DOT Driver Employment Package for MTI Limo & Shuttle Services, … · 2018. 3. 23. · Web: Instruction to submit applications Thank you for your interest in employment at MTI Li

2581 Sullivan RoadCollege Park, GA 30337

Phone: 404-669-0900 Fax: 404-207-1705

Web: www.mtilimos.com

DOT Driver Employment Package for

MTI Limo & Shuttle Services, Inc. MTI Bus Company, Inc.

MTI Charter & Tours, Inc.

Notice: Please read and sign the Drivers Notice of Due Process Rights and Authorization form before completing the employment application.


Fax: 404-207-1705 Web: www.mtilimos.com

Instruction to submit applications

Thank you for your interest in employment at MTI Limo & Shuttle Services, Inc. / MTI Bus Company, Inc. / MTI Charter & Tours, Inc. There are specific directions that must be adhered to to process your application in a timely manner.

ALL APPLICANTS MUST PASS A BACKGROUND CHECK AND DRUG TEST.

ALL DRIVER’S POSITIONS REQUIRE A CDL DRIVER’S LICENSE WITH PASSENGER ENDORSEMENT WITH 2 YEARS DRIVING EXPERIENCE.

DO

• Make sure you have completed all the information requested on the application. If phone numbers, employment dates, address, etc. are incomplete your application won’t be reviewed.

• Make sure to include your home and cell phone numbers on the application.

• You must sign the application when the information is being requested.

• All CDL Applicants must provide 10 years of work history. Any gaps in employment dates must be on the

applications.

Once you have completed your application online @ www.mtilimos.com or Fax to 404-207-1705. DON’T

***Please don’t call the office to check the status of your application***

• If your application is selected a member of our HR Department will contact you and schedule an interview.

• Please don’t submit MVR reports, social security cards, copy of driver’s license.

• Don’t come to the office to complete an application. All applications must be completed online @ www.mtilimos.com or fax to 404-207-1705.



Drivers Notice of Due Process Rights and Authorization

Applicant’s Name: Date of Application:

In accordance 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 protected group status.

TO BE READ AND SIGNED BY THE APPLICANT

I authorize MTI and its agents or representatives to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, and other persons from all liability in responding to inquires and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regarding current and/or previous employers may be used and those employer(s) will be contacted for the purpose of investigating my safety performance history as required to 49 CFR 391.23 (d) and (e).

YOUR RIGHTS REGARDING SAFETY PERFORMANCE HISTORY INFORMATION: The information you provided on this application may be used and the applicant’s prior employers may be contacted, for the purpose of investigating the applicant’s safety performance history information. Pursuant to Federal Motor Carrier Safety Regulations 49 CFR Sec. 391.23 (i) (1) you have the following rights with regard to the safety performance history information provided by your previous employers.

THE RIGHT TO REVIEW SAFETY PERFORMANCE RECORDS: You have the right to review the records provided by previous employers. You must make your request to review in writing and submit to your prospective employer no later than thirty (30) days after employment begins or notification of employment is made. You will be provided with the records within five (5) business days of receipt of your written request. If the prospective employer has not received the records at the time of your request, then the five-day period to provide access will begin on the day the records are received from the previous employer. If you fail to pick up or receive the requested records within thirty (30) days of when they are first made available to you, then your right to review is considered waived.

THE RIGHT TO HAVE ERRONEOUS INFORMATION CORRECTED: If you believe there is an error in the records, you have the right to have your previous employer correct the error. Send your request for correction to the previous employer that provided the records in question. The previous employer must either correct and forward the record to the prospective employer or notify you within fifteen (15) days of receiving your request that they do not agree that the record is in error. If the previous employer corrects and forwards the record as requested, that employer must also retain the corrected information as part of your safety performance history record and provide it to subsequent prospective employers when requests for this information are received.

