NEW HIRE CHECKLIST (DRIVER)

NEW HIRE CHECKLIST (DRIVER)

Updated 8/1/2018

NAME (Last Name, First Name, MI)

CDL or NON CDL DRUG TEST DATE FT/PT

PAY RATE SITE #/ SITE NAME

HIRE/START DATE MANAGER

GENDER M F

RACE (as per application, circle one what applies)

Hispanic White

Black/African American

Asian

Native American Indian

Native Hawaiian/ Other Pacific Islander

Two or more races

EMERGENCY CONTACT (Last Name, First Name, MI)

RELATION TO EMPLOYEE

EMERGENCY CONTACT #

Ensure that the following was sent to the Recruiter prior hiring: 1. Completed application and work history through Tenstreet 2. AVR/ Certificate of Violations/ Annual review of driving record 3. Current MVR (no older than 30 days), if submitted by the employee/ Consent to pull MVR 4. Road Test 5. Copy of Commercial Driver's License (Front and Back) 6. DOT/ Medical Card, if applicable 7. MVR Consent form, if applicable

To be completed/ signed upon hire*: 1. Driver statement of on-duty hours, if applicable 2. Social Security Card (for E-Verify) 3. TWIC, if applicable 4. I-9 5. Certificate of compliance 6. Handbook Policy 7. Training Certificate 8. Harassment Policy 9. Dropped Trailer Policy 10. Seat Belt Policy 11. Trailer Door Policy 12. Driver Duties Acknowledgement 13. Safety Gram Medical Card, if applicable 14. Safety Gram Incident Reporting 15. CSA Form, if applicable 16. Pre-employment drug testing consent & release 17. Alcohol Misuse 18. Alcohol & drug test statement 19. Medical Questionnaire

20. CDL Intent Agreement, if applicable 21. Direct Deposit/ Comdata Pay Consent 22. W-4/ State Tax/ Local Tax Forms (if applicable) 23. Annual MVR Consent

24. New Health Insurance Marketplace Coverage Options & Health Coverage

25. Referral Program 26. Ideas at Work Program 27. ADP Workforce Now Registration Instructions

*General list. Additional company/state/ site specific forms/policies may be present

Employment Eligibility Verification

Department of Homeland Security U.S. Citizenship and Immigration Services

USCIS Form I-9

OMB No. 1615-0047 Expires 08/31/2019

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,

during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later

than the first day of employment, but not before accepting a job offer.)

Last Name (Family Name)

First Name (Given Name)

Middle Initial Other Last Names Used (if any)

Address (Street Number and Name)

Apt. Number City or Town

State ZIP Code

Date of Birth (mm/dd/yyyy)

U.S. Social Security Number

-

-

Employee's E-mail Address

Employee's Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (See instructions)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

QR Code - Section 1 Do Not Write In This Space

1. Alien Registration Number/USCIS Number:

OR

2. Form I-94 Admission Number:

OR

3. Foreign Passport Number:

Country of Issuance:

Signature of Employee

Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one):

I did not use a preparer or translator.

A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Signature of Preparer or Translator

Today's Date (mm/dd/yyyy)

Last Name (Family Name)

First Name (Given Name)

Address (Street Number and Name)

City or Town

State ZIP Code

Form I-9 11/14/2016 N

Employer Completes Next Page

Page 1 of 3

Employment Eligibility Verification

Department of Homeland Security U.S. Citizenship and Immigration Services

USCIS Form I-9

OMB No. 1615-0047 Expires 08/31/2019

Section 2. Employer or Authorized Representative Review and Verification

(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")

Employee Info from Section 1 Last Name (Family Name)

First Name (Given Name)

M.I. Citizenship/Immigration Status

List A Identity and Employment Authorization Document Title

Issuing Authority

Document Number

OR

List B

Identity

Document Title DRIVER'S LICENSE

Issuing Authority DMV STATE OF

Document Number

AND

List C Employment Authorization

Document Title SOCIAL SECURITY CARD

Issuing Authority SSA

Document Number

Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority

Expiration Date (if any)(mm/dd/yyyy) Additional Information

Expiration Date (if any)(mm/dd/yyyy) N/A

QR Code - Sections 2 & 3 Do Not Write In This Space

Document Number

Expiration Date (if any)(mm/dd/yyyy)

Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy)

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.

