Company Driver Application

We are excited to see you begin your partnership with us here at NYB Ventures Group Inc and look forward to providing you with a safe, friendly and professional work environment. To finalize the On-Boarding process, please be sure to click the link and fill out the attached application, please be sure to upload the necessary documents as well!

First Name *

Last Name *

Date Of Birth *

Social Security *

Phone Number *

Email *

License Number *

License State *

Address *

Have you lived here less than 3 years? *YesNo

Please Provide Your Previous Address *

Do you have a class A CDL?YesNo

Upload a picture of your CDL

No file chosen

Is your Class A CDL older than 2yrs? *YesNo

Have you had any moving violations in the past 3 years? *YesNo

How many days are you willing to be on the road? *

List your CDL Endorsements if any.

Have you ever been denied a license, permit or privilege to operate a motor vehicle? *YesNo

Has any license, permit or privilege ever been suspended or revoked? *YesNo

Have you had any accidents in the last 5years? *YesNo

Employment History

Please list current or most recent employer first

Field Group

While employed here were you subjected to FMCSRS? *YesNo

Was your job designated as a safety-sensitive function in DOT-Regulated mode subject to drug & alcohol testing requirements of 49CFR part 40? *YesNo

Date

Employer Address

Employer Phone

Position Held

Reason for leaving

If this was a driving position what type of truck(s) did you operate?

How many Years of tractor trailer experience do you have? *

What types of equipment do you have experience with?

AGREEMENTS AND POLICIES

To Be Read and Agreed by Applicant

Date *

DRIVER'S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23

Motor carriers have the responsibility to make the following investigations and inquiries with respect to each Driver employed, other than a person who has been a regularly employed driver of the motor carrier for a continuous period which began before January 1, 1971.

(a) An inquiry into the driver's driving record during the preceding three years of to the appropriate agency of every State in which the driver held a motor vehicle operator's license or permit during those three years; (a)(2) An investigation of the driver's employment record during the preceding three years.
(b) A copy of the drivers record(s) obtained in response to State driver record agency as required must be in the Driver Qualification file within 30 days date the driver's employment begins and be retained in compliance with 391.51.
(c) Replies to the investigations of the driver's safety performance history must be placed in the Driver Investigation History file within 30 days of the date the driver's employment begins. This goes into effect after October 29, 2004.
(d) Prospective motor carrier must investigate the information from all previous employers of the applicant that employed the driver to operate a CMV within the previous three years. This information must cover general driver identification and employment verification information, data elements as specified in 390.15 for accident involving the driver that occurred in the three-year period preceding the date of employment application, and any accidents the previous employer may wish to provide.
(e) Prospective motor carrier must investigate the information from all previous DOT regulated employers that employed the driver within the previous three years from the date of the employment application in a safety-sensitive function that required alcohol and controlled substance testing specified by 49 CFR Part 40.

Divers have the following rights:

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, previous employer and the driver cannot agree on the accuracy of the information.

Drivers who wish to review previous employer-provided investigative information must submit a written request to the prospective employer when applying or as late as 30 days after employed or being of denial of employment. The prospective employer must provide this information to applicant five days of receiving the written request. If the driver has not arranged to pick up or receive the records within 30 days of the prospective employer making them available, the prospective motor carrier may consider driver to have waived request to review the records. Drivers wishing to request correction of erroneous information in must send request for the correction to the previous employer that provided records.

After October 29, 20(M, the previous employer must either correct and forward the information to the prospective motor carrier employer or notify the driver within 15 days of receiving the driver's request to correct the data that it does not agree to correct the data. Drivers wishing to rebut information in records must send the rebuttal to the previous employer with instruction to include the rebuttal in the driver's Safety Performance History.

I acknowledge that I have read and understand the contents of this document Drivers.

Date *

Driver's Name *

Hold Harmless Covenant For Worker's Compensation

To: 8601 Six Forks Rd Unit 400 Raleigh, NC 27615, USA

Date

Print Name *

Employment History

AGREEMENTS AND POLICIES

DRIVER'S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23

Hold Harmless Covenant For Worker's Compensation

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