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Do you have the legal right to work in the Unted States?
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Have you ever been convicted of a felony?
Is there any reason you might be unable to perform the functions of the job for which you have applied?

Employment History

Accident Record

Traffic Convictions & Forfeitures

Have you ever been denided a license, permit, or privlege to operate a motor?
Has any license, permit or privilege ever been suspended or revoked?

Disclosure & Acknowledgement

In compliance 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 other protected group status. I authorize you to make such investigations and inquiries of my personal, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, healthcare providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. 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 49 CFR 391.23(d) and (e). I understand that I have a 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 rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree to the accuracy of the information. This certifies that this application was completed by me, and that all entries on it and information in ti are true and complete to the best of my knowledge.

Drivers License/ Criminal History/ Social Security

In connection with my application for employment, promotion, reassignment, retention, or contract of services understood that a Motor Vehicle Report (MVR) Criminal History Report (CHR) and / or a Social Security Validation (SSV) will be requested concerning my driving record Criminal Background and the validly of my status with the Social Security Administration.

I authorize without reservation any party or agency to furnish a MVR for purposes of investigation as required by Federal Motor Carrier Safety Administration in 49 CFR 391.23 and 391.25 and/or in accordance with the employer's policies and procedures. If hired (or contracted), this authorization shall remain on file and serve as ongoing authorization to produce an MVR during my employment (or contract) period.

I authorize without reservation any party or agency to furnish an MVR, CHR, or SSV for investigation as required by the Company. If Hired (or contracted), this authorization shall remain on file and serve as ongoing authorization to procure an MVR, CHR, or SSV at any time during my employment (or contract) period. An MVR will be requested from the State that issued the individual's driver's license before employment and, once hired: requested annually after that.

I have the right to request from the party or agency obtaining the MVR CHR, SSV the nature and substance of all information on me in its files, including the source of information and the recipients of any reports issued within the two years preceding my request.

The request for an MVR, CHR, and SSV, which is a consumer report, will be made in accordance with 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).

Drug & Alcohol Testing Policy Acknowledgment

STATEMENT OF POLICY

Every covered driver is required to refrain from the use of prohibited controlled substances on and off duty. Every covered driver is required to refrain from the use of alcohol before (within 4 hours) and during the performance of safety-sensitive functions (operating on a public roadway a vehicle which requires a Commercial Driver's License).

Covered drivers will be tested for marijuana, cocaine, opioids, amphetamines and phencyclidine (PCP). Covered drivers will also be tested for alcohol. Driver applicants will be subject to pre-employment drug test. The employer must receive a verified NEGATIVE result before driver applicants will be permitted to perform safety-sensitive functions.

CONSEQUENCES OF PROHIBITED CONDUCT

Any driver who has a POSITIVE drug test result, an alcohol test with a result of 0.004 OR GREATER, or has engaged in other conduct prohibited by SECTION B of this policy, will be immediately removed from safety-sensitive functions and will be subject to disciplinary action up to and including termination. A driver who has a POSITIVE test result will not be hired.

TESTING PROGRAM ADMINISTRATIORS

Your employer has contracted with a bona fide alcohol and drug testing program administrator, as authorized under the Federal regulations, to administer the program.

ADDITIONAL REQUIREMENTS

The employer is permitted by Federal regulations to require and enforce more stringent requirements relating to safety of operation and employee and health including additional requirements relating to alcohol and controlled substances.

I hereby acknowledge receipt of Texas Coast Limousine Service, LLC's DOT Drug & Alcohol Testing Policy and / or Texas Coast Limousine, LLC's Non-DOT Drug & Alcohol Testing Policy. I agree to familiarize myself with the requirements of the appropriate policy and comply with its provisions.

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?
If you have tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for are you able to provide proof that you have successfully completed the DOT return-to-duty requirements?

One Driver's License Certification

I acknowledge and understand that anytime a driver with a Commercial Driver's License violates a state or local traffic law (other than parking), I will report it within 5 working days to my employer and within 30 days to the state that issued the license. Notification to the state is only made if the violation occurred in a state other than the one that issued the license.

I acknowledge and understand that notification of any revocation or suspension of my CDL must be made to my employer within one (1) day of receiving the notice. Drivers or employers who violate these requirements are subject to civil penalties of up to $2,500 or under certain circumstances, criminal penalties of $5,000 and/or 90 days imprisonment.

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

I provide consent to the Company to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.

I authorize without reservation any party or agency to furnish a limited report for purposes of investigation as required by the Company. If hired (or contracted), this authorization shall remain on file and serve as on-going authorization to procure a limited inquiry report at any time during my employment (or contract) period.

I understand that if the limited query conducted by the Company indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to the Company without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for the Company to conduct a limited query of the Clearinghouse, the Company must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's drug and alcohol program regulations.

 By signing below, you agree and understand the application above. 

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