Application for Employment - Voyager Trucking



Driver’s Application For Employment

Applicant name:______________________________________________Date of application:_____________________________________

Address: ________________________________________________________________________________________________________

City: _____________________ State:______________ Zip Code: _____________________________

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

TO BE READ AND SIGNED BY APPLICANT

I authorize you to make such investigations and inquires of my personal, employment, financial and/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, health care providers and other personal from all liability in responding to inquiries 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 by $9 CFR 391 23(d) and (e). I understand that I have the right to:

* Review information provided by previous employers

* Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer, and

* Have a reburial statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Signature_________________________________ Date_______________________

FOR COMPANY USE

APPLICANT HIRED__________________________________ REJECTED___________________________________

DATE EMPLOYED___________________________________ POINT EMPLOYED_____________________________

DEPARTMENT________________________________________ CLASSIFICATION______________________________

(IF REJECTED SUMMARY REPORT OF REASONS SHOULD BE PLACED IN FILE)

SIGNATURE OF INTERVIEWING AGENT__________________________________________________________________________

TERMINATION OF EMPLOYMENT

DATE TERMINATED____________________________ DEPARTMENT RELEASED FROM___________________________

DISMISSED______________________________VOLUNTARILY QUIT____________________ OTHER_______________________

TERMINATION REPORT PLACED IN FILE_________________________SUPERVISOR____________________________________

In Case of Emergency

NAME OF CONTACT__________________________ RELATIONSHIP__________________________ PHONE NUMBER__________________________

Applicant to complete

(answer all questions-please print)

Position Applied for:_______________________________________________________________________________________

Last Name: ___________________ First Name: __________________ Middle Name: _____________ SSN#_________________

List your addresses for the past 3 years

Current Address: Address__________________________ City_________________________ State___________________

Zip Code________________________ Phone________________________ How Long? ____________

Previous Addresses

Address___________________ City____________________ State__________ Zip Code________ How Long?____________

Address___________________ City____________________ State__________ Zip Code________ How Long?____________

Address___________________ City____________________ State__________ Zip Code________ How Long?____________

Address___________________ City____________________ State__________ Zip Code________ How Long?____________

Do you have the legal right to work in the United States __ Yes __No (Required for Commercial Drivers)

Date of Birth_________________ Can you provide proof of age __Yes __No

Have you worked for this company before? __Yes __No If yes, Dates From ___________ To ___________

Rate of Pay______________________________ Position_______________________________

Reason for leaving ________________________________________________________________________________________

Are you currently employed ___Yes ___No If not, how long since leaving last employment?____________________________

Who referred you? _______________________________________________________________________________________

Have you ever been bonded? __Yes __No If yes, name of bonding company__________________________________

(Answer only if job requirement)

Have you ever been convicted of a felony? __Yes __No If yes, please explain fully on a separate sheet of paper. Conviction of a

crime is not an automatic bar to employment. All circumstances will be

considered.

Is there any reason you might be unable to perform the functions of the job for which you have applied as described in the attached job description? __Yes __No

If yes, explain if you wish

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Employment history

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding three (3) years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional seven (7) years information on those employers for whom the applicant operated such vehicle. (NOTE; lost employers in reverse order starting with the most recent. Add another sheet as necessary)

Employer Name: ___________________________________________ from_________________ to ______________________

Address_________________________________________________________________________________________________

City________________________ State_________________________ Zip Code______________________________________

Position Held__________________________ Contact Person _______________________Phone No.___________________

Compensation/Salary_______________________________________________________________________________________

Were you subjected to the FMCRS white employed? __Yes __No Reason for leaving_____________________

________________________________________________________________________________________________________

Were your job designed as a safety-sensitive function in any D.O.T regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? __Yes __No

Employer Name: ___________________________________________ from_________________ to ______________________

Address_________________________________________________________________________________________________

City________________________ State_________________________ Zip Code______________________________________

Position Held__________________________ Contact Person_______________________Phone No.___________________

Compensation/Salary_______________________________________________________________________________________

Were you subjected to the FMCRS white employed? __Yes __No Reason for leaving_____________________

________________________________________________________________________________________________________

Were your job designed as a safety-sensitive function in any D.O.T regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? __Yes __No

Employer Name: ___________________________________________from_________________ to ______________________

Address_________________________________________________________________________________________________

City________________________ State_________________________ Zip Code______________________________________

Position Held__________________________ Contact Person_______________________Phone No.__________________

Compensation/Salary_______________________________________________________________________________________

Were you subjected to the FMCRS white employed? __Yes __No Reason for leaving_____________________

________________________________________________________________________________________________________

Were your job designed as a safety-sensitive function in any D.O.T regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? __Yes __No

Employer Name:___________________________________________ from_________________ to ______________________

Address_________________________________________________________________________________________________

