Employment Application

Driver's Application For Employment

Step 1 of 9

HONEY TRANSPORT, INC., P.O. Box 908, Plymouth FL 32768
Applicant Name*
First Last
Applicant Email*
Enter Email Confirm Email
Date of Application*
MM slash DD slash YYYY

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ACCIDENT RECORD
For past 3 years or more
Last accident date
MM slash DD slash YYYY
Nature of accident

(Head-on, Rear-End, Upset, etc.)
Fatalities
Injuries
Hazardous Material Spill
Accident date
MM slash DD slash YYYY
Nature of accident

(Head-on, Rear-End, Upset, etc.)
Fatalities
Injuries
Hazardous Material Spill
Accident date
MM slash DD slash YYYY
Nature of accident

(Head-on, Rear-End, Upset, etc.)
Fatalities
Injuries
Hazardous Material Spill
Accident date
MM slash DD slash YYYY
Nature of accident

(Head-on, Rear-End, Upset, etc.)
Fatalities
Injuries
Hazardous Material Spill
Accident date
MM slash DD slash YYYY
Nature of accident

(Head-on, Rear-End, Upset, etc.)
Fatalities
Injuries
Hazardous Material Spill
Accident date
MM slash DD slash YYYY
Nature of accident

(Head-on, Rear-End, Upset, etc.)
Fatalities
Injuries
Hazardous Material Spill
TRAFFIC CONVICTIONS

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TRAFFIC CONVICTIONS
and forfeitures for the past 3 years (other than parking violations).
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Location
Date
MM slash DD slash YYYY
Charge
Penalty
Location
Date
MM slash DD slash YYYY
Charge
Penalty

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EXPERIENCE AND QUALIFICATIONS - DRIVER LICENSES
List all driver licenses or permits held in the past 3 years
State
Licence Number
Type
Expiration Date
MM slash DD slash YYYY
State
Licence Number
Type
Expiration Date
MM slash DD slash YYYY
State
Licence Number
Type
Expiration Date
MM slash DD slash YYYY
State
Licence Number
Type
Expiration Date
MM slash DD slash YYYY
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
- Yes
- No
Please give details
B. Has any license, permit or privilege ever been suspended or revoked?
- Yes
- N0
Please give details

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EXPERIENCE AND QUALIFICATIONS - OTHER
Show any trucking, transportation or other experience that may help in your work for this company
List courses and training other than shown elsewhere in the application
List special equipment or technical materials you can work with (other than already shown)
EDUCATION
Highest Grade Completed*
Last School Attended & Location (city & state)*

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AUTHORIZATION
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: *Review information provided by previous employers; *Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and *Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I can not agree on the accuracy of the information.
You agree that the Prospective Employer may obtain such background reports.
I authorize HONEY TRANSPORT/BESTWAY ("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 collect 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 collect 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, wil1 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! 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 stand-alone document. The language may NOT be included with other consent forms or any other language. I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.
In connection with your application for employment with HONEY TRANSPORT/BESTWAY ("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 FM CSA 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.
As, an applicant for employment or an employee, you are a consumer with rights under the Fair Credit Reporting Act When evaluating you for employment, promotion, reassignment or retention as an employee, a consumer report or an investigative consumer report may be obtained from a consumer-reporting agency and may be obtained at any time during the application process or during your employment. I authorize Honey Transport, Inc. to obtain information from all personnel, education institutions, government agencies, companies, corporations, credit reporting agencies, Jaw enforcement agencies at the federal, state and county level, relating to my past activities, to supply information concerning my background. The information obtained may include but is not limited to, academic, residential, achievement, previous employment verification and/or job performance, workers compensation, professional licenses, credit reports, driving history, criminal history records, medical history and other related matters as my be necessary in arriving at an employment decision. I understand that a consumer report or investigative consumer report may be prepared summarizing this information. The report may include information obtained through personal interviews regarding my character, general reputation, personal characteristics and/or mode of living. I may also have the right to request additional disclosures regarding the nature and scope of the investigations as well as a written summary of my rights under the Fair Credit Reporting Act. If requested, the consumer-reporting agency will explain the contents of my file. I understand that proper identification will be required and that I should direct my request to: Honey Transport, Inc. P.O. BOX 908, Plymouth FL 32768 Phone l-888-966-2953. In the event of employment, I understand that false or misleading information given on my application or interview(s) may result in discharge. DOT Applicants Only (Drivers): I understand that information I provide regarding current and/or previous employers will be contacted for the purpose of investigation my safety performance history as required by 49 CFR 391.23. I understand that I have the right to: L Review information provided by current/previous employers 2. Have errors in the information corrected and for the previous employer resend the corrected infom1ation to the prospective employer. 3. Errors will need to be challenged by the applicant and completed in writing. 4. In the event that a pervious employer and l cannot agree on the accuracy of the information, you may have a rebuttal statement attached to the erroneous information.
Signature*
Name*
First Last
Social Security Number*
Drivers License Number*
Date*
MM slash DD slash YYYY

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Driver's Application For Employment

Step 1 of 9

APPLICANT TO COMPLETE

EMPLOYMENT HISTORY

ACCIDENT RECORD

TRAFFIC CONVICTIONS

EXPERIENCE AND QUALIFICATIONS - DRIVER LICENSES

DRIVING EXPERIENCE

EXPERIENCE AND QUALIFICATIONS - OTHER

EDUCATION

AUTHORIZATION