CDL Truck Driver Application

Application Date

How did you find us?

Website

Social Media

Garris Evans Lumber Co. Employees

Employee Referral

Mark Box for Appropriate Location

Greenville, NC

Wilson, NC

New Bern, NC

Shallotte, NC

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

Name

Phone Number

Address - Past 3 Years

Current

Years/Months

Previous 1

Previous 1 Years/Months

Previous 2

Previous 2 Years/Months

Driver's License Information

State of Issue

License Number

Type of License

Endorsements

Expiration Date

Previous Licenses - Past 3 years

State

Type of License

Reason for Return

State

Type of License

Reason for Return

Employment History

List, in reverse order, your employment history for the past 10 years. If work history is not that long, list back to first job and annotate in the margins that this was your first job.

Employment History 1

Employer

Supervisor's Name

Address

Job Position

Phone Number

Dates of Employment Start

Dates of Employment Finish

DOT Regulated

Yes

DOT Safety Sensitive Position which required Drug and Alcohol Testing?

Yes

Reason for Leaving

Employment History 2

Employer

Supervisor's Name

Address

Job Position

Phone Number

Dates of Employment Start

Dates of Employment Finish

DOT Regulated

Yes

DOT Safety Sensitive Position which required Drug and Alcohol Testing?

Yes

Reason for Leaving

Employment History 3

Employer

Supervisor's Name

Address

Job Position

Phone Number

Dates of Employment Start

Dates of Employment Finish

DOT Regulated

Yes

DOT Safety Sensitive Position which required Drug and Alcohol Testing?

Yes

Reason for Leaving

Employment History 4

Employer

Supervisor's Name

Address

Job Position

Phone Number

Dates of Employment Start

Dates of Employment Finish

DOT Regulated

Yes

DOT Safety Sensitive Position which required Drug and Alcohol Testing?

Yes

Reason for Leaving

Employment History 5

Employer

Supervisor's Name

Address

Job Position

Phone Number

Dates of Employment Start

Dates of Employment Finish

DOT Regulated

Yes

DOT Safety Sensitive Position which required Drug and Alcohol Testing?

Yes

Reason for Leaving

License History

Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

Yes

Have you ever had a license, permit or privilege revoked or suspended?

Yes

If yes to either, please explain

In the Past 3 Years, have you ever tested positive on a DOT Pre-Employment Drug or Alcohol Test, or refused to take a DOT Pre-Employment Drug or Alcohol Test at any other employer that you applied with?

Yes

If yes to either, please explain

Driving Experience

Type of Equipment

Dates Operated

Miles Run

Type of Equipment

Dates Operated

Miles Run

Type of Equipment

Dates Operated

Miles Run

Type of Equipment

Dates Operated

Miles Run

What States have you operated in?

Traffic Convictions – Past 3 Years (Exclude parking tickets)

If none check here:

None

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Location

Date

Charge

Penalty

Accidents – Past 3 Years

If none, check here:

None

Location

Date

Type

Injuries/Fatalities

Location

Date

Type

Injuries/Fatalities

Location

Date

Type

Injuries/Fatalities

Confirmation

TO BE READ AND SIGNED BY APPLICANT

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. It is also understood that the company will contact my previous employers and verify the information on this application as required by the Federal and State DOT.

Date

Signature

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Garris Evans Lumber Company, Employer (“The Company”) may obtain information about you from a third-party consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying.

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. These searches will be conducted by PeopleFacts, 135 Chesterfield Lane Maumee, OH 43537 800-772-0130 www.peoplefacts.com. The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law.

Signature

Date

Printed Name

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Employer at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school, or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by People Facts 135 Chesterfield Lane Maumee, OH 43537 800-772-0130 www.peoplefacts.com and/or Employer. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

Signature

Date

Printed Name

EMPLOYMENT VERIFICATION

Requested by Garris Evans Lumber Company, 701 West 14th Street, Greenville, NC 27834

Previous Employer

Date

I do hereby authorize my previous employers to release and forward all requested information regarding my alcohol and controlled substance testing (if I was employed as a driver) and all other records of employment including job performance to the above named carrier in connection with my application for employment, herby release my former employers from any and all liability of any type as a result of the providing the above information.

Applicant Name

Applicant Signature

Date

Hours of Service Record

Instructions: When using a driver for the first time or intermittently, a signed statement must be obtained, giving the total time on duty (driving and on duty) during the immediately preceding 7 days and the time at which the driver was last relieved from duty prior to beginning work.

Name:

Total Time on Duty Day 1:

Total Time on Duty Day 2:

Total Time on Duty Day 3:

Total Time on Duty Day 4:

Total Time on Duty Day 5:

Total Time on Duty Day 6:

Total Time on Duty Day 7:

Total Time on Duty:

I hereby certify that the information contained herein is true to the best of my knowledge and belief and that my last period of release from duty is listed below:

From Hour/Date

To Hour/Date

Signature

Date

Annual Review

Driver's Certification of Violations

Date

Offense

Location

Type of Vehicle

Date 2

Offense 2

Location 2

Type of Vehicle 2

Date 3

Offense 3

Location 3

Type of Vehicle 3

Date 4

Offense 4

Location 4

Type of Vehicle 4

Date 5

Offense 5

Location 5

Type of Vehicle 5

No violations occurred in the past 12 months

Yes

I certify that the above information is a true and complete list of traffic violations (other than parking) for which I have been convicted or forfeited bond or collateral during the past 12 months.

Driver's Printed Name

Driver's Signature

Date

This day I have reviewed the driving record of the above-named driver in accordance with 391.25 of the Federal Motor Carrier Safety Regulation. I considered any evidence that the driver has violated applicable provisions of the Federal Motor Carrier Safety Regulations and the Hazardous Materials Regulations. I considered the Driver’s Accident record and any evidence that He/She has violated laws governing the operation of motor vehicles and gave great weight to the violations, such as speeding, reckless driving, and operation while under the influence of alcohol or drugs, which indicate the driver has exhibited a disregard for the safety of the public.

After Review

The Driver meets the minimum requirements of safe driving.

The Driver is disqualified to drive a motor vehicle pursuant to 391.15.

Reviewed By

Date

Title

Signature

Notice to Driver's

DOT Required Split Sample Testing

As of August 15, 1994, Federal Regulations require that all DOT drug tests be collected in accordance with split sample procedures.

With this change, the driver has the right to have the second bottle tested at a different NIDA-approved lab should the initial test be confirmed positive. The driver will have 72 hours after a test is confirmed positive to request the second bottle be tested.

Should you require that the second bottle be tested, you will assume the cost of any subsequent testing. Should subsequent testing results report back as negative we will reimburse you for the cost of the testing.

Due to the additional expense of transporting the sample to another NIDA-approved lab, and the requirement that the confirmation be done by expensive Gas Chromatography, the testing of the second bottle will cost $125.00

I have read the above notice and understand that I will be responsible for the cost of any subsequent testing charges.

Driver's Printed Name

Driver's Signature

Date

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

I, hereby provide consent to Garris Evans Lumber Co. 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. This consent is valid from the date shown below until my employment with the above-named motor carrier ceases or until I am no longer subject to the drug and alcohol testing rules in 49 CFR Part 382.701(b) for the above-named motor carrier.

I understand that if the limited query conducted by Garris Evans Lumber Co. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information without first obtaining additional specific consent from me. If a limited query ever reveals that the Clearinghouse has information about me, I will be required to log in to the Clearinghouse website within 24 hours to grant electronic consent for the motor carrier to obtain my full Clearinghouse record per 382.701(b).

I further understand that if I refuse to provide consent to conduct a limited query of the Clearinghouse, Garris Evans Lumber Co. must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

Driver's Name

Driver's Signature

Date

Notification of Driver's Rights

In accordance with Federal Motor Carrier Safety Administration regulation 391.23(i)(I), we are required to make known to Driver applicants for employment with our company that you have the following rights regarding the investigative information that will be provided to our company pursuant to paragraphs (d) and (e) of this section of the regulation.

You have the right to review information provided by your previous employers.
You have the right to have errors in the information corrected by the previous employer and for the previous employer to re-send the corrected information to our company.
You have 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.

I understand that I have been informed of these rights in accordance with the above-listed regulations.

Applicant Printed Name

Date

Applicant Signature

Note: There are additional provisions for rights to review employment history which goes back farther than 3 years required in the application process. Should you wish to pursue these please review FMCSA Regulation 391.23 (i) (2).

MVR Request Form

Transportation Risk Management Services, LLC 76 Dunsmore Road PO Box 492 Verona, VA 24482

As part of the hiring process for a FMCSA or State Regulated Commercial Motor Vehicle driver position, I give TRMS permission to run a current Motor Vehicle Record (MVR) from the VA State DMV database. This report is being run as part of the application process for Garris Evans Lumber Co.

If I accept the position with Garris Evans Lumber Co., I also give TRMS permission on behalf of my employer to run a new MVR as required for FMCSA /State Regulatory requirements. This would be as outlined in FMCSA regulations Parts 391.23, 391.25, and 391.51 as relating to Medical Certification verification. These records once run will be the property of my employer and will be placed in my driver qualification file and maintained as required by the FMCSA/State Motor Carrier regulations.

I also understand that under the Fair Credit Reporting regulations, I have a right to see these documents by requesting, in writing, to my employer for the release of the information.

Any questions or concerns should be raised to your employer’s HR or Safety Manager.