City________________________ State_________________________ Zip Code______________________________________

Position Held__________________________ Contact Person_______________________Phone No.___________________

Compensation/Salary_______________________________________________________________________________________

Were you subjected to the FMCRS white employed? __Yes __No Reason for leaving_____________________

________________________________________________________________________________________________________

Were your job designed as a safety-sensitive function in any D.O.T regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? __Yes __No

Employer Name:___________________________________________ from_________________ to ______________________

Address___________________________________________________________________________________________________

City________________________ State_________________________ Zip Code______________________________________

Position Held__________________________ Contact Person_______________________Phone No.___________________

Compensation/Salary_______________________________________________________________________________________

Were you subjected to the FMCRS white employed? __Yes __No Reason for leaving_____________________

________________________________________________________________________________________________________

Were your job designed as a safety-sensitive function in any D.O.T regulated mode subject to the drug and alcohol testing requirements of 49 CFR Part 40? __Yes __No

** Includes vehicles having GVWR of 26,001 lbs or more, vehicles designed to transport 16 or more passengers (including the driver). Or having any size vehicle used to transport hazardous materials in the quality requiring placarding.

** The Federal Motor Carrier Safety Regulations ( FMCSRs) apply to anyone operating a motor vehicle on a highway in interstate commerce to transport passengers or property when the vehicle (1) weighs or has a GVWR of 10,000 pounds or more, (2) is designed or used to transport more than 8 passengers (including the driver), or (3) is of any size and is used to transport hazardous materials in a quality requiring placarding.

Accident record for the past 3 years or more (attach sheet if more space is required). If none, write none.

Dates Nature of Accident Fatalities Injures Hazardous

(Head on, rear-end, upset, etc) (Material Spill)

Last Accident ____________ _____________________________ _______________ _______________ ________________

Next Previous ____________ _____________________________ _______________ _______________ _________________

Next Previous ____________ _____________________________ _______________ _______________ _________________

Traffic convictions for the past three (3) years (other than parking violations). If none, write none.

Location Date Charge Penalty

_________________________ ______________________ ________________________ ________________________

_________________________ ______________________ ________________________ ________________________

_________________________ ______________________ ________________________ ________________________

_________________________ ______________________ ________________________ ________________________

(Attach sheet if more pace is required)

Experience and qualifications- Driver

List all driver licenses or permits held in the past three (3) years

State License No. Type Expiration Date

Driver __________________ _________________________ ____________________ ______________________

License __________________ _________________________ ____________________ ______________________

A. Have you ever been denied a license, permit or privilege to operate or motor vehicle? __ Yes __No

B. Has any license, permit or privilege ever been suspended or revoked? __ Yes __No

Driving Experience

Check yes or no

Dates Approx. No. of Miles

Class of Equipment equipment type From To (total)

Straight Truck __Yes __No ___________________ _______________ ________________ _________________

Tractor & Semi Tractor __Yes __No___________________ _______________ ________________ _________________

Tractor- Two Trailers __Yes __No ___________________ _______________ ________________ _________________

Tractor Three Trailers __Yes __No___________________ _______________ ________________ _________________

Motorcoach-School Bus __Yes __No___________________ _______________ ________________ _______________

To be read and signed by applicant

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.

Signature_________________________________________ 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 __Voyager Trucking Corp__(“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 . 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 __Voyager Trucking Corp._ (“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 . 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: __________________________ _______________________________________

Name (Please Print)

Signature ___________________________________________

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

REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER

with social Security Number: XXX-XX-_______ has applied to this company.

For a position as owner operator/driver and states that he/she was employed by you.

TO BE COMPLETED BY PREVIOUS EMPLOYER

|Previous Employer: |

|Print your Name: Title: |

|Signature of the person who completes this form: Date: |

|Was the applicant employed by your company? yes no If yes please continue. If no, please sign below and return. |

|Position held:__________________________________ from___________________ to________________ |

|While employed, did the applicant operate a commercial motor vehicle? yes no If yes please continue. If no, please sign below and return. Thank you. |

DRIVING EXPERIENCE

|Class of Equipment |Circle each type of Equipment | Dates |Miles Driven |

| | |From To | |

|Straight Truck |Van Tank Dump Reefer Flat bed |      |      |      |

|yes no | | | | |

|Tractor and Semi Trailer |Van Tank Dump Reefer Flat bed |      |      |      |

|yes no | | | | |

|Tractor – Doubles or Triples |Van Tank Dump Reefer Flat bed |      |      |      |

|yes no | | | | |

|Motor coach or School bus | |      |      |      |

|(more than 8 passengers) |N/A | | | |

|yes no | | | | |

|Motor coach or School bus | | | | |

|(more than 15 passengers) |N/A | | | |

|yes no | | | | |

|Other (please specify) | | | | |

ACCIDENT HISTORY

|While employed, was the applicant involved in accidents or incidents with the motor vehicle? yes no If no, skip to the next section. |

