Application

Hello Applicant

Be aware that the application below is rather lengthy so we have included an option at the bottom of the form to save it. You can then return to it at a later date. All saved applications are removed after 30 days.

There are 4 sections to this application which are as follows:

Employment Application (Required)
Alcohol & Substance Abuse Policy (Required)
Driver Responsibility & Benefit Policy (Required)
I-9: Employment Eligibility Verification (Required)
W4 Form
W9 Form

Additional Requirements

If your application is approved we require you to submit a W-9 or a W-4 form. Use the buttons below for the corresponding form.

Directions for submitting your W-9 or W-4:

Click the button/link below
Fill out the form
Download the completed form to your device
Email the downloaded form to our team

Click Here to Fill Out W-9

Click Here to Fill Out W-4

National Transportation Services

DRIVER HIRING & QUALIFICATION RECORDS CHECKLIST

Driver Initials *

Start initialing here

1. Application for qualification (a) Driver's rights (give to applicant prior to application) (b) Driver applicant Drug and Alcohol pre-employment statement (c) Controlled Substance & Alcohol testing info acknowledgement (d) Request for Driver's Safety Performance history (Application should be fully completed and signed by applicant - NO GAPS)

Driver Initials *

Start initialing here

2. Motor Vehicle Record (MVR) (All licenses held by the driver in the past 3 years must be investigated)

Driver Initials *

Start initialing here

3. Medical Examiner's Certificate

Driver Initials *

Start initialing here

4. Receipt for issuance of FMCSR Book

Driver Initials *

Start initialing here

5. Receipt for Driver's Manual/Policies

Driver Initials *

Start initialing here

6. Seven Day Prior Hours statement or copies of log sheets (To be placed with log files)

Driver Initials *

Start initialing here

7. Copy of Driver's License

Driver Initials *

Start initialing here

8. Immigration I-9 form (fully completed and signed)

Driver Initials *

Start initialing here

9. Annual Driver's Certification of Violation & Annual review of Driving record (MVR) (Must be completed at least once every 12 months from date of hire)

BASIC INFORMATION / EMERGENCY INFORMATION

Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Phone *

Date of Birth: *

EMERGENCY CONTACT:

WHO SHOULD WE CONTACT IN CASE OF EMERGENCY?

Name *

Phone *

Relationship *

In case of emergency, I authorize National Transportation Services (hereafter referred to as NTS to contact the person listed above to notify them ofthe nature ofthe emergency. In addition, I realize that my employment with NTS is at will, meaning that my employment with NT'S is not a contracted position and that either NTS or I may end employment at any time. I further agree that should I owe NTS any money during my employment, my signature below allows them to take said indebtedness from my paychecks. I also give permission to NTS to access my MVR through Department of Licensing as often as they need the report.

Employee Signature *

Start signing your signature here

Date *

APPLICATION FOR EMPLOYMENT

Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Date of Birth: *

Social Security No. *

ADDRESS(ES) FOR THE PAST 3 YEARS

ADDRESS #1

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

How long? *

ADDRESS #2

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

How long?

ADDRESS #3

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

How long?

EXPERIENCE & QUALIFICATIONS

Driver Licenses

State *

License No. *

Type *

Expiration Date *

State

License No.

Type

Expiration Date

State

License No.

Type

Expiration Date

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

Has any license, permit, or privilege ever been suspended or revoked? *YesNo

DRIVING EXPERIENCE

Class of Equipment

Straight Truck

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approx. Number of Miles (Total)

Class of Equipment

Tractor & Semi-Trailer

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approx. Number of Miles (Total)

Class of Equipment

Tractor & Two Trailers

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approx. Number of Miles (Total)

Class of Equipment

Other

Type of Equipment (Van, Tank, Flat, Etc.)

From

Approx. Number of Miles (Total)

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE

ACCIDENT #1

Date

Nature of Accident (Rear-end,Upset, Etc.)

Fatalities

Injuries

ACCIDENT #2

Date

Nature of Accident (Rear-end,Upset, Etc.)

Fatalities

Injuries

ACCIDENT #3

Date

Nature of Accident (Rear-end,Upset, Etc.)

