Application


3139 CR 205 N, Henderson, Texas 75652
Phone: (903)722-9123 Fax: (903)392-8291

Dear Potential Employee:

Thank you for considering TruCore Energy, LLC. as a place of employment. We pride ourselves in being an outstanding Company in our industry. We are confident your decision to apply with us will prove to be a good one. Before completing the Application for Qualification, please read the enclosed documents carefully to ensure that you qualify for employment with TruCore Energy, LLC. By completing this Application for Qualification, you are agreeing to the
conditions of employment listed in the application itself and in any attached forms.


APPLICATION PROCESS

APPLICATION FOR EMPLOYMENT AND QUALIFICATION: The Application for Employment and Qualification is the first step to joining TruCore Energy, LLC. Complete the form in legible printed format and sign where required. If a section does not apply, write in N/A.On the additional pages, only complete areas indicated by -> or X. Additional pages include a Request for Driver’s Safety Performance History/Information from DOT Regulated Previous Employer(s) (2 pages), Request to HireRight, Job Description for Company Representative, Controlled Substance and Alcohol Testing Information,Acknowledgement/Consent Form, and Driver’s Rights Pertaining to Release of Driver Information Under Regulation 391.23.


IMPORTANT! You must fully complete the ten-year work history (including both driving and non-driving positions as well as paid and unpaid positions). If there is a gap in employment, please be sure to document the gap using the “Declaration of Employment Status” form to explain why you were unemployed or what you were doing during that time. If more space is needed please use a separate sheet of paper. Please remember: dishonesty on any application is grounds for immediate disqualification and/or termination.

INTERVIEW: You will be required to interview with the TruCore Energy, LLC. HR Manager, David Shelton, for an initial phone interview.

SAFETY/INTAKE INTERVIEW: You will be required to meet with our Intake Coordinators and complete any certifications you may need along with providing necessary trucks information to get you on the road, safely.

ROAD TEST: You will be required to demonstrate your ability to operate Company equipment by taking a road test.

DRUG SCREEN: You will also be required to pass a DOT FMCSA drug test.

All new drivers will be required to complete a two-hour orientation prior to leaving the yard with a load. Orientation will cover; paperwork, policies, procedures, safe driving practices, log books, pay documents and other related material. All DRIVERS WILL BE REQUIRED TO BRING ALL REQUIRED PPE TO ORIENTATION FOR VERIFICATION.

Please realize that applicants are accepted for hire on a competitive basis. When positions are available, the most qualified applicants at the time are contacted. While we cannot always hire every good applicant at any given time, we do keep all applications on file for one year

We appreciate your interest in TruCore Energy, LLC.
and look forward to receiving your application in the next few days.

 

3139 CR 205 N, Henderson, Texas 75652
Phone: (903)722-9123 Fax: (903)392-8291

JOB DESCRIPTION for COMPANY REPRESENTATIVE, TRUCK DRIVER

REPORTS TO: Fleet Manager/Dispatcher

DUTIES & RESPONSIBILITIES

  • Operates three axle tractor pulling pneumatic trailers, water trailers, and other equipment as directed.
  • Pickup and deliver freight on time as directed by supervisor.
  • Acts as a company representative while meeting with customers in all job-related capacities.
  • Relays vital customer service information to immediate supervisor or management as needed.
  • Maintains a pleasant manner and is diplomatic, courteous and communicates well with customers, and others.
  • Performs other work related duties as assigned by immediate supervisor or other management
  • Maintains thorough understanding of, and complies with all company operating procedures, safety standards, and other policies.

REQUIRED QUALIFICATIONS

  • Two years of experience driving similar equipment.
  • Valid Class A CDL with tanker endorsements.
  • Proof of good health with no limitations on jobs related to pushing, pulling, and lifting requirements, etc.
  • Successful completion of pre-employment drug test.
  • Verifiable references.
  • No convictions of serious violations in the past five years to include DUI, speeding 15 mph over, following too close, erratic lane changes,reckless/careless driving.
  • No violations in the past three years to include multiple license suspensions or more than 3 moving violations in past 3 years.
  • No record of more than 2 preventable accidents/incidents in the past 3 years.
  • Ability to handle a semi-tractor and trailer(s) with safety and efficiency as demonstrated by road test (s).
  • Other qualifications as described in section 391.11 of the Federal Motor Carrier Safety Regulations.
  • Continued insurability with our insurance provider.
  • Clean and neat appearance.