|Complete the following for any accidents included in your accident register which involved the applicant in the past three years prior to the date of this |

|request, or in case is no three year history for this driver, check here Thank you. |

|DATE |LOCATION |NATURE OF ACCIDENT |NUMBER OF |NUMBER OF INJURIES |HAZARDOUS |

|(Month/Year) |City and State |(head –on,rear,upset,sideswipe,etc) |FATALITIES | |MATERIAL SPILL |

| | | | | | |

| | | | | | |

| | | | | | |

|1. Was the applicant a safe, efficient driver? yes no 2. Reason for leaving your employ: Discharged Laid off Resigned |

|Remarks:_________________________________________________________________________________________________________ |

|3. Was the applicant’s general conduct satisfactory? yes no 4. Was the applicant competent for the position sought? yes no |

Excellent Good Fair Poor Very Poor

Quality of Work __________ _________ _______ _______ ________

Cooperation with others __________ _________ _______ ______ ________

Safety habits __________ _________ _______ _______ ________

Personal habits __________ _________ _______ _______ ________

Driving skills __________ _________ _______ _______ ________

Attitude __________ _________ _______ _______ ________

You are hereby authorized to give to: VOYAGER TRUCKING CORP

All information regarding my services, character, and conduct while in your employ, and you are released from any and all liability which may result from furnishing such information to the above named company. Signature:_________________________________

(Applicants Signature)

RELEASE FOR INFORMATION FROM PREVIOUS EMPLOYER

ALCOHOL AND CONTROLLED SUBSTANCES TESTING

|Previous Employer: |

|Print your Name: Title: |

|Signature of the person who completes this form: Date: |

The person identified below has sought employment with us as a driver subject to the alcohol and controlled

Substances testing provisions of the Federal Motor Carrier Safety Regulations. Pursuant to 49 CFR

382.413, we are requesting the results of alcohol and drug testing of this individual while in your service

since January 1, 1995 and for the past two years. The driver has given written consent in the release below.

PERSON FOR WHOM INFORMATION IS REQUESTED

Name SSN:

Dates of employment with you, From:____________ To:______________

| |

|RELEASE |

| |

|I HEREBY AUTHORIZE YOU TO RELEASE ALCOHOL AND DRUG TESTING |

|RESULTS FOR THE PAST TWO YEARS TO THE COMPANY NAME BELOW. |

| |

| |

|Signature x: ____________________________________________________________. |

REPORT OF TEST RESULTS:

Not subject to Federal testing requirements.

Alcohol: Test 0.04 BAC or greater No Yes If yes, Date: ___________________

Controlled substance : Tested Positive No Yes If yes, Date: ___________________

Refusal To Test: No Yes If yes, Date: ____________________

PLEASE RETURN THIS INFORMATION TO: (Mark envelope CONFIENTIAL)

Name of individual: DIANA SANTOS

Company: VOYAGER TRUCKING CORP

Address: 451 FRELINGHUYSEN AVE NEWARK NJ 07114

If you prefer to reply by telephone, call: (973) 589-3444

If you prefer to reply by Fax: (973) 589-3447

If you prefer to reply by e-mail: DSANTOS@TTS-

Give information only to the person (s) named below:

DIANA SANTOS

Thank You for your cooperation!

Motor Vehicle Driver’s

Certification of Violations/annual review of Driver Record

MOTOR CARRIER INSTRUCTIONS. Each motor carrier shall at least once every twelve (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 twelve (12) months (Section 391.27).Drivers who have provided information required by Section 383.31 need not to repeat that information on this form.

DRIVER REQUIREMENTS: Each driver shall furnish the list as required by the motor carrier above. If 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).

Certification of Violations

To be completed by Driver

|Name of Driver: (Print) | Social Security No. |Date of Employment |

|Home Terminal (City and State) |Driver’s License No. |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) which I have been convicted or forfeited bond or collateral during the past twelve (12) months.

(MUST WRITE NONE, IF NONE TO REPORT)

|DATE |OFFENSE |LOCATION |TYPE OF VEHICLE OPERATED |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

If no violations are listed. I certify that I have not been convicted or 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 twelve (12) months.

____________________________________ ___________________________

Driver’s Signature Date of Certification

Annual Review of Driving Record

To Be Completed by Motor Carrier

MOTOR CARRIER INSTRUCTIONS: Review the Certificate of Violations above and other available information described in Section 391.25 of the Federal Motor Carrier Safety Regulations, including but not limited to the most recent Driver’s Motor Vehicle Report (Abstract). Complete the following information.

