New Hire Forms

New Hire Forms 2016-11-23T11:46:27+00:00

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 (Title II, Subtitle D, Chapter I, of Public Law 104-208),you are hereby notified that reports verifying your previous employment, drug and alcohol test results, and driving record may be obtained for employment purposes. These reports are required by Sections 382.413,391.23 and 391.25 of the Federal Motor Carrier Safety Administration Regulations.

Signature (sign below):


DRIVER DATA SHEET

FOR NEW HIRES, CASUAL AND TEMPORARY EMPLOYEES

Instructions: Motor carrier's when using a driver for the first time or intermittently shall obtain from the driver a signed statement giving the total time on duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier (Rule 395.8 (J) (2) Federal Motor Carrier Safety Regulations).

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:
Drivers Signature:
Signature Date:

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 26,001pounds or more, can transpoft 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 more, 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 Administration regulations contain certain driver licensing requirements that you as a driver must comply with, including the following:

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

2) NOTIFICATION OF LICENSE SUSPENSION, REVOCATION OR CANCELLATION: Sections 391.15(bX2) and 383.33 of the Federal Motor Carrier Safety Administration regulations require that you notify your employer the NEXT BUSINESS DAY of any revocation or suspension of your driver's license. In addition, Section 383.31 requires that any time you are convicted of violating a state or local traffic law (except parking violations), you must notify your employer in writing within 30 days. In addition, you must notify the state in writing if a violation occurs in a state other than the one which issued your license.

3) CDL DOMICILE REQUIREMENT: Section 383.23(a)(2) requires that your commercial driver's license be issued by your legal state of domicile, where you have your true, fixed, and permanent home and principal residence, and to which you have the intention of returning whenever you are absent. If you establish a new domicile in another state, you must apply to transfer your CDL within 30 days.

The following drivers license is the only one I possess:

Driver's License No. State: Expiration Date:

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

Drivers Signature:
Today's Date:  

MOTOR VEHICLE DRIVER'S

Certification of Violations/Annual Review of Driving Record

MOTOR CARRIER INSTRUCTIONS: Each motor carrier shall at least once every 12 months, require each driver it employs to prepare and furnish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted, or on account of which he/she has forfeited bond or collateral during the preceding 12 months (section 391.27). Drivers who have provided information required by Section 383.31 need not repeat that information on this form.

DRIVER REQUIREMENTS: Each driver shall furnish the list as required by the motor carrier above. lf the driver has not been convicted of, or forfeited bond or collateral on account of any violation which must be listed, he/she shall so certify (Section 391.27).

Name of Driver: Social Security Number: Date of emplyment:
Home Terminal (city and state): Drivers Lic. Number and State: Expiration Date:

I certify that the following is a true and complete list of traffic violations required to be listed (other than those I have provided under Part 383) for which I have been convicted or forfeited bond or collateral during the past 12 months.

If you have had NO violations, check this box: No Violations

Date Offense Location Type of Vehicle

lf no violations are listed above, I certify that I have not been convicted of forfeited bond or collateral on account of any violation (other than those I have provided under Part 383) required to be listed during the past 12 months.

Drivers Signature:
Today's Date:  

USA Drivers Inc.

Driver 10 Commandments

  1. USA Drivers, Inc. is your employer of record for tax and insurance purposes. In the event of an on-the-job injury or accident, we must be contacted as soon as possible at the main office, 770-368-416 . It is our responsibility to respond to your injury needs through medical care providers. If the office is closed, call the after hours number, 404-877-8478. If there is still no answer, be sure to leave a message as to when you called and how we can contact you.
  2. Call the office in the event that you cannot make it to an assignment. If you have accepted a dispatch it is important that you arrive on time. Call the after hours number if the office is closed. Our reputation is at stake.
  3. If you are not on permanent assignment it is important that you call dispatch every weekday morning between 7am and 9am to notify us of your status.
  4. Look and act like a professional driver. Dress neatly and be clean shaven. Arrive to work at least 15 minutes prior to your start time, complete your pre-trip/post-trip inspection and ensure you are ready to work by your start time. Do not milk the clock. You will not be asked back.
  5. Maintain communication with the customer. Clearly understand their requirements and call with any questions. Check in regularly!
  6. Follow all rules and regulations, including DOT requirements and all USA Drivers, Inc., policies and procedures.
  7. Always have your cDL license and medical card on your person at all times.
  8. Always think of safety, for yourself and others around you.
  9. Treat others with the respect you wish to receive. Always maintain a positive attitude.
  10. Remember, no shows and/or tardiness will not be tolerated. You will be charged $100.00 for no-shows without a two hour notice.
Signature:
Date:  

