Online Application Form – LoadEx

Thank you for your interest in LoadEx. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

To fill out this form, you will need to know the following:

Home address history for the past 3 years
SSN
Current driver license number and driver license history for the past 3 years
Employment history up to 10 years
History of traffic accidents, violations and/or convictions from the last 3 years (including DUI or reckless driving conviction and license suspension)
Military history (if applicable)

Required entry fields are followed by *, meaning you must provide the requested information to continue. If you encounter any errors during this process and cannot continue, please contact us at 919-355-6030, or 917-710-7950.

Requirements

To qualify with LoadEx, you must meet the following criteria:

CDL, Social Security Card, Medical Card
Current driver license number and drivers license history for the past 3 years
Employment history up to 10 years
History of traffic accidents, violations and/or convictions from the last 5 years (including DUI or reckless driving convictions and license suspensions)
Criminal history
Truck and trailer information if applicable
Must have Class "A" CDL.
Must be at least 23 years of age.
One (1) year verifiable OTR or regional tractor-trailer experience within the past three (3) years with a Class "A" CDL.
No DUI, DWI, Reckless Driving, Careless Driving or Negligent Driving within the past five (5) years, no more that one (1) total and NEVER in a commercial vehicle.
No more that three (3) moving violations within the past three (3) years and no more than two (2) within the past one (1) year.
No more than one (1) serious violation within the past three (3) years. No more than three (3) serious violations total.
No more than three (3) preventable accidents within the past three (3) years and no more than one (1) within the past one (1) year.
No positive drug or alcohol test results including refusals and pre-employment results.

Personal Information

Prefix

First Name *

Middle Name

Last Name *

SSN / SIN *0 / 9

Date of Birth (mm/dd/yyyy) * *

Address

Street Address *

Apartment, suite, etc

City

State

ZIP / Postal Code

Country

Contact

Phone

Email Address *

Confirm Email Address *

What position are you applying for?

If you answered "Owner Operator" or "Fleet Owner", select yes. *YesNo

Are you legally eligible for employment in the United States? *YesNo

Are you currently employed?YesNo

Do you read, write, and speak English?YesNo

Have you ever worked for this company before?YesNo

Do you have a current TWIC card?YesNo

Please enter the names of any relatives employed here:

Have you ever been known by any other name?YesNo

How did you hear about us?

If "Driver Referral", please enter the driver's name

If "Other", please explain

In case of Emergency, notify (list name, address, and phone):

Driving Experience

For each class of equipment, enter type of equipment (van, reefer, tank, etc.), start and end dates, and approximate number of total miles. If no experience in a class, enter "NONE".

Straight Truck *

Tractor and Semi-Trailer

Tractor - Two Trailers

Other *

Which safe driving awards do you hold and from whom?

Education

List highest grade completed:

List last school attended (name, city, and state):

Personal References

List name, address, city, state, phone number, and relationship:

First Reference:

Second Reference:

License Details

License Number *

Country

If you selected Other, please write the name of the country

License State/Province *

License Expiration

Physical Expiration

Is this your current driver license?YesNo

Is this a commercial driver license?YesNo

License Class

Hazmat expiration date:

Were you ever in the U.S. military?YesNo

Have you been employed, contracted, or attended a company orientation in the last 3 years? *YesNo

Have you attended a driver training school? *YesNo

Driver Training

Start Date

End Date

(If you are currently in school, please enter today's date)

School name

Street Address

City

State/Province

ZIP / Postal Code

Country

Did you graduate?YesNo

Were you subject to the Federal Motor Carrier or Transport Canada Safety Regulations while attending this truck school?YesNo

Did you perform any safety sensitive functions at this truck school, regulated by DOT, and subject to drug and alcohol testing?YesNo

GPA

Hours of Instruction

Which of the following skills were trained in your program? (Select all that apply)

Border CrossingLog BooksFederal Motor Carrier RegulationsHazardous Materials

Education Information

Have you attended a school (not related to truck driving) in the last 3 years?YesNo

School name

Start Date

End Date

City

State/Province

Country

School's Phone

What did you study? (accounting, mechanic, etc.)

Graduation Date (leave blank if no graduation)

Have you been unemployed at any time within the last 3 years?YesNo

Unemployment Information

Start Date

End Date

Comments

FMCSR

1. Under FMCSR 391.15, are you currently disqualified from driving a commercial motor vehicle? [49 CFR 391.15]YesNo

Please provide additional detail:

2. Has your license, permit, or privilege to drive ever been suspended or revoked for any reason? [49 CFR 391.21(b)(9)]YesNo

Please provide additional detail, including the dates of the suspension(s)/revocation(s):

3. Have you ever been denied a license, permit, or privilege to operate a motor vehicle?[49 CFR 391.21(b)(9)]YesNo

Please provide additional detail, including relevant dates:

4. Within the past two years, have you tested positive, or refused to test, on a pre-employment drug or alcohol test by an employer to whom you applied, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules? [49 CFR 40.25(j)]YesNo

