General Employment Application

Application For Employment

(Pre-Employment Questionnaire)                    (An Equal Opportunity Employer)

Wooster Motor Ways, Inc.
P.O. Box 19, Wooster, Ohio 44691
800-683-0564

Important Employment Notice

By completing and signing this job application, you give the company the right to contact any and all of your present and former employers and your personal references and request from them full statements about your work performance, your honesty and integrity, your earnings and your ability to get along with fellow employees. In addition, the company may run a credit check on you and you herewith give your permission to do so.

Physical Demonstration
As a part of the procedure for the completion of this job application, each applicant will be shown the written description of the essential functions of the job applied for and will be given an opportunity to ask any questions that the applicant has about the job.

Physical Examination
I understand that if I am approved for employment by Wooster Motor Ways, Inc., as being the best qualified applicant for the job, such employment is condition upon my taking a physical examination, including drug and alcohol abuse testing, to verify that I can meet the physical requirements of the job without presenting a safety hazard to myself or other employees around me. I understand and agree that this physical examination may include testing to determine if I am consuming alcohol, drugs or any other chemical substance. I also agree that, in the event I shall be employed by the company, I will submit to further physical examination when required by the company in the enforcement of its policy concerning alcohol, drugs and chemical substances. My refusal to do so will be cause for termination.

Employment Rules
In the event of my employment by the company, I agree to abide by all present and subsequently issued rules of the company.

I certify that the answers given by me to the foregoing questions and statements are true and correct and I authorize investigation of all statements contained herein. I understand that any misleading or incorrect statements may be cause for denial or termination of my employment and that the company shall not be liable in any respect if my employment is so denied or terminated because of false, misleading or incorrect statements, answers or omissions made by me in this application.

Incomplete applications will not be considered.

 

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Name
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Personal Information
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Present Address
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Permanent Address
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All job applicants will be required, if employment is offered, to complete form I-9 of the Immigration and Naturalization Service.
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Employment Desired
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Education
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Select Highest Grade Completed
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Select Number of Years Completed in College
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Present and Former Employers
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List all employers in the last 10 years, beginning with the most recent
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Employment
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Employment
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Employment
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Employment
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Employment
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Employment
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Employment
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REFERENCES
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Driver Certification

The Commercial Motor Vehicle Safety Act of 1986 sets forth requirements that commercial motor vehicle operators must comply with . This Act applies to all drivers of vehicles with a gross vehicle weight rating of 26,000 pounds or more, vehicles designed to transport at least 15 passengers, and to vehicles used to transport hazardous materials. Drivers in both intrastate and interstate commerce are covered by this Act.

A driver may possess only ONE valid drivers license, which must be from the state in which the driver lives.

A driver must report state and local motor vehicle traffic control violations (other than parking) to his/her employer within thirty (30) days including violations received while using personal vehicle.

A driver must also notify his/her employer of driver license suspensions, revocations. cancellations, lost rights, or other disqualilications by the end of the business day following the date the driver receives notice of such disqualification.

If employed after July 1, 1987, applicants for employment as a commercial motor vehicle operator must notify new employer of previous employment for the past ten (10) years including periods of unemployment.

I, THE UNDERSIGNED, HEREBY CERTIFY THAT I HAVE COMPLIED WITH THE PROVISIONS INDICATED ABOVE, AND THAT I NOW HOLD ONLY ONE VALID COMMERCIAL VEHICLE DRIVERS LICENSE, AS INDICATED BELOW. I FURTHER CERTIFY THAT ANY ADDITIONAL LICENSES I MAY HAVE POSSESSED, HAVE BEEN SURRENDERED TO THE STATE IN WHICH THEY WERE ISSUED. I FURTHER CERTIFY THAT I WILL NOTIFY MY EMPLOYER IMMEDIATELY IF I AM DISQUALIFIED AS A COMMERCIAL MOTOR VEHICLE OPERATOR FOR ANY REASON.