I have hereby reviewed the driving record of the above named driver in accordance with Section 391.25 and find that she/he (check one):

[pic] Meets minimum requirements for safety driving Is disqualified to drive a motor vehicle pursuant to Section 391.5

Does not adequately meet satisfactory safe driving performance

Action Taken with Driver: __________________________________________________________________________________

Motor Carrier Name: _______________________________________ Motor Carrier Address: _____________________________________

Reviewer’s Name Printed: ___________________________________ Title: _________________________________

Reviewer’s Signature: _____________________________________ Date: __________________________________

To be Read and signed by applicant

I authorize Voyager Trucking Corp. to make such investigations and inquires of my personal, employment, financial, PSP 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, health care providers and other persons from all liability in responding to inquiries 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, ad those employer(s) will contacted, for the purpose of investigation my safety performance history as required by 19 CFR 391.23 (d) and (e).

I understand that I have the right to:

• Review information provided by previous employers

• Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and

• I have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

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.

________________________________ ____________________________

Applicants Signature Date

National Registry Verification Form

The National Registry of Certified Medical Examiners (National Registry) is a new Federal Motor Carrier Safety Administration (FMCSA) program. All commercial drivers whose current medical certificate expires on or after May 21, 2014, at expiration of that certificate must be examined by a medical professional listed on the National Registry of Certified Medical Examiners. Only medical examiners that have completed training and successfully passed a test on FMCSA's physical qualification standards will be listed on the National Registry.

On ___/____/____ verification of certification by the National Registry was performed for the following:

Medical Examiner_______________________________________________

Registry Number________________________________________________

Name of person verifying_________________________________________

Motor Vehicles Driver’s

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 26,001 pounds or more, can transport more than 15 people, or transport hazardous materials that required placarding.

The requirements in Part 391 apply to every driver who operates in interstate commerce and operates a vehicle weighing 10,001 pounds on more, can transport more than 15 people, or transports hazardous material that require placarding.

DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1st, 1987. They are as follows:

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

If you have more than one license, keep the license from your state of residence and return the additional licenses to the state that issued them. DESTROYING a license does not close the record in the state that issued it, you must notify the state. If a multiple license has been lost, stolen, or destroyed, close your record by notifying the state of issuances that you no longer want to be licensed by that state.

2. NOTIFICATION OF LICENSE SUSPENSION, REVOCATIOON OR CANCELLATION:

Sections 391.15 (b)(2) and 383.33 of the Federal Motor Carrier Safety 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 violate a state or local traffic law (other than packing), you must report it within 30 days to: 1) your employing motor carrier, and 2) the state that issued your license (if the violation occurs in a state other than the one which issued tour license). The notification to both the employer and state must be in writing.

The following license is the only one I will possess:

Driver’s License No. ___________________________ State______________________ Exp. Date_____________

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

Driver’s Name (Printed)___________________________________________________________________________

Driver’s Signature______________________________________________ Date_________________________

Notes__________________________________________________________________________________________

_____________________________________________________________________________________________

REQUEST FOR CHECK OF DRIVING RECORD

I hereby authorize you to release the following information to _Voyager Trucking Corp for purposes of investigation as required by Sections 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability which may result from furnishing such information

____________________________ ___________________

(Applicant’s Signature) (Date)

In accordance with the provisions of Sections 604 and 607 of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1, of Public Law 104-208), I hereby certify the following:

1. The consumer (applicant) has authorized in writing the procurement of this report;

2. The consumer (applicant) has been informed in a separate written disclosure that a consumer report may be obtained for employment purposes;

3. The information requested below will be used for a “permissible purpose” (i.e., information for employment purposes) and will be used for no other purpose;

4. The information being obtained will not be used in violation of any federal or state equal opportunity law or regulation; and

5. Before taking an adverse action based in whole or in part on the report the consumer (applicant) will receive a copy of the requested report and the summary of consumer rights as provided with the report by the consumer reporting agency.

I also hereby certify that this report request and the above applicant’s release notice meet the definition of “permissible uses” of state motor vehicle records under the provisions of the Driver’s Privacy Protection Act of 1994 (Public Law 103- 322, Title XXX, Section 300002(a)).

_________________________________ _____________

(Signature of Requester) (Date)

TO: __________________________ __________________________

SIR/MADAM:

The following named person has made application with our company for the position of Driver. In accordance with Section 391.23, Federal Department of Transportation Regulations, please furnish the undersigned with the applicant’s driving record for the past three years.

The following named person is employed with our company in the position of Driver. In accordance with Section 391.25, Federal Department of Transportation Regulations, please furnish the undersigned with the employee’s driving record for the past year.