THE RIGHT TO REBUT DISPUTED INFORMATION: If the previous employer does not agree that information in the records provided is in error you rebut the disputed information in writing and send it to the previous employer with instructions to include the rebuttal in your safety performance history file. Within five (5) business days of receiving our rebuttal, the previous employer must; forward a copy of the rebuttal to te prospective employer; append the rebuttal to your safety performance information and include it as part of the response for any subsequent investigating prospective employers for the duration of the three-year data retention requirement period. You may submit a rebuttal initially without a request for correction or subsequent to a request for correction.

THE RIGHT TO REPORT FAILURES TO CORRECT ERRONEOUS INFORMATION: You may report failures of a previous employer to correct information or include our rebuttal as part of the safety performance information, to the Federal Motor Carrier Safety Administration by following procedures specified at 49 CFR Section 385.12.

I certify that this application was completed by me and that the information provided is a correct, complete and true representation of the facts as known to me.

(Applicant’s Signature) (Date)

Hire Date

Please print all information requested except signature

DRIVER EMPLOYMENT APPLICATION MTI Limo & Shuttle Services

APPLICANT INFORMATION

DOT # 930915

DOT # 1492290 DOT # 1383772

Name: (First) (Middle) (Last)

Current Address: How Long?

(Street) (City) (State, Zip)

Previous Address(es): How Long? (Street) (City) (State, Zip)

Must list all How Long? addresses for

previous 3 years. (Street) (City) (State, Zip)

How Long?

(Street) (City) (State, Zip)

Phone #: ( ) Date of Birth: Soc. Security #:

Emergency Contact Name: Relation:

Contact Address: Phone #: ( )

DRIVER’S LICENSE INFORMATION

State License # Type Expiration Date

DRIVER EXPERIENCE

Type of Equipment From (Date) To (Date) Approx. # of Miles

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

Yes D No D

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

Yes D No D

Have you ever been convicted of any criminal act involving the use of a Commercial Motor Vehicle or while driving a Commercial Motor Vehicle?

Yes D

No D

If you answered yes to any of the above 3 questions, attach a statement of explanation.

TICKETS / ACCIDENTS / ETC. Accident Record for Past 3 Years

Date Description # of Injuries / Fatalities

Traffic Convictions & Forfeitures for Past 3 Years Location Date Charge Penalty

HISTORY WITH COMPANY WHICH YOU ARE APPLYING FOR I have worked for this company before Yes D No D (If yes, please indicate hire and termination dates) Note: This information should also be reflected in employment record section.

I have applied for work for this company before Yes D No D (if yes, please indicate date(s).)

How did you hear about this employer?

EMPLOYMENT RECORD NOTE: DOT requires employment for 3 years previous and/or commercial driving experience for past 10 years be shown.

PLEASE CONTINUE EMPLOYMENT RECORD ON NEXT PAGE (PAGE 3)

Employer: Employed From: To:

Address:

Phone #: ( ) Supervisor:

Position: Reason for Leaving: Were you subject to the FMCSRs while employed? Yes D No D Was your job designated as a safety sensitive function in any DOT regulated mode subject to the drug & alcohol testing requirements of 49 CFR Part 40? Yes D No D


Address:



NOTE: If needed, make additional copies of this page to capture info regarding all employers during the past 10 years.


Address:




Address:




Address:




Address:




Address:




Address:



Answer the following sections if you are applying for a driver position pursuant to FMCSR 39121.

Do you have a valid driver’s license? Yes D No D Type: D Operator D Commercial (CDL) D Chauffeur

State License No. Class Endorsements Exp. Date Restrictions

Have you held a driver’s license in another state? Yes D No D

If yes please list all states you have held a driver’s license and driver’s license numbers

Accident record for past three (3) years or more. Please list in most recent order. If none please write none.

Date Nature of Accident (Head on, Rear End, etc.) Any Fatalities/Injuries

Traffic convictions and forfeitures for the past three (3) years (other than parking violations).