KNOWLEDGE, SKILLS & ABILITIES

  • General knowledge of Department of Transportation and other regulatory bodies governing the transportation industry.
  • General knowledge of various types of equipment, equipment maintenance, and safety requirements.
  • Thorough knowledge of commodity weight distribution and trailer loading procedures.
  • Ability to maintain a good attitude in difficult circumstances.
  • Ability to be timely, personable, and positive.
  • Ability to complete all job-related paperwork neatly, timely, and correctly.
  • Ability to operate company diesel transportation equipment with safety and efficiency.

PHYSICAL REQUIREMENTS

Drivers must have the ability to:

  • Withstand strain of sitting in the truck seat for up to ten hours a day, 60-70 hours per week.
  • Withstand the physical, mental, emotional stress of demanding schedules, customer needs, and irregular hours.
  • Enter/exit cabs and trailers safely at heights of 52 to 60 inches, using a “3-point stance”.
  • Respond alertly to heavy traffic in metropolitan areas, (i.e. Houston, Chicago).
  • See and read mirrors quickly at a 90-degree angle, 8 feet away.
All final decisions regarding qualifications and requirements are at the discretion of management.

I have read and understand the above job description and certify that I meet all qualifications and all physical requirements for this position

3139 CR 205 N, Henderson, Texas 75652
Phone: (903)722-9123 Fax: (903)392-8291

APPLICATION FOR QUALIFICATION
Answer all questions – Please print

The purpose of this application is to determine whether or not the applicant is qualified to operate motor carrier equipment according to the requirements of the Federal Motor Carrier Safety Regulations (FMSCR) and requirements of TruCore Energy, LLC. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, sex, national origin, age, marital status, religion or the presence of non-job related medical condition or handicap.

Full Name:  

Street Address:  

City, State, Zip Code  

Home Telephone  

License No. and State of Issue  

In case of emergency notify  

Application Date:   

Name of Owner/Operator:   

How were you referred?  

Social Security #  

Date of Birth  

Email:  

Endorsements: 

 

Telephone:

Have you ever been known by any name other than the one on this application? 

 

If yes, list name(s):   

List all past addresses in which you have lived during the (3) preceding years (if more space is needed, use separate sheet)

  Address City, State, Zip Dates
Past Address
Past Address

 

List all driver licenses you have held during the past three (3) years (if more space is needed, use separate sheet)

  Address City, State, Zip Dates
Past Address
Past Address

 

List states operated in for last five years:  


Have you worked for this company before? 

 

Dates: From    to   
Rate of Pay    Position    Reason for leaving    

Are you legally eligible for employment in the United States? 

 

Are you able to perform all functions of a truck driver (with or without accommodation)?

 


How many years of experience do you have operating a Class A vehicle?  

Do you have recent Tanker Truck experience

 

Do you have recent experience with double trailers?

 


If the answer to any of the below questions is “yes”, briefly explain on a separate piece of paper. Include dates and circumstances.Answering yes to any of the below questions will not necessarily disqualify you from employment with TruCore Energy, LLC

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

 

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

 

Have you ever been disqualified from driving a motor vehicle under the DOT regulations?

 

Have you ever been convicted of driving under the influence of alcohol or drugs?.

 

Have you ever tested positive or refused a DOT regulated drug and/or alcohol test?

 

Have you ever been convicted of careless or reckless driving?.

 

Have you been convicted of any crime within the last seven years?

 

Have you ever been convicted of a felony?

 


Do you have a Transportation Worker Identification Card (TWIC)

 

Have you graduated from a truck driving school?

 

If yes: Name of School , Year   

Show special courses or training that will help you as a driver:   

Which safe driving awards do you hold and from whom?   

10 YEAR EMPLOYMENT HISTORY – Page 1

PLEASE BE THOROUGH! INCOMPLETE APPLICATIONS SLOW THE HIRING PROCESS!

ALL full time, part time, voluntary, driving and non-driving employment as well as gaps in employment for previous 10 years MUST be listed.

 

Current or Most Recent Employer

Employer Name   Phone:   
Address (Street or PO Box )   Fax:  
City, State, Zip  

Dates of Employment (month/year)

From :  To :  

Person to contact for reference   Salary/Wages  
Position Held   Reason for Leaving  
Were you subject to the FMCSRs* while employed in this position?  