Fatalities

Injuries

TRAFFIC CONVICTIONS FOR PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS)

CONVICTION #1

Location

Date

Charge

Penalty

CONVICTION #2

Location

Date

Charge

Penalty

CONVICTION #3

Location

Date

Charge

Penalty

EMPLOYMENT RECORD

Note: Show ALL employment for the past three years and all Commercial Driving Experience for the past 10 years.

LAST EMPLOYER

Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Position Held *

From *

To *

Salary *

Reason(s) for leaving *

Subject to FMCSR's? *YesNo

Subject to drug/alcohol testing requirements per 49 CFR Part 40? *YesNo

SECOND LAST EMPLOYER

Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Position Held

From

Salary

Reason(s) for leaving

Subject to FMCSR's?YesNo

Subject to drug/alcohol testing requirements per 49 CFR Part 40?YesNo

THIRD LAST EMPLOYER

Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Position Held

From

Salary

Reason(s) for leaving

Subject to FMCSR's?YesNo

Subject to drug/alcohol testing requirements per 49 CFR Part 40?YesNo

FOURTH LAST EMPLOYER

Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Position Held

From

Salary

Reason(s) for leaving

Subject to FMCSR's?YesNo

Subject to drug/alcohol testing requirements per 49 CFR Part 40?YesNo

As a prospective employer, we must ask any applicant for a driving position with our company whether he/she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the applicant applied for, but did not obtain, "safety-sensitive transportation work" (driving a commercial motor vehicle) during the past two years.

I have tested positive for drugs/alcohol, or refused to take a pre-employment drug/alcohol test in the two years preceding the date of this application. *YesNo

DOT regulations prohibit our utilizing you to perform a "safety-sensitive function"(driving a commercial motor vehicle) if you had a positive test, or a refusal to test, until and unless you provide documents showing successful completion of the return-to-duty process in accordance with DOT regulations.

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

Applicant's Signature *

Start signing your signature here

Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations

Fair Credit Reporting Act Disclosure Statement

In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title I, Subtitle D, Chapter 1, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.

Applicant's Signature *

Start signing your signature here

DRIVER APPLICANT DRUG AND ALCOHOL PRE-EMPLOYMENT STATEMENT

CFR Part 40.25(j) requires the employer to ask any applicant, whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol rules during the past two years. If the potential emplovee admits that he or she had a positive test or refusal to test, we must not use the employee to perform -safety-sensitive function, until and unless, the potential emplovee provides documentation of successful completion of the return-to-duty process. (See Section 40.25(b)(5) and (e).

As an applicant, applying to perform safety-sensitive functions for our company, you are required by CFR Part 40.25(j) to respond to the following questions.

Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years? *YesNo

If you answered yes to the above question, can you provide proof that you've successfully completed the DOT return-to-duty requirements?YesNo

My signature below certifies that the information provided is true and correct.

Applicant Signature *

Start signing your signature here

Anti-Discrimination and Anti-Harassment Guide

The Company will not condone, permit or tolerate any form of discrimination and/or harassment by or against any employee, customer, vendor, independent contractor or other individual with whom our employees come into contact in connection with their employment with this Company based upon age, race, color, creed, religion, sex, sexual orientation, national origin, disability or other protected class or characteristic established under applicable federal, state or local statue or ordinance. Sexual harassment is a form of illegal sex discrimination.

Sexual harassment refers to behavior that is unwelcome, personally offensive, and which interferes with our work effectiveness. Federal law defines unlawful sexual harassment as unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature, whether by male or female, when (1) submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment, (2) submission to or rejection of such conduct by an individual is used as a basis for employment decisions affecting such individual, or (3) such conduct has the purpose or effect of unreasonably interfering with an individual's work performance or creating an intimidating, hostile or offensive work environment.

Individuals who believe they have been subjected to discrimination or harassment as described or have questions about whether certain conduct is unlawful should immediately speak to their supervisor or Sikander Sekhon This is particularly important in cases involving sexual harassment where there can be uncertainty about what is unlawful conduct.

