You are applying for a DOT position (CDL Required)
Job Description
Personal Information
The Department of Transportation requires employers to have 3 years of residency information.
If you are applying for a driving position, please complete the following five items.

Education / Training

Military Status

Employment Record
Begin with your present employer and work backward in order, list all employment for at least 10 years.
ALL time must be accounted for including self employment, unemployment, and military service.
If you have no commercial driving experience only go back 5 years.

Personal Reference

Legal Driving Record
The U.S. Department of Transportation Motor Carrier Safety Regulations require employers to have a record
(and a photocopy) of the information on your CDL on file and to have a validated copy
of your motor vehicle report from the Department of Motor Vehicles.
Please provide the information below to the best of your ability.
This information will be verified with the Department of Motor Vehicles.
Commercial Drivers License Information
Physical Description
Have you ever had a license denied, suspended or revoked?

Have you had any Traffic Violations in the past three years?

Have you had any Traffic Accidents in the past three years?

A Summary of your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every "consumer reporting agency" (CRA). Most CRAs are credit bureaus that gather and sell information about you--creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1681-1681u, at the Federal Trade Commissions web site ( The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.
Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.
Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA--usually to consider an application with a creditor, insurer, employer, landlord, or other business.
Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.
You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you--such as denying an application for credit insurance, or employment--must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.
You may choose to exclude your name form CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
You can find out what is in your file. At your request, a CRA must giv eyou the informaiton in your file, and a list of everyone who has requested it recently. There is no charge for the report if the person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that you (1) are unemployed and plan to seek employment withing 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.
You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.
You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs--to which it has provided the data--of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRAs investigation does not resolve the dispute, you may add a brief statment to your file. The CRA must normally include a summary of your statement in the future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.
The FCRA give several different federal agencies authority to enforce the FRCA:
For questions concerning or regarding:
Please Contact:
CRAs creditors and others not listed below
Federal Trade Commission Consumer Response Center Washington, DC 20580 202-326-3761 National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after banks name)
Office of the Controller of the
Currency/Compliance Management
Mail Stop 6-6 Washington, DC 20218 Savings associations and federally chartered savings banks (word "Federal" or inistials "F.S.B" appreas in federal institutions name)
Office of Thrift Supervision
Consumer Programs Washington, DC 20552 Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks)
State-chartered banks that are not members of the Federal Reserve System
Federal Deposit Insurance Corp.
Division of Compliance and Consumer Affairs
Washington, DC 20429 Federal Reserve Board Consumer and Community Affairs Washington, DC 20551
National Credit Union Administration
Federal credit unions (words "Federal Credit Union" appear in institutions name)
Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.
Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission
Department of Transportation
Office of Financial Management
Washington, DC 20590 1775 Duke Street
You can dispute inaccurate items with the source of the information. If you can tell anyone--such as a creditor who reports to a CRA--that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once youve notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.
Alexandria, VA 22314
Washington, DC 20250

The regulations of the U.S. Department of Transportation and the Federal Motor Carrier Safety Administration ("FMCSA"), specifically 49 CFR §§ 391.21, 391.23 and 382.413, require A&A Tank Truck Co. and its subsidiaries who employ truck drivers holding Commercial Driver's Licenses to obtain information from all applicants for driving positions. Section 391.21 describes what initial information must be provided on an employment application, and § 391.23 describes what investigations and inquiries relating to the applicant's driving and employment records must be made on each applicant. Section 382.413, in conjunction with § 40.25, requires employers to obtain information from previous employers of truck drivers relating to alcohol and controlled substances testing of those drivers. Under these regulations and a new directive entitled the Comprehensive Safety Analysis 2010 ("CSA 2010"), A&A must obtain and report particular data about each driver and applicant to authorities as well as provide certain information to its drivers and applicants. In order to be considered for truck driving positions at A&A, applicants must read this notice, agree to submit to and comply with the federal laws described within it and sign this form authorizing A&A to obtain information and releasing individuals and entities from liability associated with the disclosure of such information.
Authorization to Conduct Pre-Employment Reference and Background Checks. In connection with your application for employment, A&A may investigate your background and obtain one or more reports regarding your credit, driving, drug and alcohol testing, safety performance and/or criminal background history from various sources, including consumer reporting agencies. If A&A uses any credit information it obtains from a background report in a decision not to hire you or to make any other adverse employment decision regarding you, A&A will provide you with a copy of the report upon which its decision was based before taking any final adverse action. For additional information, please refer to the written summary of your rights under the Fair Credit Reporting Act which is provided with your application form. If any final adverse action is taken against you based upon a background report, A&A will notify you that the action has been taken and that the background report was the reason for the action. A&A cannot obtain background reports from consumer reporting agencies or other sources regarding you unless you consent in writing. 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 II, Subtitle D, Chapter 1, of Public Law 104-208), you are also being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained for employment purposes. If you agree that A&A may obtain such background reports, please read the following and sign below.
Authorization to Release Information to A&A Tank Truck Co. By signing this release, I understand that I am consenting to the release of drug and alcohol testing results and safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years, as well as any reference-related information about me held or known by former employers, supervisors, and co-workers. In addition, I consent to the release of any information about my education, experience, abilities, or work-related characteristics or traits held or known by other organizations or individuals, including schools and educational institutions, professional or business associates, and friends and acquaintances that A&A might
contact in the course of conducting a reference check or background investigation of my suitability for employment.
I understand and acknowledge that this release of information can involve my qualifications, performance, credentials, or other characteristics or factors affecting my suitability for employment with A&A. Specifically, I am authorizing the release of any information about my performance, knowledge, experience, skills, abilities, productivity, attitude, attendance, disciplinary action, reasons for termination, specific events, or such information or characteristics that currently are in the possession of the requested organizations or their managers or representatives.
Release of Liability and Waiver of Right to Take Legal Action. Pursuant to CSA 2010 and the DOT requirements of 49 CFR §§ 391.21, 391.23 and 382.413, I authorize A&A and its subsidiaries and/or its agents, to verify any of this information and contact any organization or individual that I have listed on my employment application or resume or mentioned in job interviews including, but not limited to, past employers, schools, military service authorities or offices, law enforcement authorities, consumer reporting agencies and motor vehicle driving records agencies. I HEREBY AUTHORIZE ALL SUCH PERSONS, PROFESSIONAL OR BUSINESS ASSOCIATES, SCHOOLS, EDUCATIONAL INSTITUTIONS, MILITARY AUTHORITIES, LAW ENFORCEMENT AUTHORITIES, AND COMPANIES TO RELEASE ANY INFORMATION CONCERNING MY EMPLOYMENT, EDUCATIONAL, MILITARY AND CRIMINAL BACKGROUND AND I HEREBY RELEASE SAID PERSONS, PROFESSIONAL OR BUSINESS ASSOCIATES, SCHOOLS, EDUCATIONAL INSTITUTIONS, MILITARY AUTHORITIES, LAW ENFORCEMENT AUTHORITIES, AND COMPANIES FROM ANY LIABILITY FOR ANY DAMAGES WHATSOEVER WHICH MIGHT ARISE FROM MY AUTHORIZATION OF A&A TO INVESTIGATE MY BACKGROUND AND OBTAIN INFORMATION THEREFROM. I understand and agree that a telephonic facsimile (fax) or photocopy of this release is valid as if it was an original.
In exchange for A&A's consideration of my employment application, I agree not to file or pursue any complaints, claims or legal actions of any kind against any organization or individual that provides background information, including but not limited to drug and alcohol testing and safety performance information, about me to A&A Tank Truck Co. or its agents in accordance with the terms and intent of this release. I also agree not to file or pursue any complaints, claims, or legal actions against A&A Tank Truck Co. or any of its employees, representative, or agents arising out of their efforts to obtain background information about me.
I hereby authorize A&A Tank Truck Co. and its employees, agents, and affiliates to obtain the information authorized above.

Below you will be required to enter an Electronic Signature which WILL BE BINDING AS YOUR ACTUAL SIGNATURE. Your Electronic Signature below indicates your agreement with the following statements:
By typing my name in the following box I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.