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?
 

 

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?  

 

May we contact this employer?  

 

 

Former Employer #2

Employer Name    Phone:    
Address (Street or PO Box )    Fax:   
City, State, Zip   

Dates of Employment (month/year)

From : To :   

Person to contact for reference    Salary/Wages   
Position Held    Reason for Leaving   
Were you subject to the FMCSRs* while employed in this position?   

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?  

 

May we contact this employer?  

 

 

Former Employer #3

Employer Name     Phone:    
Address (Street or PO Box )     Fax:    
City, State, Zip    

Dates of Employment (month/year)

From : To :    

Person to contact for reference    Salary/Wages    
Position Held     Reason for Leaving   
Were you subject to the FMCSRs* while employed in this position?   

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?

May we contact this employer?  

 

 

Former Employer #4

Employer Name      Phone:     

Address (Street or PO Box )    

Fax:     
City, State, Zip    

Dates of Employment (month/year)

From :  To :    

Person to contact for reference     Salary/Wages     
Position Held      Reason for Leaving   
Were you subject to the FMCSRs* while employed in this position?    

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?

May we contact this employer?  

 

*The Federal Motor Carrier Safety Regulations (FMCSRs) apply to anyone who operates a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle: (1) has a GVWR or weighs 10,001 or more, (2) is designed or used to transport nine or more passengers, or (3) is of any size, used to transport hazardous materials in a quantity requiring placarding.

IF NECESSARY, CONTINUE 10 YEAR HISTORY ON “10 YEAR EMPLOYMENT HISTORY – Page 2”

10 YEAR EMPLOYMENT HISTORY – Page 2

PLEASE BE THOROUGH! INCOMPLETE APPLICATIONS SLOW THE HIRING PROCESS!

ALL full time, part time, voluntary, driving and non-driving employment as well as gaps in employment for previous 10 years MUST be listed.

Former Employer #5

Employer Name      Phone:     

Address (Street or PO Box )    

Fax:      
City, State, Zip    

Dates of Employment (month/year)

From : To :   

Person to contact for reference     Salary/Wages     
Position Held      Reason for Leaving    
Were you subject to the FMCSRs* while employed in this position?   

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?

May we contact this employer?  

 

 

Former Employer #6

Employer Name       Phone:      

Address (Street or PO Box )    

Fax:      
City, State, Zip     

Dates of Employment (month/year)

From :  To :    

Person to contact for reference     Salary/Wages      
Position Held      Reason for Leaving     
Were you subject to the FMCSRs* while employed in this position?    

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?

May we contact this employer?   

 

 

Former Employer #7

Employer Name      Phone:       

Address (Street or PO Box )     

Fax:     
City, State, Zip      

Dates of Employment (month/year)

From :  To :   

Person to contact for reference      Salary/Wages     
Position Held       Reason for Leaving     
Were you subject to the FMCSRs* while employed in this position?   

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?

May we contact this employer?    

 

 

Former Employer #8

Employer Name       Phone:      

Address (Street or PO Box )     

Fax:     
City, State, Zip     

Dates of Employment (month/year)

From :  To :   

Person to contact for reference       Salary/Wages     
Position Held       Reason for Leaving     
Were you subject to the FMCSRs* while employed in this position?    

 

Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the
drug and alcohol testing requirements of 49 CFR Part 40?

Did this employer issue you a Longer Combination Vehicle Certificate (LCV)?

May we contact this employer?    

 

 

ATTACH SEPARATE SHEET IF MORE SPACE IS NEEDED FOR 10 YEAR HISTORY
DRIVING EXPERIENCE

CLASS OF EQUIPMENT TYPE OF EQUIPMENT
(Van, Tank, Flat, etc.)
DATES OF OPERATION APPROX. NO. OF MILES
(TOTAL)
Straight Truck            
Tractor – Semi Trailer            
Tractor – Two Trailers            
Motor Coach – School Bus            
Other            

 

ACCIDENT RECORD FOR THE PAST 5 YEARS
(Include Personal and Commercial, DOT and Non-DOT incidents/accidents)

Attach sheet if more room is needed

 

DATE OF
ACCIDENT
PERSONAL OR
COMMERCIAL
NATURE OF ACCIDENT
(Head-on, rear-end, upset, etc.)
Number of
Fatalities
Number
of Injuries
                   