The employee's first day of employment (mm/dd/yyyy):

(See instructions for exemptions)

Signature of Employer or Authorized Representative

Today's Date(mm/dd/yyyy)

Title of Employer or Authorized Representative MANAGER

Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative

Employer's Business or Organization Address (Street Number and Name) City or Town

655 SHILOH RD SUITE 900

ALPHARETTA

Employer's Business or Organization Name LAZER SPOT INC

State GA

ZIP Code 30005

Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)

A. New Name (if applicable)

B. Date of Rehire (if applicable)

Last Name (Family Name)

First Name (Given Name)

Middle Initial Date (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

Document Title

Document Number

Expiration Date (if any) (mm/dd/yyyy)

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative

Form I-9 11/14/2016 N

Page 2 of 3

DRIVER STATEMENT OF ON-DUTY HOURS

FOR CDL DRIVERS ONLY (For Newly Hired Drivers)

INSTRUCTIONS: Motor Carriers when using a driver for the first time shall obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395.80)(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

1

2

3

4

5

(yesterday)

6

7

DATE

HOURS WORKED

TOTAL HOURS

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?

D Yes D No

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

? D Yes

No

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

Witness:

Company Representative

? Copyright 1998 J.J. KELLER &ASSOCIATES, INC., Neenah, WI - USA - (800)327-6868

Date

Date

644-F (Rev. 2/98)

Motor Vehicle 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 transports hazardous materials that require placarding.

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

DRIVER REQUIREMENTS; Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain certain driver licensing requirements that you as a driver must comply with, Including the following:

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

2) NOTIFICATION OF LICENSE SUSPENSION, REVOCATION 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 parking), 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 your license). The notification to both the employer and the state must be ln writing.

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

The following 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:-------------------------------------

(T11is ronn ts not required for DOT compUance)

C Cnpyrlghl 2008 J.J. KELLER &ASSOCtATES, INC., Neenah, WI? USA? (800) 327-S88B ?www, ?Printed in the Untted States

90-F 1617 (REV. 3/08)

Note: Please initial all items

Please initial the following statements.

Itl: _ _ _ I acknowledge that I have recei?ved a,'1C1':opy of the?'Lazer Spot, Inc. Employee Handbook. I have read this handbook and understand the polic:fe~ contained wherein. I fully understand that all the policies and guidelines contained within it apply to me. I understand that if I do not adhere to the policies that my employment with Lazer Spot, Inc. may l;>e terminated. I am also aware that occasionally addendums to the handbook may be sent out with payroll and from that point on, will become a part of the handbook. I understand that this handbook supersedes all prior inconsistent handbooks or policies.

Itl: ____ I acknowledge that I have read and understood the Attendance Policy. I understand that if I am absent without giving prior notice, l face disciplinary action up to and including dis_c;harge, I understand that if! am excessively tardy, I will face disciplinary action up to and including discharge,

Itl: _ _ _ _ 1 acknowledge that I have read the Equal Opportunity Policy. I fully understand. that all hiring, career progress and compensation will be solely based upon my valid requirements and job performanc?e. If I feel that I have subjected to unlawful discrimination, I will bring the issue to the company's attention through the proper management channels..

Itl: ____ As a condition of employment, a DOT Physical Examination will be performed by a qualified medical examiner designated by the company, Lazer Spot, Inc, does accept other companies' physical examinations. I understand that $50.00 will be deducted from my last pay check to cover the cost of this exam if my employment with Lazer Spot, Inc. ends within 180 days from the date of the physical.

Itl: ____ I acknowledge that Haz-Mat certification is required at some sites. If this certification is required by the site, I understand that Lazer Spot, Inc. will reimburse me the price of the Haz-Mat Certification, and that if my employment at Lazer Spot, Inc. ends before 180 days have passed since the reimbursement, then the amount of the Haz-Mat certification will be deducted from my last paycheck.

Itl: ____ I understand that a mandatory pre employment Drug Screen will be given in accordance

with Lazer Spot, Inc.'s Drug and Alc.ohol ................
................

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