Please provide additional detail about what happened:

Date of last positive or refusal:

5. In the past three (3) years, have you ever been convicted of any of the following offenses committed during on-duty time [49 C.F.R. 391.15 and 49 C.F.R. 395.2]:YesNo

Driving a commercial motor vehicle with a blood alcohol concentration ("BAC") of .04 percent or more
Driving under the influence of alcohol, as prescribed by state law
Refusal to undergo drug and alcohol testing as required by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations
Driving a commercial motor vehicle under the influence of any21 C.F.R. 1308.11 Schedule I identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug
Transportation, possession, or unlawful use of a 21 C.F.R. 1308.11 Schedule I identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while you were on duty driving for a motor carrier
Leaving the scene of an accident while operating a commercial motor vehicle
Or any other felony involving the use of a commercial motor vehicle

In the three years before the conviction you identified above, had you been convicted on a separate occasion of either the same offense or one of the other offenses listed above? [49 C.F.R. 391.15(c)(3)]YesNo

Date of most recent conviction identified above:

Please provide additional detail on each conviction for which you answered "Yes" above:

Incident Details

Have you had any moving violations or traffic convictions in the past 3 Years?YesNo

Violation Date

Charge / Description:

State/Province

Were you in a Commercial Vehicle?YesNo

Fine Amount (if applicable)

Comments if you answered "Other" to any question, please provide additional detail:

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?YesNo

Accident Details

Please enter detailed information about this accident below, whether the accident was chargeable, recordable, reportable, or your fault:

Date of Accident / Incident

Type of Accident / Incident

Hazmat Accident / IncidentYesNo

Was the vehicle towed away?YesNo

City

State/Province

Were you in a commercial vehicle?YesNo

If yes, was this a Department of Transportation recordable accident?YesNo

Were you at fault?YesNo

Please enter detailed information about this accident, whether the accident was chargeable, recordable, reportable, or your fault

CDL License

Medical Card

Confirmation

Type Your Name

A Summary of Your Rights Under the Fair Credit Reporting Act

IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with H&D Trucking Corp ("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 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 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 H&D Trucking Corp ("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 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.

DISCLOSURE FOR CONSUMER REPORTS

In connection with my application for employment (including contract) with Voyager Nation Inc, I understand consumer reports will be requested by Voyager Nation Inc ("Company"). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, education, accidents, licensure, credit, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, CDLIS, workers' compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies that maintain such records. In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained. If I am hired (or contracted), I understand that Company can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment or contract period.

AUTHORIZATION FOR CONSUMER REPORTS

I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment or contract period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information.

This authorization is conditioned upon the following representations of my rights:

I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request (California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 3180 Mulford Rd, Mulberry, FL 33860, 630-568-5911 to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.

Agency Contact Information:

HireRight
Attn: Consumers Department
14002 E. 21st Street, Suite 1200
Tulsa, OK 74134
(800) 381-0645
http://www.hireright.com/applicants

iiX
1716 Briarcrest Drive
Suite 200
Bryan, TX 77802
(866) 560-7015

Asurint
Compliance Dept
PO Box 14730
Cleveland, Ohio 44114
800-906-2034
Email: compliance@asurint.com

Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
(877) 219-9283
support@tenstreet.com

As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me.

I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, (206) 464-7744.

EMPLOYMENT / CONTRACTOR VERIFICATION ACKNOWLEDGEMENT AND RELEASE

I hereby authorize my previous employers and trucking schools for the past three years to release and forward to H&D Trucking Corp ("Company") all information regarding my:

1. Record of Alcohol and Controlled Substance Testing/Training, in accordance with Parts 382 and 40 of the Federal Motor Carrier Safety Regulations (49 CFR Part 382 and 49 CFR Part 40, Section 40.25.). I understand that information to be released by my previous employer(s) is limited to the following DOT-regulated testing items: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested; (iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation.

2. Record of safety performance history, including employment dates, work history and accidents, in accordance with Part 391 of the Federal Motor Carrier Safety Regulations (49 CFR Part 391).

To Be Read And Signed By Applicant For Independent Contractor or Driver Qualification

It is understood that the information in this Authorization to Release Information form will be used and that prior employers and trucking schools will be contacted for purposes of investigation as required by Section 391.23 of the Motor Carrier Safety Regulations.

It is agreed and understood that Company 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 prior employers and all others named from all liability for any damages on account of furnishing such information.

It is further understood an investigative report may be made whereby information is obtained through personal interviews with third parties, such as family members, business associates, financial sources, friends, neighbors, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living, whichever may be applicable.

Per Section 391.23(i)(1) of the Federal Motor Carrier Safety Regulations:

1. You have the right to make a written request, within 30 days of qualification or notice of denial, for any information provided by previous employers and trucking schools.

2. You have the right to have errors in the information corrected by the previous employer and for that employer or trucking school to re-send the corrected information.

3. You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer or trucking school and you cannot agree on the accuracy of the information.