                   
                   

 

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 5 YEARS (Other than parking violations)

Attach sheet if more room is needed

 

DATE PERSONAL OR
COMMERCIAL
LOCATION CHARGE PENALTY
                   
                   
                   

 

TO BE READ AND SIGNED BY APPLICANT


This certifies that this application, including all attachments, was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I understand and agree that:

  1. Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination of employment.
  2. The company will make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment, related papers and oral interviews. I authorize such investigation and the giving and receiving of any such information requested by the company and I release from liability any person giving or receiving any such information. I understand that falsification of data so given or another information discovered as a result of this investigation may
    prevent my being hired, or if hired, may subject me to immediate dismissal.
  3. I agree to familiarize myself with, and to abide by all present and subsequently issued rules of the company.

I further understand that this is an application for employment and that no employment contract is being offered I have read and understand the above.

DECLARATION OF EMPLOYMENT STATUS

(This form must be completed by applicant if there are periods of time that cannot be verified, for instance: unemployment, self-employment, traveling, retirement, etc.)

Under the Federal Motor Carrier Safety Regulations Section 391.23, TruCore Energy, LLC is required to verify employment background of all prospective drivers for the preceding three (3) years. You have indicated that you were employed or selfemployed during the time period shown below. This form is designed to enable you to account for those periods during your employment history which cannot be verified by any other means. In the section below, please fill in the dates and describe your activities during those times.


Dates:           From (Month/Year) :     To (Month/Year)   

During the period specified I was engaged as follows:   

I also confirm that during the above period, the statements I have checked below are true:


Dates:           From (Month/Year) :     To (Month/Year)    

During the period specified I was engaged as follows: 

I also confirm that during the above period, the statements I have checked below are true:


Dates:           From (Month/Year) :     To (Month/Year)    

During the period specified I was engaged as follows:    

I also confirm that during the above period, the statements I have checked below are true:


I understand that this document is considered part of my employment application, and as such, any material misrepresentation or deliberate omission of a fact on this form may be justification for refusal of, or if employed, termination from employment.

 

CONTROLLED SUBSTANCE AND ALCOHOL TESTING INFORMATION
ACKNOWLEDGEMENT/CONSENT FORM

As a condition of employment with TruCore Energy, LLC, Commercial Motor Vehicle (CMV) Driver Applicants must submit to a pre-employment controlled substances test as required by the Federal Motor Carrier Safety Regulations (FMCSR) Section 382.301. A motor carrier must receive verified negative test results for the applicant driver for the applicant to be eligible for employment.

If you are hired, you will be subject to laws requiring additional controlled substances and alcohol testing 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 for a controlled substance(s) and/or alcohol test (including pre-employment testing), will be immediately removed from a safety-sensitive position as required by Part 382 of the FMCSR. Federal law prohibits a driver 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 described in FMCSR Part 40, Subpart O.

Should you need the services of a Substance Abuse Professional (SAP), please contact your general manager or the Human Resource Department for a current list of SAP’s.

All controlled substances and alcohol testing will be conducted in accordance with Parts 40 and 382 of the FMCSR.

I ,  ,have read the above controlled substance and alcohol testing requirements and understand them.

 

3139 CR 205 N, Henderson, Texas 75652
Phone: (903)722-9123 Fax: (903)392-8291

 

 

 

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
  • (1)(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 must 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:

  1. The right to review the information provided by previous employers.
  2. The right to have errors in the information corrected by previous employer and for that previous employer to re-send the corrected information to the prospective employer
  3. 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 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.

 

FROM: TruCore Energy, LLC, Human Resource Dept.
3139 CR 205 N
Henderson, TX 75652
Phone: (903) 722-9123
Fax: (903) 392-8291
TO:   

 

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

The person named below has applied for employment as a TRUCK DRIVER and states that he/she was employed by you as a    from  to  .  The applicant has waived any claim of liability against your company for information submitted in response to this inquiry. 

►NAME OF APPLICANT   

SOCIAL SECURITY #   

DATE   


SECTION 1: WORK HISTORY (TO BE COMPLETED BY PREVIOUS EMPLOYER)

1. Is employment record with your company as stated above? 

 

2. If employed as a driver, what type of equipment did he/she operate?

Type of trailer(s) pulled:   

3. Was this driver issued a Longer Combination Vehicle (LCV) certificate (§380 of the FMCSRs) by your company? 

 

If yes, please attach copy of LCV Certificate.