Date Location Charge Penalty

Have you ever been denied a license, permit or privilege to operate a vehicle? Yes D No D

If yes, please explain:

Have you ever had a license, permit or privilege suspended or revoked? Yes D No D


Have you ever been disqualified for violations of the FMCSR’s? Yes D No D


FOR COMPANY USE

Applicant hired: Rejected:

Date employed: Position:

Date terminated: Who terminated employee:

Dismissed: Voluntary Quit: Other:

2581 Sullivan Road • College Park, GA 30337

Phone: 404-669-0900 • Fax: 404-207-1705 www.mtilimos.com

Reference Release Form

Applicant Name:

Former Employer:

Social Security #: Dates employed:

The above named applicant is being considered for employment with MTI and has listed your organization as a former employer. We would appreciate your verification and completion of this form at your earliest convenience. Information provided will be treated in confidence. Please return this form to us in the enclosed, self-addressed, stamped envelope. Thank you for your assistance.

Applicant’s Authorization

I consent to and authorize the above named former employer, and its agents and employees, to furnish any reference information concerning me, including achievement, wage history, performance, attendance, personal history, disciplinary information and reason for separation of employment, relating to my employment with the former employer. It is expressly understood that any information given is to be used for the purpose of determining my acceptability for employment. I also hereby release the above named former employer, and its agents and employees, from all liability for damages or claims, including but not limited to defamation, interference with contract, or prospective economic advantage and negligence, I have or may have which arise or result from any reference information provided pursuant to this authorization or any attempts to comply with this information.

Applicant’s signature: Date:

Record of Employment

Position held: Dates employed:

Summary of essential duties:

Reason for leaving:

Salary at termination: Eligible for rehire? Yes D No D

Please rate the following: Excellent Good Average Fair Poor Job Knowledge Accuracy Productivity Dependability Attendance Overall Performance

Comments:

Signature: Title: Date:

Reference Release Form

I authorize to seek from all my previous and present schools and employers, and authorize all my previous and present schools and employers to release to MTI Limo and Shuttle Services/MTI Bus Company/MTI Charter and Tours, any and all information pertaining to my educational and employment history.

If I am offered employment, I also authorize the disclosure to MTI Limo and Shuttle Services/MTI Bus Company/MTI Charter and Tours of any medical history that may be necessary to verify information provided as a part of the application process.

I release, promise to hold harmless, and covenant not to sue MTI Limo and Shuttle Services/MTI Bus Company/MTI Charter and Tours on the basis of its attempts to obtain information from my previous and present schools and employers. I release, promise to hold harmless, and covenant not to sue my previous and present schools, employers, or health care providers on the basis of the disclosure of information to MTI Limo and Shuttle Services/MTI Bus Company/MTI Charter and Tours.

Name of Applicant:

Signature of Applicant:

Date:



I hereby authorize MTI Limo & Shuttle Services, Inc. / MTI Bus Company, Inc. / MTI Charter & Tours, Inc. and Background Checks Systems, Inc. and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: Verification of Social Security Number, current and previous residences, employment history including all personnel files, education, character references, credit history and reports, criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions, birth records, motor vehicle records to include traffic citations and registration and any other public records. I , authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may have. I understand that I must provide my date of birth to adequately complete said screening, and acknowledge that my date of birth will not affect any hiring decisions. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me, to furnish bearer with any and all information in their possession regarding me in connection with an application for employment. This authorization and consent shall be valid in original, fax, or copy form. I hereby release Background Checks Systems, Inc., and its agents, officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may at any time, result to me, my heirs, family or associates because of compliance with this authorization and request to relapse. You may contact me as indicated below, I understand that a copy of this authorization may be given to me at any time, provided I request it in writing. Information on this application and results of the background investigation will be maintained in confidence in accordance with company hiring practices.



