you.
- PLEASE NOTE: This form is NOT a part of your official application for employment. This information will be recorded and maintained in a confidential file, separate from all other records.
- This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:
- Disabled Veteran: A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or a person who was discharged or released from active duty because of a service-connected disability.
- Recently Separated Veteran: Any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.
- Active Duty Wartime or Campaign Badge Veteran: A veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.
- Armed Forces Service Medal Veteran: A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.
- As a Government contractor subject to VEVRAA, we request this information in order to measure the effectiveness of the outreach and positive recruitment efforts we undertake pursuant to VEVRAA. If you believe you belong to any of the categories of protected veterans listed above, please indicate by checking the appropriate box below.
- Protected veterans may have additional rights under USERRA—the Uniformed Services Employment and Reemployment Rights Act. In particular, if you were absent from employment in order to perform service in the uniformed service, you may be entitled to be reemployed by your employer in the position you would have obtained with reasonable certainty if not for the absence due to service. For more information, call the U.S. Department of Labor's Veterans Employment and Training Service (VETS), toll-free, at 1-866-4-USA-DOL.
- The information you submit will be kept confidential, except that (i) supervisors and managers may be informed regarding restrictions on the work or duties of disabled veterans, and regarding necessary accommodations; (ii) first aid and safety personnel may be informed, when and to the extent appropriate, if you have a condition that might require emergency treatment; and (iii) Government officials engaged in enforcing laws administered by the Office of Federal Contract Compliance Programs, or enforcing the Americans with Disabilities Act, may be informed.
VOLUNTARY SELF—IDENTIFICATION OF DISABILITY
Why are people being asked to complete this form?
- Because we do business with the government, we must reach out to, hire, and provide equal opportunity to qualified people with disabilities. To help us measure how well we are doing, we are asking you to tell us if you have a disability or if you have ever had a disability. Completing this form is voluntary, but we hope that you will choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used against you in any way.
- If you already work for us, your answer will not be used against you in any way. Because a person may become disabled at any time, we are required to ask all of our employees to update their information every five years. You may voluntarily self‐identify as having a disability on this form without fear of any punishment because you did not identify as having a disability earlier.
How do I know if I have a disability?
- You are considered to have a disability if you have a physical or mental impairment or medical condition that substantially limits a major life activity, or if you have a history or record of such an impairment or medical condition. Disabilities include, but are not limited to:
- Blindness
- Deafness
- Cancer
- Diabetes
- Epilepsy
- Autism
- Cerebral palsy
- HIV/AIDS
- Schizophrenia
- Muscular dystrophy
- Bipolar Disorder
- Major Depression
- Muscular Sclerosis (MS)
- Missing limbs or partially missing limbs
- Post‐Traumatic stress disorder (PTSD)
- Obsessive Compulsive Disorder
- Impairments requiring the use of a wheelchair
- Intellectual disability (previously called mental retardation
Reasonable Accommodation Notice
- Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples of reasonable accommodation include making a change to the application process or work procedures, providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.
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- The cost of the Pre-Employment Drug Screen is $26.00. You will not be required to pay this fee until your first paycheck. We will automatically deduct $26.00 from your paycheck, to cover the costs of the pre-employment drug screen.
- I have read the above statements and agree to the terms:
- El costo del pre- Empleo para el examen de drogas es de $26.00. No se le pedirá que pague esta tarifa hasta que reciba su primer cheque de pago. Deduciremos automáticamente $26.00 de su cheque de pago, para cubrir los costos del examen
- He leído las declaraciones anteriores y acepto los términos.
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