Art Logistics - Driver Application For Employment

Art Logistics, Inc.
13067 Main St.
Lemont, IL 60439

Please complete the following application to be considered for employment by Art Logistics, Inc. Do not use the browser back button or exit the browser as all unsubmitted data will be lost. After successful submission of this application a copy will be email to the address you have specified.

We look forward to adding any new qualifying applicants to our team!

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





Applicant Details




Contact Information


Current Address






YesNo

Mailing Address





Other Verifications



Other Questions



Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 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 7 years information on those employers from whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent.)

*Includes vehicles having GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity required 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 GVWR of 10,001 pounds or more, (2) is designed or used to transport 9 or more passengers, OR (3) is of any size and is used to transport hazardous materials in a quantity requiring placarding.



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Employer #7

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Employer #8

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Employer #9

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Employer #18

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Employer #19

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Additional Employers


PREVIOUS EMPLOYER INFORMATION RELEASE AUTHORIZATION

This release authorizes all previously checked past employers to release and forward the information requested by Art Logistics concerning alcohol and controlled substance testing and accident history records within the past three (3) years of the date of this application ${timestamp;date}.

I hereby authorize my previous employer to release and forward the information requested by Art Logistics, Inc. concerning my alcohol and controlled substance testing and accident history records within the previous three (3) years from the date of my employment application (${timestamp;date}). The information should be sent to my prospective employer Art Logistics, Inc. 13067 Main St. Lemont, IL 60439, confidential fax (630)628-3035 or confidential email [email protected]

Accident Record

NoYes

Accident #1





More Accidents

Accident #2





More Accidents

Accident #3





More Accidents

Accident #4





More Accidents

Accident #5





Additional Accidents

Traffic Convictions and Forfeitures

NoYes

Conviction/Forfeiture #1




Conviction/Forfeiture #1




Conviction/Forfeiture #3




Conviction/Forfeiture #4




Conviction/Forfeiture #5




Additional Convictions/Forfeitures

Licence Qualifications


List all driver licenses or permits held in the past 3 years.

License / Permit #1




License / Permit #2




Additional Licenses / Permits

Driving Experience

Tractor and Semi-Trailer





Other Qualifications






PERSONAL AND CONFIDENTIAL MEDICAL REVIEW QUESTIONNAIRE

This information is requested to ensure that you can safely perform the essential functions of the job and that you meet all applicable federal regulations governing physical qualifications of commercial drivers. The information you provide below is considered personal, confidential and medical in nature and will be treated as such by handling it confidentially.












I hereby certify that the information contained on this form is true and correct and that there are no omissions. I authorize any physician, medical facility, past employers, and/or privileged agency by Art Logistics, Inc. to furnish or verify workers compensation and medical information

PREVIOUS PRE-EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT

Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive, or refuses to test, on any pre-employment drug or alcohol test administered by an employer to which the employee 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 the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process. (see Sec. 40.25(b)(5) and (e))


NoYes


NoYes

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.

I have read and understood all of the statements above.

I hereby certify that the information contained on this form is true and correct and that there are no omissions. I authorize any physician, medical facility, past employers, and/or privileged agency by Art Logistics, Inc. to furnish or verify workers compensation and medical information.

Driver Consent - If you agree that the Prospective Employer may obtain background reports, please click Agree.

IMPORTANT NOTICE REGARDING BACKGROUND REPORTS

A consumer report and a criminal background report may be procured by Art Logistics Inc. (the “Company”) as part of your application for employment and to periodically obtain updated reports. Among the reports that may be procured by the Company are reports from the Pre-Employment Screening Program (PSP) conducted by the Federal Motor Carrier Safety Administration (the information obtained from this program is hereinafter referred to as a “PSP Report”) for applicants applying for positions as commercial drivers. As required by the Fair Credit Reporting Act (the “FCRA”), this disclosure is to inform you that a consumer report, including information as to character, general reputation, personal characteristics, and mode of living, whichever are applicable, may be procured from time to time. Such reports may contain public information concerning your driving record, safety record, workers’ compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies, which maintain such records. Background checks are conducted only in accordance with state and local laws.

This signed Authorization is my authorization and consent for the Company to procure consumer and criminal background reports, including a PSP Report, from time to time as required by the Company for employment purposes. I understand and agree that I am subject to a consumer and criminal background report to determine my eligibility, and continued eligibility, for employment and I specifically authorize the release, without any liability to the Company whatsoever, of any findings for those purposes only. I further understand that I am consenting to 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 further understand and agree that consumer and criminal background reports and PSP Reports are an absolute and unconditional condition precedent to acceptance or approval by the Company of my application for employment and continued employment, and the results of those reports may also, in the sole and absolute discretion of the Company, constitute grounds for rejection or termination. However, should the information received in the consumer report be adverse and the reason in whole or in part for denial, a copy of the adverse report will be provided to me. Should I dispute the information obtained from the Consumer Reporting Agency, I have the right to obtain a free disclosure of the consumer report if the report is requested within 60 days. Should I dispute the accuracy or completeness of any information provided by the Consumer Reporting Agency, I can dispute the inaccurate items with the source of the information. I further understand that neither the Company 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 https://dataqs.fmcsa.dot.gov. If I am challenging 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 States for adjudication. I acknowledge and confirm that obtaining the reports and information are reasonable and necessary in order to determine my qualifications and competency for employment. This authorization shall remain on file and shall serve as on-going authorization for the Company to procure consumer and criminal background reports, including PSP Reports, at any time during my employment and the qualification process with respect thereto. I understand that, upon termination of my employment for any reason, this authorization will have no further effect.

I hereby certify that I have read the foregoing and understand the contents of this Disclosure and Authorization. I also understand the remedies available to me should I disagree with the Consumer Reporting Agency with respect to the consumer report.