Driver Name

Driver's License Number

State

Driver's Signature

Date

Garris Evans Lumber Company Inc. Driving Policy

Garris Evans has made a commitment to safety, service, and quality to both our employees and customers. Garris Evans insists that both our employees and non-employees operate all vehicles owned by or used by Garris Evans in a safe and economical manner. The following summarizes policy guidelines:

Vehicles are not to be operated unless in a safe operating condition.
Drivers must be physically and mentally able to drive safely.
Drivers must conform to all traffic laws and allowances made for adverse weather and traffic conditions.
Respect the rights of other drivers and pedestrians. Courtesy is contagious.
Drivers may not use drugs or alcohol or be under the influence of drugs or alcohol while operating a vehicle

Accidents

All accidents are to be reported to the management of Garris Evans immediately after the accident occurs. Driver must follow the Vehicle Accident Procedures and complete in entirety the Federated Preliminary Accident Report. All accidents will be reviewed, and a determination made as either preventable or non-preventable which results from factors outside of a driver's control.

A preventable accident is defined as an accident in which the driver failed to do everything reasonably possible to avoid it.

MVR Standards

Motor Vehicle Records (MVRs) will be checked periodically on all employees where driving is a part of their job. The MVR will be reviewed to ascertain the employee holds a valid license and their driving record is within the parameters set by company management. MVR checks which reveal the following will disqualify the employee from driving company-operated vehicles, or those vehicles in the care and custody of Garris Evans:

Three (3) or more traffic violations and/or at-fault accidents over a three-year period for drivers aged 25 and older, two (2) traffic violations and/or at-fault accidents for drivers age 18 through 24, or
One or more of the following types of serious traffic convictions within the past 3 years will disqualify the employee from driving company-operated vehicles, or those vehicles in the care and custody of Garris Evans:
- Driving while under the influence or while disabled by the use of drugs
- Refusal to submit to test for alcohol (e.g., Failure to take a Chemical Test, Blood Test, or Breath Analyzer Test)
- Leaving the scene of an accident without reporting it
- Homicide, assault, or criminal negligence resulting from the operation of a vehicle
- Driving while license is suspended or revoked
- Reckless or dangerous driving, which results in injury to a person
- Racing
- Passing a stopped school bus

Violations include seat belt violations, but do not include such non-moving violations as weight violations or improper or inadequately maintained equipment.

Distracted Driving and Mobile Devices

We deeply value the safety and well-being of all employees. Due to the increasing number of accidents resulting from distracted driving and the use of mobile devices, it is our company policy that you do not engage in activities that cause you to become distracted when driving, including, but not limited to:

Sending or reading text messages
Using a handheld mobile device for either outgoing or incoming calls
Truck Drivers should not be on the phone while driving, either with their hands or hands-free.
Make all adjustments to programming controls of audio or navigation systems prior to operation.
Searching for and/or reaching for items in the vehicle
Eating or drinking beverages while driving
Reading maps or other printed material while in motion

The above restrictions apply anytime the vehicle is in motion. It is our company policy that, in all circumstances, you pull the vehicle over to a safe area prior to engaging in these activities. Employees are also expected to follow all state laws regarding mobile device usage.

Vehicle Usage

Your primary responsibility when driving a motor vehicle for our organization is driving the vehicle safely. Garris Evans has developed the following expectations for you as a driver to help ensure company- owned vehicles and/or those used by company employees will be operated in a safe and economical manner.

Seat belts must be worn at all times when the vehicle is in motion.
Defects and needed repairs of any company vehicle will be reported to management so necessary repairs can be made.
Cargo must be secured, and doors locked while in-route and when company vehicles are parked.
All accidents must be reported to the manager in accordance with Garris Evans’s Accident Reporting Policy.
All traffic violations received will be paid for by you, the employee.
No permission may be given to any other person, including family members, to drive company vehicles. Specific permission must be obtained from company management for any personal use of a company vehicle.
The use of radar detectors is forbidden in all vehicles owned or used by the company.
Hitchhikers and passengers, other than company employees or authorized persons, are not permitted in company vehicles.

Company consequences for failing to follow company policy

Employees who violate this policy may be subject to disciplinary action.
Employees who violate this policy may be subject to disciplinary action including termination.

All current drivers of Garris Evans must have a signed copy of Garris Evans’s Driving Policy retained in a management file. Your signature below certifies your agreement to comply with this policy, and you are willing to accept the consequences of failing to do so.

Employee Signature

Date

Employee Name (printed)

Acknowledgement of Receipt

Download Driver’s Information Packet
I acknowledge receipt of the “Driver’s Information Packet”. This package contains educational materials and policy concerning the use of alcohol and drugs as required by 382.601(d).

Signature

Date

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