NAME OF APPLICANT/DRIVER ___________________________

ADDRESS _________________________________________________________________________________________

(Number & Street) (City) (State) (Zip Code)

FORMER ADDRESS ________________________________________________________________________________

(Number & Street) (City) (State) (Zip Code)

DATE OF BIRTH ____________________ SSN _____________________ LICENSE NO. ________________________

REQUESTED BY

Company Name_____________________________ Typed Name___________________________

Title____________________________________ Signature____________________________

[pic]

[pic]

DRIVER STATEMENT OF ON-DUTY HOURS

(For Newly Hired Drivers)

INSTRUCTION: 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 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. NOTE: Hours for any compensated work during the preceding 7 days, including work for a non-motor carrier entity, must be recorded on this form.

Driver Name (Print)____________________________________________________________________

Social Security Number ______________ Driver’s License: State _________ Number _______________

Class _____ Endorsement(s) ______ Restriction(s) ___________________________________________

Type of License _____________________________ Issuing State ______________________________

|DAY |

I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at

__________________A.M/ P.M. On _______________________________

TIME DAY MONTH YEAR

_____________________________ ________________

Driver’s Signature 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 paragraphs (8) and (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 nonmotor carrier entity. (check one)

Are you currently working for another employer? □ Yes □ No

At this time do you intend to work for another employer while still employed by □ Yes □ No

this company?

I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.

___________________________ _______________________

Driver’s Signature Date

Seat Belt Policy

In accordance with Federal Motor carrier Regulation (FMCSR) 49 CFR Part 392, Section 392.16, a motor vehicle which has a seat belt assembly installed at the driver’s seat shall not be driven unless the driver has properly restrained himself/herself with the seat belt assembly.

Therefore, it is the policy of this Company that you, as a Driver, abide by this FMCSR and restrain yourself with the seat belt assembly while operating your Commercial Motor Vehicle.

Here’s why you should wear your seat belt…….

You increase the chance of avoiding death and injury up to 50%

A non-belted driver ejected from a vehicle in a crash is four times more likely to be killed or injured!!!

Crash tests show that hitting the ground after jumping from a five story building has the same force with which the driver would hit the windshield at just 40 miles per hour!!

More than 80%of crashes occur at speeds between 30 to 40 mph

It’s your life….buckle up!!!!!!

_____________________________________________________________

DRIVERS SEAT BELT AGREEMENT

I have read and understand the above FMCSR regulation and safety facts covering the use of seat belts and hereby agrees to abide by the use of my seat belt. It is understood that failure to use a seat belt could result in a traffic fine or disciplinary action.

_________________________________ _________________________

Driver’s Signature Date

Voyager Trucking Corporation

Termination policy

IMMEDIATE TERMINATION: TICKETED FOR DRUGS OR ALCOHOL

OTHER REASON TO BE TERMINATED: REACHING NJSA POINTS SCHEDULE

39:4-52 Racing on Highway

39:4-84 Failure to pass to right of vehicle proceeding in opposite direction

39:4-89 Tailgating

39:4-96 Reckless Driving

39: 4-98 Exceeding maximum speed 30mph or more over limit

39: 4-128.1 Improper Passing of School Bus

______________________________ ___________________________

Driver’s signature date

Cell Phone Policy

FMCSA PASSED THE FINAL RULE ON CELL PHONE USE FOR DRIVERS OF COMMERCIAL MOTOR VEHICLES (CMV) EFFECTIVE JANUARY 3rd, 2012. THIS RULE RESTRICTS A CMV DRIVER FROM HOLDING A MOBILE TELEPHONE TO CONDUCT A VOICE COMMUNICATION AND FROM DIALING A MOBILE TELEPHONE BY PRESSING MORE THAN A SINGLE BUTTOM. THIS LAW ALSO RESTRICTS THE USE OF PUSH TO TALK (NEXTEL TYPE) PHONES.

LIMITING THE USE OF CELL PONES, INCLUDING TEXTING AND HANDS FREE DEVICES, TO TIMES WHEN WE ARE NOT OPERATING A MOTOR VEHICLE, WILL REDUCE EXPOSURE TO ACCIDENT AND INJURIES.

VOYAGER TRUCKING CORP. HAD ADOPTED THE FOLLOWING POLICY EFFECTIVE IMMEDIATELY. EVEN THOUGH CELL PHONE USE IS ALLOWED WITH A HANDS FREE DEVICE IT IS OUR COMPANY POLICY THAT DRIVERS DO NOT TALK ON A CELL PHONE UNTIL THEY ARE PARKED AT A SAFE AND LEGAL LOCATION. A DRIVER RECIVING AN INCOMING CALL ON A HANDS FREE DEVICE , MAY BRIEFLY ACKNOWLEDGE THE INCOMING CALL AND INFORM THE CALLER THEY WILL CALL BACK ONCE THEY HAVE PARKED IN A SAFE, LEGAL LOCATION.

TEXTING IS NEVER ALLOWED WHILE OPERATING A CMV.

