Job Application

Pre-employment application

Thank you for your interest in A22 INC. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.

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

PERSONAL INFO:

First Name *

Middle Name

Last Name *

Phone *

Email Address *

Social Security Number *

Date of birth *

Address *

CDL A Number *

Expiration Date *

State of issuance *

PLEASE ANSWER THE FOLLOWING QUESTIONS:

1. Have you ever applied for a job in this company before? *YesNo

2. Have you ever worked for this company before? *YesNo

Date From

Date To

3. Has any of your licenses, permits or privileges ever been suspended or revoked? *YesNo

If you answered “YES”, please explain in detail:

4. Do you have at least 1 year of experience in OTR driving in the last 2 years? *

5. When did your last job end (How long have you been off? *

6. Where do you live? *

7. How often do you need to be home? *

8. How many years of experience do you have? *

9. Do you have any violations on your PSP from the previous 3 years? *

10. Have you received any citations in the previous 3 years? *

11. Have you had any accidents in the previous 3 years? *

12. Have you ever been convicted? *

13. Have you ever refused to be tested for drugs/alcohol? *YesNo

Have you ever had a positive drug/alcohol test? *YesNo

If you answered “YES”, please explain in detail:

14. Are you currently employed? *YesNo

Company Name and Address

Supervisor/ Manager Contact and Phone Number

Your Position in the Company

Previous Company Name and Address

Supervisor/ Manager Contact and Phone Number

Your Position in the Company

15. Do you agree us to contact your current/ previous Company for Verification of Employment purposes? *YesNo

APPLICANT`S INFORMATION RELEASE CONSENT
I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold A22, Inc., any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.

To Be Read and Signed by Applicant:

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file. It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse. 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.

I hereby authorize and request (Name All Prior Employers)

to release any and all information pertaining to my employment records as required by 49 CFR Section 391.23 and Section 40.25(b) to the above named company. You are released from any and all liability which may result from releasing such information. The Federal Motor Carrier Safety Regulation require that this information be released as part of Driver Qualification Process. Per 49 CFR Section 40.25(h), you are required to immediately release this information.

Applicant's Signature *

Applicant`s Full Name: *

Social Security Number *

Date *

Prospective Employer: A22, Inc

EMPLOYMENT HISTORY:

Please state all employment history in the past 3 years and Commercial Driving Experience for the past 10 years.

Company Name:

From:

To:

Company’s Phone#:

Company’s Address:

Position:

Reason for Leaving :

Where you subject to FMCSRs while employed here?YesNo

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?YesNo

Company Name:

From:

To:

Company’s Phone#:

Company’s Address:

Position:

Reason for Leaving :

Where you subject to FMCSRs while employed here?YesNo

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?YesNo

Company Name:

From:

To:

Company’s Phone#:

Company’s Address:

Position:

Reason for Leaving :

Where you subject to FMCSRs while employed here?YesNo

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?YesNo

Company Name:

From:

To:

Company’s Phone#:

Company’s Address:

Position:

Reason for Leaving :

Where you subject to FMCSRs while employed here?YesNo

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?YesNo

Company Name:

From:

To:

Company’s Phone#:

Company’s Address:

Position:

Reason for Leaving :

Where you subject to FMCSRs while employed here?YesNo

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?YesNo

Company Name:

From:

To:

Company’s Phone#:

Company’s Address:

Position:

Reason for Leaving :

Where you subject to FMCSRs while employed here?YesNo

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?YesNo

Company Name:

From:

To:

Company’s Phone#:

Company’s Address:

Position:

Reason for Leaving :

Where you subject to FMCSRs while employed here?YesNo

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?YesNo

BACKGROUND CHECK DISCLOSURE AND RELEASE AUTHORIZATION FORM FOR EMPLOYMENT PURPOSES

Background Screening Disclosure
A22, INC. (the “Company”) may request a comprehensive review of your background information from a consumer reporting agency in connection with your employment application and for employment purposes, including promotion, reassignment, or retention as an employee. Your background information may be obtained in the form of consumer reports and/or investigative consumer reports. These reports may be obtained at any time after receipt of your authorization and, if you are hired by the Company, throughout your employment. ESupervision.com, and its designated agents and representatives or another consumer reporting agency will prepare or assemble the reports. The scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: consumer credit, names and dates of previous/current employment, worker’s compensation claims, criminal history records (from local, state, federal, international and other law enforcement agencies’ records), sexual offender’s lists, wants and warrants records, motor vehicle records, military records, educational verification, license verification, civil cases, OIG/GSA, OFAC/patriot act, any sanction lists, finger printing and drug testing. These reports may include information as to your general reputation, character, personal characteristics, mode of living, work habits, job performance and experience along with reasons for termination of past employment from previous employers. You may request more information about the nature and scope of any investigative consumer reports by contacting the Company. A summary of your rights under the Fair Credit Reporting Act is also being provided to you.