Name (Print) First Middle (full name) Last Maiden

Print All Former Names Used:

(1)

(2)

Social Security Nember: - - Sex:

Race:

D/O/B:

Current Street Address:

City:

State: Zip:

Drivers License Number: State of Issuance:

May We Contact Your Employers: May We Contact Your Supervisors:

Comments:

Signature: Date

Print Residences in the previous 10 years (City & State)

Address:

Address:

Address:

Address:

Address:

Address:

Using the numbers below, please indicate whether you have been convicted of any crimes listed below: 1. Homicide/Murder 2. Rape or Molestation 3. Burglary/Robbery/Larceny 4. Threats of Harassment 5. Assault or Fighting 6. Destruction of Property 7. Drug Trafficking/Use or Possession 8. Child Abuse/Domestic Violence 9. Public Intoxication/Drunk & Disorderly 10. Theft/Receiving Stolen Goods 11. Fraud 12. Prostitution 13. Other

Number of Violation (s):

Status/Disposition:

Applicant Signature: Date:

SAFETY PERFORMANCE HISTORY RECORDS REQUEST

Section 1: TO BE COMPLETED BY PROSPECTIVE EMPLOYEE

I, (Print Name) First, M.I., Last Social Security Number Date of Birth

Hereby authorize:

Previous Employer: Telephone:

Street: Fax No.:

City, State, Zip:

To release and forward the information requested by section 2 and 3 of this document concerning my Alcohol and

Controlled Substance Testing records within the previous 3 years from To: (M/Y of employment dates)

Attn: Phone:

Prospective Employer: MTI Limo & Shuttle Services/MTI Bus Company/MTI Charter & Tours Street: 2581 Sullivan Road City, State, Zip: College Park, GA 30337 Fax:

In compliance with §40.25(g) and 391.23(h), release of this information must be made in a written form that ensures confidentiality, such as fax, letter, or email.

Applicant’s Signature: Date:

Section 2: TO BE COMPLETED BY PREVIOUS EMPLOYER ACCIDENT HISTORY

The applicant named above was employed by us. Yes D No D

Employed from (m/y) to (m/y)

1. Did he/she drive motor vehicle for you? Yes D No D If yes, what type? D Straight Truck D Tractor Trailer

Other (Specify)

2. Reason for leaving your employ: D Discharged D Resignation D Lay Off D Military Duty

If there is no safety performance history to report, check here D, sign below and return.

ACCIDENTS: Complete the following for any accidents included on your accident register (§390.15(b) that involved the applicant in the 3 years prior to the application date shown above, or check here D if there is no accident register date for this driver.

Date Location No. of Injuries No. of Fatalities Hazmat Spill

1.

2.

3.

Please provide information concerning any other accidents involving the applicant that were reported to government

agencies or insurers or retained under internal company policies:

Signature: Title: Date:

Section 3: TO BE COMPLETED BY PREVIOUS EMPLOYER

If driver was not subject to DOT testing requirements while employed by this employer please check here D, fill in the

dates of employment from (m/y) to (m/y) , complete bottom of Section 3, sign, and return.

Driver was subject to DOT testing requirements from (m/y) to (m/y) . YES NO

1. Has this person had an alcohol test with a result of 0.04 or higher? D D

2. Has this person tested positive or adulterated or substituted a test specimen for controlled substances? D D

3. Has this person refused to submit to a post-accident, random, reasonable suspicion, or follow up controlled substance test? D D

4. Has this person committed other violation of Subpart B of Part 382 or Part 40? D D

5. If this person has violated a DOT drug & alcohol regulation, did this person complete a SAP prescribed rehabilitation program in your employ, including return-to-duty and follow-up tests? If yes, please send documentation with this form. D D

6. For a driver who successfully completed a SAP’s rehabilitation referral and remained in your employ, did this driver subsequently have an alcohol test result of 0.04 or greater, a verified positive drug test, or refuse to be tested? D D

In answering these questions, include any required DOT drug or alcohol testing information obtained from prior employers in the 3 years prior to the application date shown in Section 1.

Name: Telephone:

Company:

Street: City: State: Zip:

Section 3 completed by (Signature): Date:

Section 4: TO BE COMPLETED BY PROSPECTIVE EMPLOYER

1st Attempt

This form was (check one) D Faxed to previous employer D Mailed D Other

By: Date:

2nd Attempt


By: Date:

3rd Attempt


By: Date:

Information was received by: D Fax D Mail D Other

Date received:

Documents

DOT Driver Employment Package for MTI Limo & Shuttle Services, … · 2018. 3. 23. · Web: Instruction to submit applications Thank you for your interest in employment at MTI Li