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List below any valid licenses to operate a motor vehicle, which you now hold
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Authorization
I authorize investigation of all statements contained in this application!or employment. I authorize a background investigation; and education institutions. law enforcement authorities, and any other organizations and individuals to release such Information and documents as deemed appropriate or necessary by Wooster Motor Ways. I understand that falsifications, omissions, or misstatements of information may result in refusal to hire, or if hired, dismissal from employment.I certify that I, the undersigned applicant, have personally completed this application.I agree thatWoosterMotor Ways, my previous employers, and all parties providing information shall not be held liable in any respect if any employment offer is not tendered, is withdrawn, or my employment is terminated due to falsifying the statements and answers in the application. Further, that I will be required as a condition of employment to agree to Wooster Motor Ways's dispute resolution procedure, including binding arbitration, to resolve any and all claims related to my employment, except as provided in a labor agreement or by law.
 
I understand that as a condition of employment.I will be required, prior to employment, to take and pass a controlled substances test. I understand that Company benefits and rules and regulations may be changed, modified, deleted, or added to by the Company at any time, at the Company's sole option and without any prior notice. Wooster MotorWays is an at-will employer, and I understand that my
employment may be terminated at any time with or without cause and with or without notice either at my option or the option of the Company. No employee agent or representative of Wooster Motor Ways has authority to enter into verbal agreement for employment. I understand that if I do not meet Company requirements. I may be subject to termination of employment.
 
In accordance with §391 .21 of the Federal Motor Carrier Safety Regulations, please note that all of your previous employers will be contacted for the purpose of investigating your safety performance history information as required by FMCSR §391.23 {d) and (e). Also note that you have the following rights regarding the investigative information provided to Wooster Motor Ways as specified in FMCSR §391.23 (i):
  • The right to review information provided by previous employers
  • 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
  • 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.
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.
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Employment verification release per FMCSR §397.23 and 49 CFR 40.25.

I hereby authorize the above named employer(s) to release all records of employment to Wooster Motor Ways for purposes of my application, including assessments of my job performance, ability, and fitness, including the dates of any and all alcohol or drug tests, with confirmed results, and/or my refusal to submit to any alcohol and drug tests and any rehabilitation completed under direction of a Substance Abuse Professional (SAP) and/or Medical Review Officer (MRO) to each and every company (or their authorized agents) making such request in connection with my application for employment with said company. I hereby release the above named company and its employees, officers, directors and agents from any and all liability of any type as a result of providing the following information to the below mentioned person and/or company.

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Acknowledgments & Authorization
I acknowledge that I have received and carefully read and understand the separate Disclosure and Authorization Regarding Background Investigation for Employment Purposes; and the separate Summary of Rights under the Fair Credit Reporting Act that have been provided to me by the Company. I also acknowledge receipt of and that I have carefully read and understand (as applicable), the separate California Disclosure and Summary of Rights under California Civil Code Section 1786.22; the separate New York Article 23-A; and the separate San Francisco Fair Chance Ordinance Official Notice that have been provided to me.
 
By my signature below, I authorize the preparation of background reports about me, including background reports that are Investigative consumer reports by H ireRight, and to the furnish ing of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment or engagement for services (including independent contractor or volunteer assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me or contracts for my services, my consent will apply, and the Company may, as allowed by law, obtain from HireRight (or from a consumer reporting agency other than HireRight) additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period.
 
I understand that if the Company obtains a credit report about me, then it will only do so where such information is substantially related to the duties and responsibilities of the position in which I am engaged or for which I am being evaluated.
 
I understand that information contained in my employment (or contractor or volunteer) application, or otherwise disclosed by me before or during my employment (or contract or volunteer assignment), if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing herein shall be construed as an offer of employment or contract for services.
 
I understand that the information included in the background reports may be obtained from private and public record sources, including without limitation and as appropriate: government agencies and courthouses; educational institutions; and employers. Accordingly, I hereby authorize all of the following, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all other federal, state and local government agencies and courts; educational institutions (public or private); testing agencies; information service bureaus; credit bureaus and other consumer reporting agencies; other public and private record/data repositories; motor vehicle records agencies; my employers; the military; and all other individuals and sources with any information about or concerning me. The information that can be disclosed to the consumer report ing agency and its agents includes, but is not limited to, information concerning my: employment and earnings history; education, credit, motor vehicle and accident history; drug/alcohol testing results and history; criminal history; litigation history; military service; professional licenses, credentials and certifications; social security number verification; address and alias history; and other information.
 