TEXTING INCLUDES PHONE TEXTING, PDA USE, SATELLITE COMMUNICATIONS OR ANY OTHER EXISTING TEXTING COMMUNICATION DEVICES.

VOYAGER TRUCKING CORP. VIOLATION OF THIS POLICY MAY RESULT IN DISCIPLINARY ACTIONS, UP TO AND INCLUDING TEMRINATION.

NO CALL, NO TEXT, NO TICKET!!!!

_______________________________ ___________________________

DRIVER’S SIGNATURE DATE

EMPLOYEE CONSENT FORM

I, _____________________________________________________, do hereby give my consent

(Print Name)

to Voyager Trucking to collect urine samples from me on any given date and I further give my consent to the Company to forward the sample(s) to the testing laboratory for its performance of appropriate tests thereon to identify the presence of Drugs and/or Alcohol. I further give the laboratory my permission to release the results of such tests to the Company’s Medical Review Officer and National Safety Compliance, Inc. I understand that the refusal to submit to testing or a positive test results will affect my initial or continued employment and result in disciplinary action as described in the Company’s Drug and Alcohol Policy. I also understand that it is not the purpose of this text to identify any disability I may have.

_______________________________ _____________________

Employee/Applicant Signature Date

Driver notification

I, _________________________________________________, am fully aware of the Drug and Alcohol

(Printed Name)

Policy that is effective for Voyager Trucking. I also understand that should I test positive for drugs and/or alcohol, or should I refuse to test for drugs and/or alcohol, I will accept the consequences set forth in this policy and by the Department of Transportation.

__________________________________ ______________________

Employee/ Applicant Signature Date

Certification of Driver’s Road Test

INSTRUCTIONS: If the road test is successfully completed, the person who gave it shall complete a certificate of the driver’s road test. The original or copy of the certificate shall be retained in the employing motor carrier’s driver qualification file of the person examined and a copy given to the person who was examined. (49 CFR 391.33 (e)(f)(g)).

CERTIFICATION OF ROAD TEST

Driver’s Name: _________________________________________________________________

Social Security No. _____________________________________________________________

Operator’s Driver License: ______________________________________________________

State: ____________________________________________________

Type of Power Unit: ____________Tractor Trailer____________________________________

Passenger carrier, type of bus: Tractor-Trailer

This is to certify that the above named driver was given a road test under my supervision on __________________consisting of approximately five miles of driving.

It is my considered opinion that this driver possesses sufficient driving skill to operate safely the type of commercial motor vehicle listed above.

____________________________________________

Signature of Examiner

____________________________________________

Title

VOYAGER TRUCKING CORPORATION.451 FRELINGHUYSEN AVE NEWARK, NJ 07114

DRIVER’S ROAD TEST EXAMINATION

Driver’s Name________________________________________ Phone_________________________

Driver’s Address_______________________________________________________________________

City_________________________________________ State__________ Zip Code________________

The road test shall be given by the motor carrier or a person designated by it. However, a driver who is a motor carrier must be given the test by another person. The test shall be given by a person who is competent to evaluate and determine whether the person who takes the test has demonstrated that he or she is capable of operating the vehicle and associated equipment that the motor carrier intends to assign.

Rating of Performance

___________________ The pre-trip inspection (As required by Sec. 392.7)

__________________ Coupling and uncoupling of combination units, if the equipment he or she may drive includes combination units

__________________ Placing the equipment in operation.

__________________ Use of vehicle controls and emergency equipment

__________________ Turning the vehicle.

__________________ Braking and slowing the vehicle in traffic and while passing other vehicles.

__________________ Braking and parking the vehicle.

________________ Other, Explain: _____________________________________________________

Type of equipment used in giving test: ___________________________________________________

Date__________of _____________20__ Examiner’s Signature________________________

Record of Road Test

Driver’s Name_______________________________ License No._____________________ State_______

Address________________________________ City________________ State________ ZIP___________

Tractor______ Trailer______ Speed_____ Supervisor_______________________ Date______________

For those items that apple, checkmark if driver’s performance is satisfactory, mark with an X if driver’s performance is unsatisfactory. Explain unsatisfactory items under remarks. Use not applicable (NA for items that do not apply)

