Online Application

Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Driver License Number*
Issuing State*
Expiration Date*
Driving Experience*
License Endorsements
Please check any below that apply
- HazMat
- Doubles/Triples
- Tanks

Felonies or Misdemeanors
In the past 5 years have you been convicted of a felony or misdemeanor? If yes, please explain. Massachusetts residents should not provide information on criminal history.
Has your license ever been revoked or suspended?
If yes, please explain.
Convictions
Please check any below that apply
- DWI,DUI
- Reckless/Carelees Driving
- 15 MPH Over Speed Limit

Date of accident
Accident Type
Were there injuries?
- Yes
- No
Were there fatalities?
- Yes
- No
Damages
Notes (Description, Whose Fault, Etc.)
Date of accident
Accident Type
Were there injuries?
- Yes
- No
Were there fatalities?
- Yes
- No
Damages
Notes (Description, Whose Fault, Etc.)

Social security number
Please enter your social security number below, we are committed to the responsible protection of your social security number (SSN). Then, read and agree to the following terms to submit your application.
I authorize Smail Trucking LLC to make investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release previous employers, schools, federal, state and local agencies and other persons from all liability in responding to inquiries and releasing information in connection with my application for employment with Smail Trucking LLC I acknowledge that a telephonic facsimile, internet form or copy of this release shall be as valid as the original. This release is valid for all federal, state, county and local agencies and authorities. AGREEMENT AND RELEASE (PLEASE READ THE FOLLOWING STATEMENT CAREFULLY) This certifies that my qualification form was completed by me and all entries on it are true and complete to the best of my knowledge. I also agree that falsified information and significant omissions may result in my disqualification now or at any time. I understand that Smail Trucking LLC uses an electronic filing and signature system which includes the imaging and storing of forms and applications. Therefore, my original paper application may not be retained. I understand that an electronic signature will be binding upon me to the same extent as if handwritten. I understand that my qualification can be terminated, with or without cause, at any time at the discretion of either Smail Trucking LLC or myself. In accordance with Section(s) 382.405, 382.413, & 391.23 of the FMCSR, I authorize any and all persons and/or institutions to provide any relevant information, including but not limited to my accident history, that may be required to complete my qualification and I agree to release them from any and all liability for supplying said information. Smail Trucking LLC Consumer Reports Disclosure and Release In connection with my application for employment with Smail Trucking LLC, I understand that Smail Trucking LLC may obtain one or more consumer/background reports which may contain public record information, driving history, employment history, criminal history, and/or safety history from consumer reporting agencies, including but not limited to DAC Services (also known as HireRight), e-Verifile, The Work Number, Ten Street, DriverFACTS, and/or the Federal Motor Carrier Safety Administration (FMCSA) via Pre-Employment Screening Program (PSP). These reports may include, but not be limited to the following types of information from federal, state, and other agencies which maintain such records: 1. Names and dates of previous employment/contract services 2. Reasons for termination of employment or termination of contract services 3. Work Experience 4. Accident history/Driving Record 5. Previous records requests from other companies; and 6. Criminal reports Smail Trucking LLC cannot obtain consumer/background reports unless you consent in writing. If you agree that we may obtain such consumer/background reports, please read the following and sign below: 1. In connection with your application for employment with Smail Trucking LLC, 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. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: 2. I authorize Smail Trucking LLC (Smail Trucking LLC) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I 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 understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. 3. I further understand that neither the Prospective Employer 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 State for adjudication. 4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. Other reports may provide information regarding my employment history and criminal records from the previous seven (7) years. I understand and acknowledge that this release of information may assist Smail Trucking LLC to make a determination regarding my suitability as a driver or contractor. If you desire to receive a copy of your investigative consumer/background reports that were provided to Smail Trucking LLC, you may do so by making such a request to us and providing proper identification. If you desire to receive a copy of your investigative consumer/background reports that were provided to us, if applicable, by HireRight/DAC Services, e-Verifile, PSP/FMCSA, The Work Number, Ten Street, or DriverFACTS, you may obtain a free copy from the respective consumer reporting agency within 60 days of your request. You may also dispute the accuracy or completeness of any information in your consumer/background reports via the contact information listed below: HireRight, Inc./DAC Services 4500 S. 129th East Ave, Tulsa, OK 74134 1-800-381-0645 e-Verifile.com, Inc. 900 Circle 75 Parkway, Suite 1550 Atlanta, GA 30339 1-800-853-3228, Ext. 3 PSP/FMCSA 1200 New Jersey Avenue, SE Washington, DC 20590 1-800-832-5660 The Work Number 11432 Lackland, St. Louis, MO 53146 1-866-662-3343 Ten Street 1120 Ease 25th Street, Tulsa, OK 74114-2614 (877) 219-9283 DriverFACTS 5051 E Orangethorpe Ave, Suite E265, Anaheim, CA 92807 (888) 844-4730 I have read the above Consumer Reports Disclosure and Release provided to me by Smail Trucking LLC. I understand that if I sign this consent form, Smail Trucking LLC may obtain a report of my work history, criminal history, driving, crash and inspection history. I further understand that if I am hired by Smail Trucking LLC or if Smail Trucking LLC contracts with me, that DAC Services may obtain my work history with Smail Trucking LLC and that such history will be supplied by DAC Services to other companies that subscribe to DAC Services and to companies requesting information related to my work history with Smail Trucking LLC. I hereby authorize Smail Trucking LLC and its employees, authorized agents and/or affiliates to obtain the information disclosed above. This authorization shall remain on file and shall serve as ongoing authorization for Smail Trucking LLC to obtain consumer/background reports at any time during my employment or while providing contractual services for Smail Trucking LLC.
Agree to terms*
- Yes
- No
THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Smail Trucking LLC (“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. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication. Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization. AUTHORIZATION If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Smail Trucking LLC (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing 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 understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee. I further understand that neither the Prospective Employer 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 challenge 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 State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. 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.
Sign to agree to these terms*
Please sign (type) your name below to agree to these terms and complete your application.

Driver Application

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