By my signature below, I also promise that the personal information I provide with this form or otherwise in connection with my background investigation is true, accurate and complete, and I understand that dishonesty or material omission may disqualify me from consideration for employment. I agree that a copy of this document in faxed, photocopied or electronic (including electronically signed) form will be valid like the signed original. I further acknowledge that I have received additional state law notices that I have reviewed and read.
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Additional State Law Notices
Please also note the following:
 
CALIFORNIA: Pursuant to section 1786.22 of the California Civil Code, you may view the file maintained on you by the consumer reporting agency during normal business hours. You may also obtain a copy of this file, upon submitting proper identification and paying the actual copying costs, by appearing at the consumer reporting agency's offices in person, during normal business hours and on reasonable notice, or by certified mail. You may also receive a summary of the file by telephone, upon submitting proper identification and written request. The consumer reporting agency has trained personnel available to explain your file to you, including any coded information, and will provide a written explanation of any coded
information contained in your file. If you appear in person, you may be accompanied by one other person, provided that person furnishes proper identification. Proper identification includes documents such as a valid driver's license. social security account number, military identification card, and credit cards. II you cannot identify yourself with such information, the consumer reporting agency may require additional information concerning your employment and personal or family history to verify your identity.
 
HireRight, LLC will prepare the background report for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761. Information about HireRight's privacy practices is available at www.hireriqht.com/Priyacy-Policy.aspx.
 
Additional California-specific information is set out below.
 
MASSACHUSETTS: Upon request to the Company, you have the right to know whether the Company requested an investigative consumer report about you and, upon written request to the Company, you have the right to receive a copy of any such report. You also have the right to ask the consumer reporting agency (e.g., HireRight) for a copy of any such report.
 
MINNESOTA: You have the right in most circumstances to submit a written request to the consumer reporting agency (e.g., HireRight) for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The consumer reporting agency must provide you with this disclosure within 5 days after (i) its receipt of your request or (ii) the date the report was requested by the Company, whichever date is later.
 
NEW JERSEY: You have the right to submit a request to the consumer reporting agency (e.g., HireRight) for a copy of any investigative consumer report the Company requested about you.
 
NEW YORK: You have the right, upon written request to the Company, to be informed of whether or not the company requested a consumer report or an investigative consumer report about you. Shown above is the address and telephone number for HireRight, the consumer reporting agency used by the Company. You may inspect and receive a copy of any such report by contacting that consumer reporting agency. A copy of Article 23-A of the New York Correction Law is also provided below.
 
WASHINGTON STATE: If the Company requests an investigative consumer report, you have the right, upon written request made to the Company Within a reasonable period of time after your receipt of this disclosure, to receive from the Company a complete and accurate disclosure of the nature and scope of the investigation requested by the Company. You are entitled to this disclosure within 5 days after the date your request is received or the Company ordered the report, whichever is later. You also have the right to request a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.
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DISCLOSURE AND AUTHORIZATION REGARDING BACKGROUND INVESTIGATION FOR EMPLOYMENT PURPOSES
Disclosure
 
WOOSTER MOTOR WAYS (the "Company") may request from a consumer reporting agency and for employment -related purposes, a "consumer report(s)" (commonly known as "background reports") containing background information about you in connection with you r employment, or application for employment, or engagement for services (including independent contractor or volunteer assignment s, as applicable).
 
HireRight, LLC ("HireRight") will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612,(800) 400-2761.www.hireriqht.com.
 
The background report(s) may contain information concerning your character, general reputation, personal characteristics, mode of living, or credit standing. The types of background information that may be obtained include, but are not limited to: criminal history; litigation history; motor vehicle record and accident history; social security number verification; address and alias history; credit history; verification of your education, employment and earnings history; professional licensing, credential and certification checks; drug/alcohol testing results and history; military service; and other information.
 
Authorization
 
I hereby authorize Wooster Motor Ways to obtain the consumer reports described above about me.
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IMPORTANT DISCLOSURE REGARDING BACKGRO UND REPORTS FROM THE PSP Online Service
In connection with your application for employment with Wooster Motor Ways ("Prospective Employer'1, Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspect ion 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 FMC SA 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 electron ic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA : the name, address, and t he toll free telephone number of FMCSA; that t he 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 Employe r 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:1/dataqs.trncsa.dot.gov. ti 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.
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AUTHORIZATION
If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:
 
I authorize Wooster Motor Ways ("Prospective Employe") to access the FMCSA Pre-Employment Screen ing Prog ram (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.
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Acknowledgement
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