SECTION 5- Complete Section 5 only if you are applying for a truck driving position
List any accidents you've been involved with in the last three (3) years:
**If you completed any courses or training that would apply to driving please list in the education section.
Section 6- ALL APPLICANTS MUST COMPLETE THIS SECTION
Please read the following statement carefully before signing to indicate your understanding.
I certify that all of the information furnished on the Application is true, complete and correct. I understand and agree that any falsification, misrepresentation or omission of material fact either on this Application or during the pre-hire process will be reason for (1) my not being offered employment or (2) dismissal at any time from the service of the Company if employed.
I understand and agree that, if hired, my employment is at-will, meaning that my employment and compensation is for no definite period and may, regardless of the time and manner of payment of my wages and salary, be terminated at any time by me or the Company, with or without cause, and without any previous notice. This provision supersedes any prior oral, written or other representations, promises, contracts or statements made by or on behalf of the Company. I also understand and agree that the Company has the right to unilaterally modify and /or terminate any policies, practices, procedures and standards it has adopted or implemented, to the extent not limited by law. I acknowledge that no Company employee or representative has either the power or authority, prior to or after my hire, to enter into any agreement for employment for any specified period of time, or to make any representations or agreements contrary to any of the foregoing, unless that agreement is in writing and signed by the President of the Company. I also understand that if I change my employment from working for the Company to working for another company which is a parent, subsidiary or affiliate of the Company, or which is controlled by, controlling or under common control with the Company, then the terms of this application shall control my employment with the other company unless there is a written agreement contrary to the terms of the Application, signed by the President of the Company, or if I sign a new Application for the other Company.
I agree that, unless a shorter limitations period is provided for by law, any claim, action, suit or proceeding against the Company arising out of my employment or termination of employment, including, but not limited to, claims arising under any civil rights statutes, must be brought within 180 days of the event giving rise to the claims, or the date of my termination, whichever is earlier, or be forever barred. I waive any limitation periods to the contrary.
The Immigration Reform and Control Act of 1986 states that employers must require all persons hired to submit documents to the employer showing their identity and their right to be lawfully employed in the United States. It also requires that the employee complete and sign a government form to this effect.
If the Company hires you, you will need to furnish documents for inspection that verify your identity and indicate that you are legally permitted to work in the United States. Documents that are acceptable include your driver’s license, or state issued I.D., and your Social Security card or birth certificate. These documents must be provided with three (3) working days of employment. If the original documents are not available, you must submit proof that you are applied for the required documents.
I authorize investigation of all statements contained in this Application for any employment-related purpose. I release the listed references and all employers, except those specifically excepted below * to provide the Company with any and all applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to the Company.
Section 7- IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
1. In connection with your application for employment with Evans Distribution Systems, 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 (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 your 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 Evans Distribution Systems, 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 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.
I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, 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.