Authorization and Release

authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, institution, school or university, law enforcement or public agency may have. I authorize the full release of the information described above, without any reservation, throughout any duration of my employment at the Company. I certify that all information provided below is true and accurate to the best of my knowledge. This authorization and consent shall be valid in original, facsimile (“fax”), or copy form. I understand that ESupervision’s privacy practices can be found at https://esupervision.com.

Signature: *

Date *

The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose. PLEASE PRINT LEGIBILY:

Full Name (First Middle Last) *

Maiden/AKA/Previous Name(s) *

Social Security Number *

Date of birth *

Driver's License Number *

State of Issue *

Current Address *

City

State

ZIP / Postal Code

Phone 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
A22, 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.
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 A22, 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 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 *

Signature *

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.
NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49
C.F.R. 383.5.
LAST UPDATED 12/22/2015

Disclosure About a Background Check
A22 Inc may obtain one or more “consumer reports” about you from a consumer reporting agency for employment purposes. A “consumer report” is a background screening report that may include information about your criminal history, sex offender registry status, credit history, driving history, education history, employment history, professional licenses, name, social security number and other information about you. The information in a “consumer report” may bear on your character, general reputation, personal characteristics, and/or mode of living. “Employment purposes” includes evaluating you for employment, promotion, reassignment, or retention. The Federal Trade Commission’s staff has said that the term may apply to employees, independent contractors, independent agents, and volunteers.
Authorization For Background Check
By signing below, you acknowledge that: (a) you received the following separate documents, (b)
they are clear, conspicuous, and separate from any other documents, (c) you read and understood them, and (d) we may rely on them for one or more background investigations and resulting reports:
• Disclosure About Background Check on You
• Additional Notice About Investigative Consumer Reports
• A Summary of Your Rights Under the Fair Credit Reporting Act
• Additional Notice About Medical Information
• Additional Notices Under State Law (including any other documents it identifies)
By signing below, you (a) authorize and permit us (A22 Inc) to obtain “consumer reports” and “investigative consumer reports” about ; (b) authorize any consumer reporting agency from whom we request those reports to obtain information about your from any public or private information source; (c) authorize anyone to provide information about you to that consumer reporting agency; ( d) authorize and instruct that consumer reporting agency to provide those reports to us; (e) consent to those reports including results of fitness-for-duty assessments, drug tests, and alcohol tests; and (f) authorize us to share those reports with others for legitimate business purposes related to your application or relationship with us.
By signing below, you acknowledge that a fax, image, or copy of this authorization Is as valid as the original.
By signing below, you make these acknowledgments and authorizations to be valid for the duration of your application or relationship with us.
The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose. PLEASE PRINT LEGIBILY:

Applicant`s Signature: *

Applicant`s Full Name: *

Social Security Number *

Address: *

Phone Number: *

CDL Number and State: *

Date: *

Hiring Process:
First, we submit your information to our insurance for approval and it usually takes 1 business day before we receive an answer from them. After receiving confirmation from the insurance, we will contact you to schedule an In-person interview. During the interview we will be performing road test, pre-trip inspection test and hours of service test. Next step would be pre-employment drug test. It usually takes 1-2 business days to receive results. After results are received you will receive a 2-3hours orientation course and will fill out required forms and documents. Finally, we will assign you a truck and then you will finally be ready for open road.
Usually, the hiring process takes 1-3 business days.
Please note: We only hire safe, professional and responsible drivers. You must have a smart phone with a camera so that you are able to professionally communicate with customers and company personal.
Submitting this application certifies that this form was completed by me and all entries and information on it are true and complete to the best of my knowledge. I authorize A22, Inc. to make investigations and inquires of my driving history and past employment. I hereby authorize A22, Inc. to check my MVR from DMV for review as part of the process of hiring me as a driver.

Applicant`s Signature: *

Applicant`s Full Name: *

Date: *

Pre-employment application

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For DOT verifications please attach your signed release here and we will get it back to you as soon as possible.

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