Application No. ______Pre-Employment
PRE-EMPLOYMENT DRIVER APPLICATION
Completed before approval · Pro Logistics Services Inc.
COMMERCIAL DRIVER APPLICATION
FILL IN ALL BLANKS & PROVIDE ALL INFORMATION REQUESTED — PRINT OR TYPE
Original page 1
Date:
Full Name:
Date of Birth:Social Security Number:
Cell Phone:Email:
Emergency Contact Name and Number:
Address in the last 3 years:
Previous Address:
CDL Information — State:Number:Exp Date:
Previous CDL Info — State:Number:Exp Date:
Have you ever had your CDL denied, Canceled, Revoked or Suspended?

OTR Employment History — Last 5 Years

List all Accidents in the Past 3 Years

List all Violations in the Past 3 Years

List all Clearinghouse Violations in the Past 2 Years

As of November 2024, if a Driver has an open Clearinghouse violation his CDL will be downgraded.

CERTIFICATION
Original page 3

I certify 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.

Name:
Signature (type, then sign)
Date:
General Consent for Full Queries of the FMCSA
Drug and Alcohol Clearinghouse
Original page 4

I, , hereby provide consent to PRO LOGISTICS SERVICES INC. to conduct a full unlimited queries (Pre employment and Annual 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 understand that if the full query conducted by Pro Logistics Services Inc indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Pro Logistics Services Inc without first obtaining additional specific consent from me.

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

Employee Signature (type, then sign)
Date:
AUTHORIZATION FOR RELEASE OF INFORMATION
FOR EMPLOYMENT SCREENING
Original pages 5–6

Driver Record Screening Disclosure

I hereby authorize EmbarkSafety LLC and its designated agents and representatives to conduct a comprehensive review of my driver record background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment and retention as an employee. I understand that the scope of the consumer report / investigative consumer report may include information about my names, motor vehicle records, license verification. Upon Request, Embark Safety LLC will supply a copy of the completed consumer report along with a copy of an individual's rights under the Fair Credit Reporting Act.

Authorization and Release

I , 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 reservation, throughout any duration of my employment at Pro Logistics Services Inc. 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.

Notice to Massachusetts Applicants: Under Mass. Ann. Laws chapter 93 §§ 50, a Consumer Reporting Agency may furnish a report intended to be utilized for employment purposes.

⚠ This page must be PRINTED and PHYSICALLY SIGNED by the applicant. Electronic signatures are NOT acceptable for this document — the office will collect the hand-signed copy.
IMPORTANT DISCLOSURE REGARDING
BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
Original pages 7–8

The below disclosure and authorization language is for mandatory use by all account holders.

In connection with your application for employment with Pro Logistics Services Inc ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and inspection reports will provide specific reasons for any adverse employment action. The PSP Report does not provide adjudicative determinations as to fault or any other determination with respect to the crash and inspection data provided.

I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

Signature (type, then sign)
Date:

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. The language must be used in whole, exactly as provided, and must exist as one stand-alone document. NOTICE: The prospective employment concept referenced in this form contemplates the definition of "employee" contained at 49 C.F.R. 383.5. LAST UPDATED 2/11/2016.

SAFETY PERFORMANCE HISTORY RECORDS REQUEST
Original page 9
PART 1: TO BE COMPLETED BY PROSPECTIVE EMPLOYEE
Print Name (First, M.I., Last):
Social Security Number:Date of Birth:
Previous Employer:Email:
Street:Telephone:
City, State, Zip:Fax No.:

To release and forward the information requested by section 3 of this document concerning my Alcohol and Controlled Substances Testing records within the previous 3 years from the employment application date. In compliance with §40.25(g) and 391.23(h), release of this information must be made in a written form that ensures confidentiality, such as fax, email, or letter.

Applicant Signature (type, then sign)
Date:
SAFETY PERFORMANCE HISTORY — PART 3
Original page 10
PART 3: TO BE COMPLETED BY THE PREVIOUS EMPLOYER (Drug and Alcohol History — the prior-employer DOT testing questions). The driver does not complete this page — it is sent to and completed by the prior employer, then returned to the office.
RECORDS REQUEST FOR
DRIVER/APPLICANT SAFETY PERFORMANCE HISTORY
Original page 11

This request is made by the driver/applicant in compliance with the Department of Transportation regulations. §391.23(i)(2) — Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as thirty (30) days after being employed or being notified of denial of employment.

PART 1: COMPLETED BY THE DRIVER/APPLICANT
Prospective Employer:
Street / P.O. Box:
Applicant Signature (type, then sign)
Date:
VERIFICATION OF EMPLOYMENT RELEASE FORM
Original page 12

The Federal Motor Carrier Safety Regulations require all previous employers of this applicant to respond to this request for information within 30 days. Failure to comply with this request is in violation of 49 CFR 391.23 and 40.25, for which you may be prosecuted.

Former Employer's Name:Date:
Mailing Address:
City / State / Zip:
Telephone #:Fax Number:
Email Address:

I, , hereby authorize the release of all records of employment, including assessments of my job performance, ability, and fitness, including the dates of any and all alcohol or drug tests, with confirmed results, and/or my refusal to submit to any alcohol and drug tests and any rehabilitation completion under direction of a Substance Abuse Professional (SAP) and/or Medical Review Officer (MRO).

Applicant Signature (type, then sign)
Date:
REQUIRED DOCUMENT UPLOADS
Driver's License — Front (required)
Clear photo of the front of your CDL.
Driver's License — Back (required)
Clear photo of the back of your CDL.
Medical Examiner Card (required)
Your current DOT medical examiner's certificate.
Pro Logistics Services Inc · Pre-Employment Driver Application · completed before approval · progress saves automatically · production form — no sample data
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