USA DRIVERS, INC
DRUG TESTING NOTIFICATION AND CONSENT

I understand, as required by the Federal Motor Carrier Safety Regulations, 49 CFR Part 391, andlor company policy, all prospective drivers must submit to a test involving collection of a urine sample which will be tested for the following substances: marijuana, cocaine, opiates, amphetamines and phencyclidine (PCP). In addition, I agree to become a participant in a random and post-accident drug and alcohol-testing program following D.O.T. published guidelines.

I understand, if I test positive for use of a controlled substance, or fail to pass an alcohol breathalyzer test utilizing D.O.T. limits, I am not medically qualified to operate a commercial vehicle.

I understand the result of the drug test(s) will be maintained by USA Drivers, Inc. I hereby authorize USA Drivers, Inc., to release the results of the test to any company for
employment or contract for services purposes.

I hereby agree to submit to a urine drug screen andlor an alcohol breathalyzer test.

Signature:
Date:  

PRE-EMPLOYMENT DRUG TESTING
Consent and Release Form

We are pleased to have offered you a position with USA Drivers, Inc.
To ensure that all new employees are able to perform their duties safely, pre-employment drug testing is required by law and your employment is contingent on a negative result. The cost of testing is $50.00 and will be paid by USA Drivers. However, if you quit, or are terminated for cause within the first two (2) weeks of employment the cost will be deducted from your final paycheck.

With this understanding, I hereby consent to a urinalysis as a contingent part of an offer of employment with USA Drivers, Inc.
Applicant Signature:
Date:

USA DRIVERS INC
DIRECT DEPOSIT AUTHORIZATION FORM

Name:
SSN:
I hereby authroize: USA Drivers Inc.
To initiate:
Draft/Debit
Credits/Payments

To my:

I understand that, if necessary, an adjusting debit or credit entry may be made to correct an error. I also authorize the financial institution named below to credit and/or debit my account for the correcting entries. I duly certify that I am an authorized signer of said account and have the right to enter into this agreement.
ACCOUNT INFORMATION
Name of Bank:
City, State:
Bank routing number:
Account Name:
Account Number:

This authority will remain in full force and effect until such time as USA DRIVERS INC has received written notification from me that the draft authorizationhas been revoked. It is further provided that written notification of termination, by either party, shall be provided in such time and manner as to afford either party reasonable opportunity to act on it.

Signature:
Date:

POST JOB OFFER MEDICAL QUESTIONNAIRE

Date: Position:
Name:
Do you ever have..

Reactions to medicines: YesNo

Reactions to oils: YesNo

Reactions to chemicals: YesNo

Skin Rashes or Eczema: YesNo

Have you ever had..

Seizures or Convulsions: YesNo

Epilepsy: YesNo

Paralysis: YesNo

Numbness of Hands or Feet: YesNo

Double Vision: YesNo

Severe headaches: YesNo

Migraine headaches: YesNo

Dizzy Spells: YesNo

Have you ever had..

Asthma: YesNo

Hay Fever: YesNo

Shortness of breath when walking: YesNo
Have you ever had..

Neck injury or pain: YesNo

Back injury or pain: YesNo

Shoulder injury or pain: YesNo

Neck surgery: YesNo

Back surgery: YesNo

Knee surgery:YesNo

Shoulder surgery: YesNo

Rheumatism or arthritis: YesNo

Fracture/Break of bone: YesNo


Have you ever had..

High blood pressure: YesNo

Heart trouble: YesNo

Heart attack: YesNo

Heart surgery: YesNo

Fainting spells: YesNo

Varicose Veins: YesNo

Swelling of ankles: YesNo


Do you have or ever had..

Hernia: YesNo

Diabetes: YesNo




Medicine, Drugs, Alcohol..

Are you taking medicine regularly?: YesNo

Are you currently using illegal drugs or harmful substances?: YesNo

How much:

How often:


Eyes..

Do you use contacts or eye glasses: YesNo
Our Company policy mandates that if an employee refuses to submit to or cooperate with a blood or urine test after an accident, he/she shall forfeit workers Compensation Benefits Type your initials:
Misrepresentation as to preexisting physical or mental conditions may void your workers compensation benefits Type your initials:
Explantion of all YES answers:
Signature: