ONLINE EMPLOYMENT APPLICATION

TODAYS DATE
TODAYS DATE
Name *
Name
PHONE NUMBER *
PHONE NUMBER
ADDRESS *
ADDRESS
DATE OF BIRTH *
DATE OF BIRTH
Are you Currently Employed? *
Are you able, with or without reasonable accommodation, to perform the essential duties of the job for which you are applying? (Lifting, pushing pulling up to 75 lbs, standing walking, bending, repetitive arm/shoulder motion) *
Do you have any previous injuries that may be aggravated by performing job duties *
Are you legally authorized to work in the USA? *
Have you ever been convicted of a felony? *
DRIVING EXPERIENCE *
HAVE YOU EVER TESTED POSITIVE TO DRUGS OR ALCOHOL *
PREVIOUS EMPLOYER
IDI Logistics Inc. Safety Performance and Drug & Alcohol Testing History Request Prospective Employee: Pursuant to Federal Motor Carrier Safety Admin. Regulations Part 40.25 & Part 391.23 hereby authorize the release of all driver performance information, along with Alcohol & Controlled substance testing records within the past three years form the date of this request to the prospective employer as listed above.
INITIAL
INITIAL
ADDRESS
ADDRESS
START DATE EMPLOYED
START DATE EMPLOYED
END DATE OF EMPLOYMENT
END DATE OF EMPLOYMENT
EMPLOYER PHONE #
EMPLOYER PHONE #
Was your job designated as a Safety-Sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFRPART40 *
Did you operate a commercial Motor vehicle with a GVWR of 10,001 or more, or that required a CDL? *
PREVIOUS EMPLOYER
ADDRESS
ADDRESS
START DATE EMPLOYED
START DATE EMPLOYED
END DATE OF EMPLOYMENT
END DATE OF EMPLOYMENT
EMPLOYER PHONE #
EMPLOYER PHONE #
Was your job designated as a Safety-Sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFRPART40
Did you operate a commercial Motor vehicle with a GVWR of 10,001 or more, or that required a CDL?
PREVIOUS EMPLOYER
ADDRESS
ADDRESS
START DATE EMPLOYED
START DATE EMPLOYED
END DATE OF EMPLOYMENT
END DATE OF EMPLOYMENT
EMPLOYER PHONE #
EMPLOYER PHONE #
Was your job designated as a Safety-Sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirement of 49 CFRPART40
Did you operate a commercial Motor vehicle with a GVWR of 10,001 or more, or that required a CDL?
AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT SCREENING
DRIVER RECORD SCREENING DISCLOSURE I hearby authorize Embark Safety L.L.C. and it’s designed agents and representatives to conduct a comprehensive review of my driver record background through a consumer report and/or an investigation 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 information about my character, general reputation, personal Characteristics, and mode of living as well as information that is not limited to, the following areas: names and dates of previous/current employment, work experience, Bureau of Workers Compensation/claims, criminal history records(from local, state, federal, international and other law enforcement agencies records)sexual offenders list, wants and warrants records, motor vehicle records, military records, educational verification, license verification, credit history, civil cases, OIG/GSA, USA PATRIOT Act/OFAC, any sanction lists, FBI finger printing, internet searches, social media information, and which an drug testing. Upon Request, Embark Safety L.L.C. will supply a copy of the Completed consumer report along with a copy of an individual’s rights under the fair Credit Reporting Act.
I (PLEASE INITIAL BELOW) ,authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, or public agency may have. I authorize the full release of the information described above, without any reservations, throughout any duration of my employment at IDI Logistics Inc. I hereby release Embark Safety L.L.C, 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 for release form. I certify that all information provided below is correct to the best of my knowledge. This authorization and consent shall be valid in original, fax, or copy form. The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any purpose.
DAE OF BIRTH
DAE OF BIRTH