4. Was this driver a: 

 

5. General area traveled:   

6. Commodities transported:   

7. While under your employment was he/she convicted of any traffic violations? . 

 

If yes, list all, including date and type:   

8. While under your employment was his/her license(s) suspended, revoked or denied? 

 

If yes, please explain:   

9. Reason for leaving your employment: 

 

Details of discharge:    

10. Would you re-employ this person: 

 

Please explain:   

11. Additional comments?   


SECTION 2: ACCIDENT INFORMATION (TO BE COMPLETED BY PREVIOUS EMPLOYER)

Please provide the following information as required by 391.23(d)(1)(2) on any accidents, as defined by 390.5 and/or from your Accident Register (FMCSR 381.15) which the above-named driver/applicant was involved within the past three years while in your employment. Previous employers may include additional detailed information on minor accidents/incidents at their discretion. If there were no accidents please check here 

DOT ACCIDENTS:

Date City/State #of Fatalities Preventable Brief Description
             

 

   
             

 

   
             

 

   

NON-DOT INCIDENTS:                                               Carriers may provide information about non-DOT incidents

 

Date City/State Preventable Brief Description
         

 

   
         

 

   
         

 

   

 

Print Name:   

Title:   

Phone:   

Date:   

 

EMPLOYMENT VERIFICATION
Non-DOT Employer
AUTHORIZATION TO RELEASE INFORMATION

PLEASE RETURN VIA FAX AS SOON AS POSSIBLE TO:
TruCore Energy, LLC
Human Resource Dept.
(903) 722-9123 Phone
(903) 392-8291 Confidential Fax
TO:  

I,  , hereby authorize you to release all records of employment, including assessments of my job performance, ability and fitness, including dates and results of any and all
alcohol or drug screens. I hereby release the above named 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.

►Print Applicant Name:    

►Social Security No:   

►Date:   


To be completed by previous employer:

Dates of Employment:         From:                       To:   

Please briefly describe the duties this person performed for your organization:   

Attendance?
Late arrivals?

 

Work performance? 

 

Reason for leaving your employ? 

 

Please explain:  

Would your re-employ this person? 

 

Please explain:   

Additional comments?   


Previous Employer to complete:

Completed by:   

Date:   

Company Name:   

Phone number:   

 

REQUEST TO DATCS and HireRight

PART I – DOT DRUG AND ALCOHOL RELEASE

I authorize, per 49 CFR Part 391.23, the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed below to DATCS for the sole purpose of transmitting such records to the above listed employer. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years; (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations (i.e., violations of 49 CFR 382 Subpart B); (v) information obtained from previous employers of a drug and alcohol rule violation(s) and (vi) documents, if any, of completion of a return-to-duty process following a rule violation.

The information that I have authorized DATCS to review involves tests required by DOT. If any carrier (company/school) listed below furnishes DATCS with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and /or alcohol tests and/or tests with results below 0.04 during the three year period and the name and phone number of any substance abuse professional who evaluated me during the past three years.

APPLICANT:

►Print Applicant Name:   

►Social Security Number:   

►Gender:   

►Birth date:   

►Date:   


OFFICE USE:

Company City State Area Code & Phone Number
               
               
               

 

FMCSA Notification of Driver Rights

In compliance with 49 CFR Part 391.23, you have certain rights regarding the performance history information that will be provided to prospective employers. I) You have the right to review information provided by previous employers. II) You have 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 prospective employers. III) 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. (2) Drivers who have previous DOT regulated employment history in the preceding three years and wish to review previous employer-provided investigative information must submit a written request to prospective employers. This may be done at any time including when applying or as late as 30 days after being employed or being notified of denial of employment. Prospective employers must provide this information within five business days of receiving the written request. If prospective employers have not yet received the requested information from the previous employer, then the five-day deadline will begin when the requested safety performance history information is received. If you have not arranged to pick up or receive the requested records within 30 days of prospective employers making them available, prospective employer may consider you to have waived your request to review the record.


