Fabrication/Semi Trailer Technician – Hammond, IN

I hereby state that:

1. I am an employee or prospective employee of the Company designated below.
2. I authorize the said Company, or its agents to obtain my Motor Vehicle Report from the Secretary of State's Department of Licensing, to be used for the following purposes:
   1. By said Company to verify information relating to my license and qualifications to determine whether I should be employed to operate a commercial vehicle upon public highways and/or
   2. By the Company's insurance carrier for underwriting purposes.
3. I understand that "Commercial Vehicle" means any vehicle for which the principal use is the transportation of commodities, merchandise, produce, freight, animals or passengers for hire
4. I hereby certify that the Company has made all disclosures to me as required under Section 606 of the Federal Fair Credit Reporting Act, 15 USC 1681d.
5. I have been advised, and hereby acknowledge and agree, that the MVR may be sent between parties via facsimile or email, both of which are non-secure modes of transmission.
6. I further understand that no information contained in the MVR shall be divulged, sold, assigned or otherwise transferred to any third person or party.

By typing my name below, I acknowledge that I have actual knowledge of the contents of this form and I understand the requirements and further agree that this is valid as my signature.

The Federal Motor Carrier Safety Regulations - Section 391.103
The Pre-Employment testing requirements apply to all driver-applicants of this company.

1. A motor carrier shall require a driver-applicant who the motor carrier intends to hire or use to be tested for the use of controlled substances as a prequalification condition.
2. A driver-applicant shall submit to controlled substance testing as a prequalification condition.
3. Prior to collection of a urine sample under 391.107 of this subpart, a driver-applicant shall be notified that the sample will be tested for the presence of controlled substances.

As a condition of my employment, I agree to the urine sample collection and controlled substance testing. I understand a positive test for controlled substances based on the Urinalysis Test will medically disqualify me from the operation of a commercial motor vehicle for this company.

The Medical Review Officer will maintain the results of the Urinalysis Test. Negative and positive results will be reported to the company. My written authorization is required for the Urinalysis Test results to be given to other parties.

I have read and understand the above conditions for the Pre-Employment Urinalysis Notification.

By typing my name below, I acknowledge that I have actual knowledge of the contents of this form and I understand the requirements and further agree that this is valid as my signature.

I hereby authorize you to release the following information to ILLINI STATE TRUCKING for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability, which may result from furnishing such information.

By typing my name below, I acknowledge that I have actual knowledge of the contents of this form and I understand the requirements and further agree that this is valid as my signature.

If you need to provide additional information regarding felony convictions, previous employment, accident records or traffic convictions, please upload additional files here.

Must be .txt, .doc, .docx, or .pdf only

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

By typing my name below, I acknowledge that I have actual knowledge of the contents of this form and I understand the requirements and further agree that this is valid as my signature.