Supervisors who receive complaints of discrimination or harassment or who are made aware of conduct that may constitute discrimination or harassment must immediately notify Sikander Sekhon (or, if appropriate Sherry Meske, in place of Sikander Sekhon).

All complaints will be investigated promptly and the existence of a complaint will be disclosed only to the extent necessary to make a prompt and thorough investigation or to take appropriate corrective measures. In all cases, the person who initiated the complaint will be informed of the findings and disposition of the matter at the conclusion of the investigation. Management will ensure that there is no coercion, retaliation, intimidation, discrimination or harassment directed against any individual who registers a complaint or serves as a witness on behalf of another individual.

PERSONS WHO ENGAGE IN PROHIBITED DISCRIMINATION OR HARASSMENT WILL BE SUBJECT TO APPROPRIATE DISCIPLINE UP TO AND INCLUDING TERMINATION OF EMPLOYMENT.

I acknowledge receipt of this Anti-Discrimination and Anti-Harassment Guide and fully understand the contents thereof. I also acknowledge that the consequences for participation in any form of harassment or discrimination could include legal action and dismissal from your position with our company.

Signature *

Start signing your signature here

Driver Certification for Other Compensated Work

INSTRUCTIONS: When employed by a motor carrier, a driver must report to the carrier all on-duty time working for other employers. The definition of on-duty time found in Section 395.2 paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations includes time performing any other work in the capacity of or in the employment or service of, a common, contract or private motor carrier also performing any compensated work for any non-motor carrier entity.

Are you currently working for another employer? *YesNo

At this time, do you intend to work for another employer while still employed by this company? *YesNo

Driver Status *New EmployeePart-timeTemporary

I hereby certify that the information given above is true and I understand that once I become employed with this company if I work for an additional employer(s) for compensation, I must inform this company immediately of such employment activity.

Driver's Signature *

Start signing your signature here

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 that employed the driver to operate a CMV within the previous three years. This information must cover general driver identification and employment verification information, data elements as specified in 390.15 for accidents 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 emplovers.
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 prospective 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 motor carrier 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 driver'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.

Driver's Signature *

Start signing your signature here

CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS

MOTOR CARRIER INSTRUCTIONS:

The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds or, can transport more than 15 people, or transports hazardous materials that require placarding.

DRIVER REQUIREMENTS:

Parts 383 and 391 of the Federal Motor carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:

POSSESS ONLY ONE LICENSE: you, as a commercial vehicle driver, may not possess more than one motor vehicle operator's license.

If you have more than one license, keep the license from your state of residence and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed by that state.

NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 391.5 (b)(2) and 383.33 of the Federal Motor Carrier Safety Regulations required that you notify your employer thenext buisness day of any revocation or suspension of your driver's license. In addition, Section 383.31 requires that any time you violate a state or local traffic law (other that parking), you must report it within 30 days to your employing motor carrier, and the state that issued your license (if the violation occurs in a state other t h a nt h e one which issued your licensed). The notification to both the employer and state must be in writing.

The following license is the only one I will possess:

Driver's License No. *

State *

Expiration Date *

DRIVER CERTIFICATION: I certify that I have read and understood the above requirements.

Applicant's Signature *

Start signing your signature here

SEVEN-DAY PRIOR LOG FORM

(datasheet for new, casual, or temporary drivers)

Instructions:

At the time of initial employment as a driver, or when being employed occasionally, the regulations of the Department of Transportation [Section 395.8 (j)(2)] require the motor carrier to obtain from you a signed statement giving the total time on duty during the immediately preceding 7days and the time at which you were last relieved from duty prior to beginning work for the motor carrier. In the spaces below, show the number of hours worked (onduty) in each of the last 7 days.

