License Information

Education

General

In Case of Emergency, Contact

Certification & Authorization — Must Be Read and Signed

It is agreed and understood that the employer or its agents may investigate the applicant's background; the applicant releases employers and persons named herein from liability for furnishing such information. Pursuant to the Fair Credit Reporting Act and FMCSR §§382.413 and 391.25, reports verifying previous employment, previous drug and alcohol test results, and driving record may be obtained for employment purposes. This application in no way obligates the employer to employ the applicant. Any false statement submitted will be deemed sufficient reason for rejection or termination, irrespective of time lapsed before discovery. I understand an investigative consumer report may be requested covering character, work habits, performance, experience, driving record, and reasons for past terminations, and I consent to the release and future sharing of such information with insurers and subscribing companies. Employment and compensation may be terminated with or without cause at any time. No representative other than the President or Chief Operating Officer may enter into an employment agreement for a specified period. I agree to submit to physical, drug, and alcohol testing as required.

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 (49 CFR 391.21).

MLB Workforce is an Equal Opportunity Employer.

Employment History

Employment History (10-Year)

List starting with your most recent employer. You must provide a complete 10-year work history and account for all gaps between jobs. The FMCSRs apply to operation of a CMV in interstate commerce when the vehicle has a GVWR of 10,001 lbs or more, is designed to transport 9+ passengers, or transports placardable hazardous materials. Add one block per employer.

Collisions (Past 3 Years)

List all motor-vehicle collisions (commercial and private) during the past three years. If none, leave this section empty. To add additional lines click on the "Add" button below the section.

Traffic Convictions & Forfeitures (Past 3 Years)

List all traffic convictions/forfeitures (commercial and private, other than parking) for the past three years. If none, leave this section empty. To add additional lines click on the "Add" button below the section.

Driving Experience

Consents & Authorizations

Authorization / Liability Release (Employment Verification)

I hereby authorize my previous employers to release all records of employment, including assessments of job performance, ability and fitness, drug and alcohol test results, and accidents, to MLB Workforce (or its authorized agents). I release those companies from any and all liability of any type as a result of providing this information. This information is requested in compliance with §40.25 and §391.23.

Certificate of Compliance with Driver License Requirements

Part 383 of the FMCSRs applies to every person who operates a CMV in interstate, foreign, or intrastate commerce; operates a vehicle with a GVWR of 26,001 lbs or more; can transport 16 or more passengers including the driver; or transports placardable hazardous materials. If the above applies: (1) a driver may not possess more than one license, which must be from the driver's state of domicile; (2) the driver must notify the carrier and the licensing state within 30 days of any traffic violation (other than parking); (3) the driver must notify the carrier the next business day after any license revocation or suspension; and (4) the driver must provide previous work history when applying to operate a CMV.

I hereby agree that I have read and understand the above requirements, and the license I listed in this application is the only license I possess.

Driver Certification for Other Compensated Work

When employed by a motor carrier, a driver must report all on-duty time working for other employers, including any compensated work for a non-motor-carrier entity (§395.2).

Release & Documentation of Pre-Employment Drug & Alcohol Testing Information by Applicant?Driver Required by Part Part 40.25(j)

Answer both items regarding the past three (3) years.

If you answered YES to either item, you must provide documentation of successful completion of the return-to-duty process required by Part 40, Subpart O.

Driver Acknowledgement Statement

Initial each item to acknowledge receipt and understanding.

I acknowledge receipt of, and certify that I have fully read and understand, the drug & alcohol policy and educational materials implemented by my employer (to be used with Parts 40, 382, and 392 of the FMCSRs).

I hereby attest, as a commercial driver license holder, I understand the Federal Motor Carrier Safety Regulations as prescribed by the U.S. Department of Transportation. I further understand that obeying these regulations is a condition of my initial and continued employment.

PSP Disclosure & Authorization (FMCSA Pre-Employment Screening Program)

In connection with your application for employment with MLB Workforce ("Prospective Employer"), the 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 information obtained 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 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 the 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 Emmployer 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 MLB Workforce ("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 I am authorizing release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years, and acknowledge this release may assist the Prospective Employer in determining 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.fmcas.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 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

NOTICE: FMCSA requires this disclosure/authorization language to be used in whole, exactly as provided, as one stand-alone document.

FMCSA Drug & Alcohol Clearinghouse — Limited Query Consent

I hereby provide consent to MLB Transportation Resources, Inc. to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists. I understand this consent shall remain on file and serve as ongoing consent for multiple limited queries at any time during my employment or contract period without additional consent. If I refuse consent, MLB is required to prohibit me from performing safety-sensitive functions. If a limited query indicates information exists, MLB must conduct a full query within 24 hours, which requires my specific consent within the Clearinghouse; if I do not grant it, I will be removed from safety-sensitive functions.