PART II – CONSUMER REPORT DISCLOSURE AND RELEASE

In connection with your employment or application for employment (including contract for services), consumer reports may be requested from HireRight . These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, academic history, professional credentials, and drugs/alcohol use. Such reports may contain public record information concerning your driving record, workers’ compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from HireRight concerning previous driving record requests made by others from such state agencies and state provided driving records.

You have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that HireRight has previously furnished within the three-year period preceding you request. HireRight may be contacted by mail at P.O Box 33181, Tulsa, Oklahoma, 74153, or by phone at (800) 381-0645.

I AUTHORIZE, WITHOUT RESERVATION, HireRight, AND ANY PARTY OR AGENCY CONTACTED BY HireRight, TO FURNISH THE ABOVE-MENTIONED INFORMATION. This authorization does not apply to drug and alcohol information obtained under Part I. 

I hereby consent to your obtaining the above information from HireRight, and I agree that such information which HireRight has or obtains, and my employment history (not DOT Drug and Alcohol information without a specific consent by me) with you if I am hired, will be supplied by HireRight to other companies which subscribe to HireRight. I hereby authorize procurement of consumer report(s) if hired or contracted by this authorization. For Part II reports only, shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment or contract period

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PART III – POST-ACCIDENT TESTING
§382.303 Post-accident testing.

(a) As soon as practicable following an occurrence involving a commercial motor vehicle operating on a public road in commerce, each employer shall test for alcohol for each of its surviving drivers:

(a)(1) Who was performing safety-sensitive functions with respect to the vehicle, if the accident involved the loss of human life; or(a)(2) Who receives a citation within 8 hours of the occurrence under State or local law for a moving traffic violation arising from the accident, if the accident involved:

(a)(2)(i) Bodily injury to any person who, as a result of the injury, immediately receives medical treatment away from the scene of the accident; or
(a)(2)(ii) One or more motor vehicles incurring disabling damage as a result of the accident, requiring the motor vehicle to be transported away from the scene by a tow truck or other motor vehicle.
(b) As soon as practicable following an occurrence involving a commercial motor vehicle operating on a public road in commerce, each employer shall test for controlled substances for each of its surviving drivers:
(b)(1) Who was performing safety-sensitive functions with respect to the vehicle, if the accident involved the loss of human life; or
(b)(2) Who receives a citation within thirty-two hours of the occurrence under State or local law for a moving traffic violation arising from the accident, if the accident involved:
(b)(2)(i) Bodily injury to any person who, as a result of the injury, immediately receives medical treatment away from the scene of the accident; or
(b)(2)(ii) One or more motor vehicles incurring disabling damage as a result of the accident, requiring the motor vehicle to be transported away from the scene by a tow truck or other motor vehicle.
(c) The following table notes when a post-accident test is required to be conducted by paragraphs (a)(1), (a)(2), (b)(1), and (b)(2) of this section:

Table for §382.303 (A) and (B)

Type of accident involved Citation issued to the CMV
driver
Test must be performed by
employer
i  Human fatality   

 

 

 

ii  Bodily injury with immediate medical treatment away from the scene  

 

 

 

iii. Disabling damage to any motor vehicle requiring tow away  

 

 

 

 

(d)(1) Alcohol tests. If a test required by this section is not administered within two hours following the accident, the employer shall prepare and maintain on file a record stating the reasons the test was not promptly administered. If a test required by this section is not administered within eight hours following the accident, the employer  shall cease attempts to administer an alcohol test and shall prepare and maintain the same record. Records shall be submitted to the FMCSA upon request.

(d)(2) Controlled substance tests. If a test required by this section is not administered within 32 hours following the accident, the employer shall cease attempts to administer a controlled substances test, and prepare and maintain on file a record stating the reasons the test was not promptly administered. Records shall be submitted to the FMCSA upon request.

(e) A driver who is subject to post-accident testing shall remain readily available for such testing or may be deemed by the employer to have refused to submit to testing. Nothing in this section shall be construed to require the delay of necessary medical attention for injured people following an accident or to prohibit a driver from leaving the scene of an accident for the period necessary to obtain assistance in responding to the accident, or to obtain necessary emergency medical care.

(f) An employer shall provide drivers with necessary post-accident information, procedures and instructions, prior to the driver operating a commercial motor vehicle, so that drivers will be able to comply with the requirements of this section.