Day 1

Date *

Hours Worked *

Day 2

Date *

Hours Worked *

Day 3

Date *

Hours Worked *

Day 4

Date *

Hours Worked *

Day 5

Date *

Hours Worked *

Day 6

Date *

Hours Worked *

Day 7

Date *

Hours Worked *

Total Hours Worked *

I hereby certify that the information given above is correct to the best of my knowledge and belief. and that I was last relieved from work at:

Time *

Hours

Minutes

Date *

Signature *

Start signing your signature here

CONTROLLED SUBSTANCE & ALCOHOL TESTING INFORMATION ACKNOWLEDGEMENT CONSENT FORM

As a condition of employment with National Transportation (Motor Carrier) commercial motor vehicle driver applicants submit to pre-employment controlled substance test as required by federal motor Carrier safety regulations (FMCS) section 382.301. A Motor carrier must receive verified negative test Results for applicant driver for the applicant to be eligible for employment. If you are hired, you will be subject to law requiring additional controlled substances and alcohol testing on you under numerous situations including but not limited to the following:

Post-accident- section 382.303
Random - section 382.305
Reasonable suspicion-section 382.307
Return to duty- section 382.309
Follow- up-section 382.311

A driver who tests positive to a controlled substance and/or alcohol test, will be immediately removed from a safety sensitive position as required by part 382 of the FNCSR. federal law prohibits a driver from returning to a safety sensitive position for any motor carrier until and unless the driver completes the substance abuse professionals (SAP) evaluation, referral and educational/treatment process, as describe in FMCS part 40subpart O.

The following is a referral list of substance abuse professionals: (to be completed by carrier)

Name:	Perlman, David	Paul, Jan
Address:	20102 Cedar Valley Road Suite 203 Lynnwood, WA 98036	411 West Mercer St. Seattle, WA 98119 USA	www.saplist.com
Phone:	425-478-0152	206-898-2312

ALL CONTROLLED SUBSTANCES AND ALCOHOL TESTING WILL BE CONDUCTED IN ACCORDANCE WITH PARTS 40 AND 382 OF THE FMCS.

I have read the above controlled substances and alcohol testing requirements and understand them. I acknowledge receipt of the referral list of Substance Abuse Professionals.

Applicant's Signature *

Start signing your signature here

Alcohol and Controlled Substance Employee's Certified Receipt

This is to certify that I have been provided educational materials that explain the requirements of 382.601 and my employer's policies and procedures with respect to meeting the requirements. The materials include detailed discussion of the following checked items:

Initials *

Start signing initials here

The designated person to answer questions about the materials.

Initials *

Start signing initials here

The categories of drivers subject to Part 382.

Initials *

Start signing initials here

Sufficient information about the safety-sensitive functions and periods of the workday that compliance is required.

Initials *

Start signing initials here

Specific information concerning prohibited driver conduct.

Initials *

Start signing initials here

Circumstances under which a driver will be tested.

Initials *

Start signing initials here

Test procedures, driver protection and integrity of the testing process, and safeguarding the validity of the test.

Initials *

Start signing initials here

The requirement that tests are administered in accordance with Part 382.

Initials *

Start signing initials here

An explanation of what will be considered a refusal to submit to a test and the consequences.

Initials *

Start signing initials here

The consequences of Part 382 Subpart B violations including removal from safety-sensitive functions and 382.605 procedures.

Initials *

Start signing initials here

The consequences for drivers found to have an alcohol concentration of 0.02 or greater but less than 0.04.

Initials *

Start signing initials here

Information on the affect of alcohol and controlled substances use on:

an individual's health
signs and symptoms of a problem
work
personal life
available methods of intervening when a problem is suspected

Employee's Signature *

Start signing your signature here

Certificate of Violations & Annual Review

I. CERTIFICATE OF VIOLATIONS. I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past twelve months.

Date *

Offense *

Location *

Type of Vehicle Operated *

Date

Offense

Location

Type of Vehicle Operated

Date

Offense

Location

Type of Vehicle Operated

Date

Offense

Location

Type of Vehicle Operated

Date

Offense

Location

Type of Vehicle Operated

Date

Offense

Location

Type of Vehicle Operated

If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral as a result of any violation required to be listed during the past twelve months.

Driver's Signature *

Start signing your signature here

Request for Driver's Safety Performance History Information from DOT Regulated Previous Employer(s)

Driver to complete this section As a Commercial Motor Vehicle (CMV) Driver, I understand that per the Federal Motor Carrier Safety Regulations (FMCSRs) Part 391.21, the following information will be requested from all previous Employers for which I operated a CMV, subject to the F M C S Parts 390 and/or 40, 382 & 383, within the past three years, from date shown below. I also acknowledge that this information will be used in determining my eligibility to be hired, that I have the right to review this information and rebut any errors in these statements from my prior employers, as described in the FMCSR Part 391.23.

