Driver

Dear Applicant: Per FMCSR 391.21(d) Before an application is submitted, the motor carrier shall inform the applicant that the information he/she provides for the employment history may be used, and the applicant's prior employers may be contacted, for the purpose of investigating the applicant's safety performance history information. The prospective employer must also notify the driver in writing of his/her due process rights as specified in § 391.23(i) regarding information received as a result of these investigations. You the applicant have the following rights: (i) The right to review information provided by previous employers; (ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; (iii) The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

If your current residence is less than 3 years, list below all residences for the past 3 years.

Please provide your employement status for every day of the past 3 years. Also, please account for all commercial driving experience dating back 10 years from today.

Past Employer 1

Licenses
List all licenses held in the last 3 years. (State, License #, Type/Edorsement, Exp. Date)

Experience

Violations of Motor Vehicle Laws & Ordinances

Accident Review for past 3 years

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty and reason for non-consideration or subsequent dismissal if hired or denial of authorization to drive. It is also agreed and understood that the motor carrier or his agents may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his/her furnishing such information. I understand that nothing contained in this application or in the granting of any interview or a road test is intended to create an employment contract between this company and myself, for either employment, authorization to drive, or for the providing of any benefits. I agree to furnish such additional information that may be necessary and complete such examinations as may be required to complete my application file including, but not limited to a pre-employment negative urine test and successful completion of human performance evaluation including, but not limited to a Department of Transportation physical. No promises regarding employment or authorization to drive have been made to me, and no such promises exist unless specifically made by this Company in writing. It is agreed and understood that if qualified, hired or contract started, I may be on a probationary period during which time I may be disqualified without recourse. I understand employment or authorization to drive with this carrier is on an "at-will" basis that allows me to quit, be fired, or lease agreement revoked at any time with or without notice and with or without cause. 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.

By this document, Ottery Transportation, Inc., discloses to you that a consumer report, including an investigative report containing information as to your character, general reputation, personal characteristics, driving records, and mode of living may be obtained for employment purposes as part of the pre-employment background investigation and at any time during your employment. Should an investigation consumer report be requested you have the right to demand a complete and accurate disclosure of the nature and scope of the investigation requested and a written summary of your rights under the Fair Reporting Act. Please sign below to signify receipt of the foregoing disclosure.

I certify that I have read and accept the above Applicant Statement.

I understand that as part of the Department of Transportation Driver Qualification process (specifically DOT 49 CFR Parts 382 CONTROLLED SUBSTANCES AND ALCOHOL USE AND TESTING) Ottery Transportation, Inc. is required to obtain the results of all DOT required drug and/or alcohol tests (including refusals to be tested).

I understand that I must give Ottery Transportation, Inc. written authorization to obtain the above mentioned information from all of the companies for which I performed a safety sensitive function, or for which I took a pre-employment and/or non-DOT drug and/or alcohol test, during the past three years. I also understand that my signing of this authorization does not guarantee me a job with Ottery Transportation, Inc.

Below, I have listed all of the companies for which I performed a safety sensitive function, or for which I took any drug and/or alcohol test during the past three years. I hereby authorize the companies to furnish Ottery Transportation, Inc. the following information concerning my drug and/or alcohol tests:

1: All verified positive drug test results during the past three years.
2: All alcohol tests with a result of 0.04 or higher alcohol concentration during the past three years.
3: All refusals to be tested (including verified adulterated or substituted drug test results) during the past three years.
4: Any violations of DOT agency drug and alcohol testing regulations or alcohol and controlled substance prohibitions during the past three years.
5: Any drug and/or alcohol rule violations provided by a previous employer during the past three years.
6: Documentation of successful completion of DOT return to duty requirements, to include SAP information and follow-up tests and/or documentation of non-completion or refusal of SAP referral during the past three years.
7: All testing violations subsequent to the successful completion of an SAP rehabilitation during the past three years.

• I authorize Ottery Transportation, Inc. to use my Social Security Number and Drivers License Number(s) to investigate my background, character, general reputation, record of convictions, deferred prosecutions, charges pending, motor vehicle records and prior employment/lease by contacting my prior employers/lessors, references or any other individuals or agencies Employer considers necessary;

• I authorize Employer, my prior employers/lessors, educational institutions, references, and any other individuals or agencies contacted by Employer to release any and all information they may have regarding me and absolve those parties who provide information requested from any and all liability related to their doing so;

•I acknowledge that any employment offered to me is at the will of Employer and may be terminated by Employer at any time, without cause.

• I agree that not updating, or providing false, misleading or incomplete statements or data in this application and/or supplemental documents is grounds for immediate termination of my employment, regardless of when such information is discovered.

I understand that in order to investigate my safety employment history, per FMCSA regulations, Ottery Transportation, Inc. must investigate the information I have provided by contacting all previous DOT regulated employers/lessors under which I was employed/leased in a safety-sensitive function within the previous three years from the date of this employment application.

Applicants have the following rights regarding the investigative information that will be provided to Ottery Transportation, Inc. pursuant to FMCSA Reg 391.23 (i)(1):

1: The right to review investigative information provided by previous DOT employers/lessors for the preceding three years by submitting a written request to Ottery Transportation, Inc., Attn: Safety Director, within 30 days after being employed or of being notified of denial of employment.
2: The right to have errors in the information corrected by their previous employer/lessor and for that previous employer/lessor to re-send the corrected information to Ottery Transportation, Inc. Applicants must send the request for the correction to the previous employer/lessor that provided the records to Ottery Transportation, Inc.
3: The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer/lessor and the applicant cannot agree on the accuracy of the information. Applicant must send the rebuttal to the previous employer/lessor with instructions to include the rebuttal in that applicant's safety performance history.


I certify that all entries and information on and in this application and all supplemental documents are true and complete to the best of my knowledge and I hereby agree to all of the above.

Ottery Transportation, Inc.'s hiring criteria and application process may be changed at any time at Ottery's discretion without prior notice.

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 Ottery Transportation, Inc., 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 PSI' 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 Ottery Transportation, Inc. 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.

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. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one joint stand-alone document or individually as two separate stand-alone documents, (i.e., one Disclosure form, and one Authorization form). The language may NOT be included with other consent forms or any other language.

As the employer, Ottery Transportation, Inc. must ask whether you have tested positive or refused to be tested on any pre-employment drug or alcohol test. Applicable tests would have been administered by a motor carrier to which you applied for, but did not obtain safety-sensitive transportation work (as covered by DOT agency drug and alcohol testing rules) during the past two years.

If I have, then I am including below the appropriate substance abuse provider information.

I hereby certify the accuracy of this statement.