Part 1 – Pre-trip inspection and emergency equipment

_____Checks general condition approaching unit

_____looks for leakage of coolants, fuel lubricants

_____Checks under hood – oil, water, general condition of engine compartment, steering

_____Checks around unit – tires, lights, trailer hookup, brakes, marker lights, horn, windshield wipers

_____Tests brake action, tractor protection valve and parking brake

_____Check horn, windshield wipers, mirrors, emergency equipment; reflectors, flares, fuses, fire extinguisher

_____Checks instruments for normal readings

_____Checks dashboard for warning lights for proper functioning

_____Cleans windshield, windows, mirrors, lights, reflectors

_____Reviews signs previously reported

Part 2 – Coupling and uncoupling

_____Lines up units

_____Connects glad hands to trailer to apply trailer brakes before coupling

_____Connects glad hands and light lines properly

_____Couples without difficultly

_____Raises landing gear fully after coupling

_____Visually checks king kin assembly to be certain of proper coupling

_____Assure that surface will support trailer before uncoupling

Part 3 – Placing vehicle in motion and use of controls

A) Engine

_____Places transmission in neutral before starting engine

_____Starts engine without difficulty

_____Allows proper warm-up

_____Understands gauges on instrument panel

_____Maintains proper engine speed while driving

_____Does not abuse motor

B) clutch and transmission

_____Starts loaded unit smoothly

_____Uses clutch properly

_____Times gearshifts properly

_____Shifts gears smoothly

_____Uses proper gear sequence

C) breaks

_____Knows proper use of tractor protection valve

_____Understands low air warning

_____Tests service brakes

_____Builds full air pressure before moving

D) steering

_____Controls steering wheel

_____Good driving posture and good grip on wheel

E) Lights

_____Knows lighting regulations

_____Uses proper headlight beam

_____Dim lights when meeting or following traffic

_____Adjusts speed to range headlights

_____Proper use of auxiliary lights

Part 4 – backing and parking

_____ A backing

_____Gets out and checks before rechecking conditions on long back

_____Avoids backing from blind side

_____Signals when backing

_____Controls speed and direction properly while backing

B) Parking

_____Straight and in formation

_____Engages Brakes properly

_____Out of gear

Part 5 – Slowing and stopping

_____Uses gears properly ascending

_____Gears down properly descending

_____Stops and restarts without rolling back

_____Tests brakes before descending grades

_____Uses brakes properly on grades

_____Uses mirrors to check traffic to rear

_____Signals following traffic

_____Avoids sudden stops

_____Stops smoothly without excessive fanning

_____Stops before crossing sidewalks when coming out of driveway or ally

_____Stops clear of pedestrian crosswalks

Part 6 – Operating in traffic passing and turning

A) Turning

_____Signals intention to turn well in advance

_____Gets into proper lane well in advance of turn

_____Checks traffic conditions and turns only when intersection is clear

_____Restricts traffic from passing on right when preparing _____to complete right hand turn

_____Completes turn promptly and safely and does not impede other traffic

B) Traffic signs and signals

_____Approaches signal prepared to stop if necessary

_____Obeys traffic signals

_____Uses good judgement on yellow light

_____Starts smoothly on green

_____Notices and heeds traffic signs

_____Obeys “stop” signs

C) Intersections

_____Adjusts speed to permit stopping if necessary

_____Checks for cross traffic regardless of traffic controls

_____Yields right of way for safety

D) Grade Crossings

_____Adjusts speed to conditions

_____Makes safe stop, if required

_____Selects proper gear and does not shift gears while crossing

_____Knows and understands federal and state rules governing grade crossing

E) Passing

_____Passes with sufficient clear space ahead

_____Does not pass in unsafe locations

_____Signals change of lanes

_____Warns driver being passed

_____Pulls out and back with certainty

_____Does not tailgate

_____Does not block traffic with slow pass

_____Allows enough room when returning to right lane

F) Speed

_____Speed consistent with basic ability

_____Adjusts speed properly to road, weather, traffic conditions, legal limits

_____Slows down in advance of curves, intersections, etc

_____Maintains consistent speed

G) Courtesy and Safety

_____Uses defensive driving techniques

_____Yields right of way for safety

_____Goes ahead when given right of way by others

_____Does not crowd other drivers or force way through traffic

_____Allows faster traffic to pass

_____Keeps right and in own lane

_____Uses horn only when necessary

_____Generally courteous and uses proper conduct

Part 7 – Miscellaneous

A) General Driving ability and habits

_____Consistently alert and attentive

_____Adjusts driving to meet changing conditions

_____Performs routine functions without taking eyes from road

_____Checks instruments regularly while driving

_____Willing to take instructions and suggestions

_____Adequate self-confidence in driving

_____Is not easily angered

_____Positive attitude

_____Good personal appearance, manner, cleanliness

_____Good physical stamina

B) Rules and regulations

_____Knowledge of company rules and policies

_____Knowledge of regulations, federal, state, local

_____Knowledge of special truck routes

General Performance: Satisfactory_____ Needs Training_____ Unsatisfactory_____

Comments:

_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature of Supervisor _____________________________

VOYAGER DRIVER POLICY

Voyager Trucking Corp, is 100%committed to your safety, our customers’ safety and those in our community. Driving is a MAJOR part of your employment with Voyager Trucking Corp. Your personal driving record has a direct relationship to your value to this company and our ability to employ you.

Required Licenses and Permits

All employees who are in a potential driving position are required to maintain a valid Commercial Driver’s licenses. The company may verify each employee’s driving record prior to employment and whenever else necessary during the course of employment to ensure compliance.

When applying for a job at Voyager Trucking Corp involving the operation of a motor vehicle, you will provide, you will provide us with:

• Your name, address, date of birth, and social security/ driver’s license number

• Your permission to have your driving record obtained and reviewed

• Your agreement that your driving record is a vital part of your employment application and that you may not be hired due to it.

• Your previous addresses for the past three years

• Expiration date of driver’s license

• List of all motor vehicle accidents and violations or driving abstract report.

• Any driver’s license suspension or revocation

• List of all past employers for the last three years with names and addresses and your written permission.

Driver Records

Voyager Trucking Corp. reserves the right to investigate an employee’s driving record and take whatever action necessary or appropriate based on the information gained. Every employee who drives any company vehicle must possess a valid commercial driver’s license and have a driving record with no “DUI” convictions within the last three (3) years and not more than two (2) moving violations within the last three (3) years.

Employees are required to report all vehicles accidents and moving violations (whether incurred on the job or not) to their supervisor within forty-eight (48) hours of an accident or receiving a violation. Failure to report accidents and/or moving violations (including “DUI” violations) will result in disciplinary action, up to and including termination.

Employees who offered the chance to take a remedial and/or defensive driving course to remove a traffic violation from their record will complete the course in the prescribed amount of time. Costs for the course shall be borne by the company.

Employees who are in driving positions will be automatically terminated upon receipt of a third traffic violation within a three (3) year period or if driving record had adverse effect on our commercial auto policy rates.

Personal Use

Employees who drive company vehicles shall not, at any times, use company vehicles for personal reasons. This policy shall be strictly enforced with disciplinary action, up to and including termination. Employees are restricted from personal use if any kind, including, but not limited to, the following:

• Using company vehicles to run personal errands on or off clock.

• Transporting non-employees in company vehicles, including family members

• Allowing non-employees to use company vehicles for any reason.

Duties of a Voyager Trucking Corp. Driver

You will:

• Report all citations and convictions with full detail to employer immediately

• Report suspension of license

• Every 12 months, fill out a form listing any violation convictions. A driver must inform his employer within 48 hours of any violation or conviction.

• Not speed, ever.

• Wear seat belt at all times.

• Conduct yourself in a civil manner at all times and ALWAYS avoid or back down from any confrontation

• Never argue with another driver or a police officer

• Not speak on phone or text while driving

• Report any maintenance issues of the vehicle immediately to ___Voyager Trucking___

• Comply with and agree to Alcohol Rules*

*Alcohol Rules

• You may never consume alcohol while on duty.

• You may not consume alcohol within 8 hours proceeding reporting for duty or have a blood alcohol concentration of 0.02 or greater.

• You may never possess alcohol including medications like cough syrup or cold medicine that contain alcohol.

• You may not consume alcohol within 8 hours proceeding an accident or until after having blood alcohol level tested

• You may never use any drug that affects your ability to safely operate a motor vehicle. Refusing to submit to any mandated alcohol or drug test including breath and saliva testing, blood testing, and urine testing will result in termination on the sport. Failure to comply with ll of the above my result in unpaid suspension or immediate termination.

If you are in an accident:

• Stop vehicle/shut off engine. Exit vehicle if safe to do so.

• Place warning reflectors around the scene

• Attend to any injured persons.

• See that help is summoned (i.e., police, ambulance, etc)

• Notify your supervisor/manager

• Obtain badge numbers of police.

• Be courteous

• Answer police questions truthfully

• Do not discuss details of the accident with any other people.

• Do not assume responsibility

• Keep notes on any statements made at the scene by you and others involved.

• In glove compartment keep and “Accident Kit” to include the following:

o Accident Report

o Pencil (pens Freeze in the winter)

o Disposable camera

ACKNOWLEDGMENT

________________________acknowledges that this driver manual has been reviewed with him/her

Print Name

On _________________ and agrees to abide by its rules. ____________________________agrees with it

Date Print Name

and recognizes that driving is a very serious business and that his/her driving record will affect his/her

value to Voyager Trucking Corp. and its ability to employ him/her.

Date__________________

Reviewed and agreed to by: ________________________________________________

Company Official: ________________________________________________________

Driver Signature: _________________________________________________________

LOG SHEET FOR PREVIOUS EMPLOYMENT REFERENCES

PERSON FOR WHOM INFORMATION IS REQUESTED

Name:_____________________________________________ SSN No.__________________________

1. Date___________________________

Notes:______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Reviewed by:______________________

2. Date:___________________________

Notes:_____________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Reviewed by:______________________

3. Date:___________________________

Notes:______________________________________________________________________________________

______________________________________________________________________________________

______________________________________________________________________________________

Reviewed by:_______________________

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