I hereby authorize this Company to release all records of employment, including assessments of my job performance, ability and fitness (including dates of any and all alcohol or drug tests, those confirmed results and/or my refusal to submit to any alcohol or drug tests and any rehabilitation completion under direction of (SAP/MRO) to each and every company (or their authorized agents) which may request such information in connection with my application for employment with said company. I hereby release this company, and its employees, officers, directors, and agents from any and all liability of any type as a result of providing information to the above mentioned person and/or company.

LAST EMPLOYER

Previous Employer *

Contact Person *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Telephone Number *

Fax Number *

I worked for this Company from *

to *

Applicant's Signature *

Start signing your signature here

SSN or ID Number *

SECOND LAST EMPLOYER

Previous Employer *

Contact Person *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Telephone Number *

Fax Number *

I worked for this Company from *

to *

Applicant's Signature *

Start signing your signature here

SSN or ID Number *

THIRD LAST EMPLOYER

Previous Employer *

Contact Person *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Telephone Number *

Fax Number *

I worked for this Company from *

to *

Applicant's Signature *

Start signing your signature here

SSN or ID Number *

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with National Transportation Services, Inc.("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 (FMCS).

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 F M C S 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 F M C S 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 FMCS, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCS) 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 National Transportation Services, Inc. ("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 there lease 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 DataQssystem 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 FMCAR 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.

Signature *

Start signing your signature here

This section involves reading the DRIVER RESPONSIBILITY AND BENEFIT POLICY and acknowledging the policies and procedures.

CLICK HERE TO VIEW IT AND THEN SIGN BELOW

I have read and agree to abide by all policies and procedures in this manual and I understand my responsibilities to drive safely and maintain a safe vehicle. I further give permission to National Transportation Services, Inc. to secure my complete driving record at any time.

In addition, if I exit before my 90 day probationary period I will be responsible to reimburse $55.00 for the pre-employment drug test performed. Owner operators will be responsible to reimburse $55.00 for the pre-employment drug test and $105.00 for placards given for each unit registered with National Transportation Services, Inc.

Signature *

Start signing your signature here

Driver's License Number *

Issuing State *

This section involves reading the ALCOHOL AND SUBSTANCE ABUSE POLICY and acknowledging the policies and procedures.

CLICK HERE TO VIEW IT AND THEN SIGN BELOW

ACKNOWLEDGMENT OF RECEIPT AND REVIEW OF DOT DRUG & ALCOHOL POLICY ADDENDUM

I acknowledge that I have received a copy of the Company's Addendum to its DOT Drug & Alcohol Policy

I have read and understand the company drug and alcohol policy. I have also received a copy of the company drug and alcohol policy as required by 49 CFR Part 382.601.

Signature *

Start signing your signature here

This is the last section that needs to be completed before submitting this form. This section corresponds to the I-9 form (Employment Eligibility Verification)

You can find the original form HERE. Refer to it if needed.

Section 1. Employee Information and Attestation

First Name *

Middle Initial

Last Name *

Other Last Names Used (if any)

Address *

Apt. Number

City or Town *

State *0 / 2

Zip Code *

Date of Birth *

U.S. Social Security Number *

Employee's Email Address

Employee's Phone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States2. A noncitizen national of the United States3. A lawful permanent resident4. An alien authorized to work

Alien Registration Number/USCIS Number: *

Expiration date, if applicable: *

Aliens authorized to work must provide only one of the following document numbers to complete Form 1-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number

Alien Registration Number/USCIS Number:

Form I-94 Admission Number:

Foreign Passport Number:

Country of Issuance:

Signature of Employee *

Start signing your signature here

Today's Date *

Preparer and/or Translator Certification(checkone):

RadioI did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator *

Start signing your signature here

Today's Date *

First Name *

Last Name *

Address *

City or Town *

State *0 / 2

Zip Code *

The last few things we'll need from you before you submit your application are: