Technician Application

Page 1

Logo323 Cash Memorial Blvd.
Forest Park, GA 30297
Phone: (800) 584-9131 Fax (404) 362-4293

We do not discriminate on the basis of color, race, religion, national origin, sex, age, or non-job
related disability. It is our intention that all qualified applicants be given equal opportunity
and that selection decisions be based on job related factors.

NOTE: Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Use blank paper if you do not have enough room on this application. PLEASE PRINT or type, except for signature on back of application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.












Position














Page 3

General




Driving Experience and Qualification





Page 4

Education

Experience and Qualifications  Indicate Training And Show Experience In The Following 
Years of Experience Description
Computer Skills
Brakes
Driveline
Welding
Electrical
Engine
Schools Attended  Please List All Technical and College Schools Attended Below:







Page 5

Employment Record.
List all employers for last ten (10) years. A resume does not replace employment history. Start with last or current position, including military experience, and work back. If unemployed for more than 1 month, list separately as “unemployed.” (Attach a separate sheet of paper if necessary) Gaps in employment must be accounted for.















Page 6

Applicant Must Read and Sign

DRIVER’S PRIVACY PROTECTION ACT DISCLOSURE

In accordance with the provisions of Section 272 (b)(3)(A) of the Driver’s Privacy Protection Act, title 18 Part 1, chapter 123, you are being informed that a personal motor vehicle record will be obtained only with your expressed written permission and will be used only to verify the accuracy of personal information submitted by you on this application and will be on-going in the event such report is needed in the future for qualification purposes only.

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

In accordance with the provisions of Section 604 (b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996, Title 11, Subtitle D, Chapter 1 of Public Law 104-208, you are being informed that your consumer report, including Motor Vehicle Reports, may be obtained for qualification purposes.

I am seeking driver qualification with Premier Transportation and hereby direct and authorize the appropriate state agency to make available to Premier Transportation any criminal record a state law enforcement agency has on file in reference to me. In addition, I hereby authorize Premier Transportation to obtain copies of my credit history, educational records, employment and driver’s license information.

 

APPLICANT MUST READ AND SIGN

I certify that I have read and understand all of the employment application. Further, that I completed this application and that all of the information I supplied in this application packet is full and complete statement of fact and contains no material omissions. It is understood that if falsification is discovered, it will constitute grounds for rejection of application for employment or, if hired, dismissal from employment upon discovery thereof. If hired, I agree to abide by all rules and policies of Premier Transportation.

I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job. I also understand that if offered a job, the offer may be conditioned on the results of a physical examination and drug/alcohol tests.

In addition, I authorize, Premier Transportation, to obtain the necessary hospital reports and other documents that would indicate whether there were any controlled substances in my system if I am seriously injured while on-the-job and cannot provide a specimen at the time. The authorization conforms with Section 391.113(B) of the Federal Motor Carrier Safety Regulations.

I understand that prior to any hiring decision that I have the following rights regarding the investigative information that will be provided to employer pursuant to 49 CFR 391.23(d) and (e): 1. The right to review information provided by current/previous employers; 2. The right to have errors in the information corrected by the previous employers and for that previous employer to re-send the corrected information to the prospective employer; 3. The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and driver cannot agree on the accuracy of the information.

I also understand that this application is not a contract of employment. I understand that if I am employed I will be an at-will employee and I may voluntarily  leave my employment or my employment may be terminated at any time for any reason. I acknowledge that no written or oral statements have been made to or relied upon by me regarding the length of employment or the reasons for which my employment can be terminated.

I authorize Premier Transportation to conduct a thorough Background Investigation in accordance with state and federal law and authorize my previous employers to release any information requested by Premier Transportation and hold them harmless of all liability from the release of said information. Also, in accordance with the provisions of 49 CFR 382.405 and 382.413, I hereby authorize and require my previous and/or current employers to release the following to Premier Transportation by whatever means is most expedient: The results (including any refusal to test or pre-employment positive) of all Drug and Alcohol tests taken by me pursuant to the provisions of 49 CFR while in their employment, as well as any other information received from a past employer that indicated a violation of FMCSR Part 382.

 





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