(g)(1) The results of a breath or blood test for the use of alcohol, conducted by Federal, State, or local officials having independent authority for the test, shall be considered to meet the requirements of this section, provided such tests conform to the applicable Federal, State or local alcohol testing requirements, and that the results of the tests are obtained by the employer.

(g)(2) The results of a urine test for the use of controlled substances, conducted by Federal, State, or local officials having independent authority for the test, shall be considered to meet the requirements of this section, provided such tests conform to the applicable Federal, State or local controlled substances testing requirements, and that the results of the tests are obtained by the employer.

(h) Exception. This section does not apply to:
(h)(1) An occurrence involving only boarding or alighting from a stationary motor vehicle; or
(h)(2) An occurrence involving only the loading or unloading of cargo; or
(h)(3) An occurrence in the course of the operation of a passenger car or a multipurpose passenger vehicle (as defined in §571.3 of this title) by an employer unless the motor vehicle is transporting passengers for hire or hazardous materials of a type and quantity that require the motor vehicle to be marked or placarded in accordance with §177.823 of this title.

I acknowledge that I have read and understand the contents of this document.

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Date:   

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 TruCore Energy LLC, 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.

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 FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) 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 TruCore Energy 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 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.

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 DataQs system 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 FMCSR 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.

Date   

Print Name   

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.
LAST UPDATED 12/28/17

DRIVER STATEMENT OF ON-DUTY HOURS

(For Newly Hired Drivers)

 

INSTRUCTIONS: Motor carriers when using a driver for the first time shall obtain from the driver a signed statement giving the total time on-duty during the immediate 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. NOTE: Hours for any compensated work during the preceding 7 days, including work for non-motor carrier entity, must be recorded on this form.

Driver Information:

Motor Vehicle Operator’s License Number: 

Type of License:            Issuing State:   

DAY 1 2 3 4 5 6 7 TOTAL HOURS
DATE                                 
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 at work at:    

on       

Date:   


DRIVER CERTIFICATION FOR OTHER COMPENSATED WORK

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

  1. Are you currently working for another employer? 

     

  2. At this time, do you intend to work for another employer while employed by this company? 

     

Date:   

Emergency Contact Information

Please list at least two contacts

Contact Name:   

Phone Number:   

Email:   

Relationship:   

 

Contact Name:   

Phone Number:   

Email:   

Relationship:   

 

Contact Name:   

Phone Number:   

Email:   

Relationship:   

RELEASE OF CDL HOLDER’S REPORTED

POSITIVE ALCOHOL OR CONTROLLED

SUBSTANCE TEST RESULTS

Use this form to obtain the CDL holder’s reported positive alcohol or controlled substsnce test results information.

This form should ONLY be used if you wish to inquire whether or not prospective driver (CDL Holder)

has had a positive alcohol or controled substance test result reported to the Texas Department of Public Safety in compliance with state low

THIS FORM IS NOT REQUIRED FOR REPORTING A POSITIVE ALCOHOL OR CONTROLLED SUBSTANCETEST.

  1. This form must be completed in full and include the driver’s origilale signature.
  2. Deliver, mail, Email or FAX the completed form to:

      Texas Department of Public Safety

      Motor Carrier Bureau, MSC #0521

      6200 Guadalupe, Building P

      Austin, Texas 78752-4019/Facsimile: 512-424-5310

      Email: MCB.VPR@dps.texas.gov

      

 

Print name of CDL Holder

Phone Number

Print full Address, City, State, and Zip of CDL Holder

Socisl Security

Driver License Number of CDL Holder

State

Date of Birth

 

authorize release of any and all of CDN holder’s reported positive alcohol or controlled substance test result reported under Texas state law to

TRUCORE ENERGY LLC (903)722-9150

3139 CR 205 N Henderson, TX 75652

 

Date: 

 

 

Leave this empty:

TruCore Energy, LLC http://www.trucoreenergy.com
Signature Certificate
Document name: Application
Unique Document ID: c72f79b74adc47eb13d3d431fd8fd4de1b146de0
Timestamp Audit
May 2, 2018 3:24 pm GMTApplication Uploaded by Deborah Miller - recruiter@trucoreenergy.com IP 194.242.96.13
June 5, 2018 11:29 pm GMT Document owner Recruiting@TruCoreEnergy.com has handed over this document to D.miller@trucoreenergy.com 2018-06-05 23:29:10 - 75.109.195.168