Owner Operator Driving and Equipment Lease Agreement by fom79730

VIEWS: 152 PAGES: 13

Owner Operator Driving and Equipment Lease Agreement document sample

More Info
									OWNER OPERATOR VITAL INFORMATION SHEET
                     Owner Operator Vital information Sheet

Applicant Name_________________________________________
Date of Application______________________________________

                             Continuum Transportation Services, LTD.
                            4500 Lee Rd, Suite 138, Cleveland, Oh 44128

Qualified applicants are considered for driving positions as owner operators and drivers for owner operators. I understand
that the position is as an independent contractor, not an employee of Continuum Transportation Services, LTD. In
compliance with applicable law and regulation, qualified applicants are considered without regard to race, color, religion,
sex, national origin, age, marital status, veteran status, non job related disability or other protected group status.



                                      To Be Read and Signed by Applicant

I authorize Continuum Transportation Services, LTD. And any of its employees, agents or contractors, to make such
investigations and inquiring of my personal employment , financial or medical history, any related matters as may be
necessary or required in determining whether to qualify me as a driver for Continuum transportation. I hereby release
Continuum Transportation Services, LTD. As well as my current and former employers, schools (including technical
schools and professional training schools), health care providers and any other persons from any and all liability arising
out of or related to responding to inquiries from Continuum Transportation and releasing any information to Continuum
Transportation in connection with my application.

In the event that Continuum Transportation Services, LTD. qualifies me, I recognize and acknowledge that any false or
misleading information I provide in this application may result in Continuum Transportation terminating my contract as an
owner operator. I also recognize and acknowledge that I am required to abide by all provisions of the equipment lease
agreement between Continuum Transportation and the owner of the vehicle, and my failure to abide by the provisions
may result in termination of our business relationship.

I understand that the information I provide in this application regarding current and/or previous employers may be used
and those employer(s) will be contacted for the purpose, in part, of investigating my safety performance history as
required by 49 CFR 391.23 (d) and (e). I understand that I have a right to (1) review information provided by the previous
employers, (2) have errors in the information corrected by previous employers, (3) have the previous employer forward
corrected information to the prospective employer and (4) have a rebuttal statement attached to the allegedly erroneous
information if the previous employer and I cannot agree on the accuracy of the information.


Driver Signature________________________________




                            For Continuum Transportation Services, LTD. use only



____ Applicant Accepted                  ____Applicant Rejected                    ____Owner Operator

Start Date:_____/_______/_______                _____Driver Termination Date:____/_____/_____



                               Continuum Transportation Services, LTD.
                                                   4500 Lee Rd. Suite 138, Cleveland, Oh 44128




                                                              Applicant to Complete
                                                              (Answer all questions, Please print)

Position applied for_____________________________________________________________________

Last Name____________________________First_________________________Middle_____________

Social Security_________-__________-__________
List your Addresses of residency for the past 3 years
Current Address

Street____________________________________________City_________________________________

State____________Zip_______________Phone___________________How long?__________________

Previous Address

Street____________________________________________City_________________________________

State____________Zip_______________Phone___________________How long?__________________

Street____________________________________________City_________________________________

State____________Zip_______________Phone___________________How long?__________________



Emergency Contact_____________________________________________________________________

Name________________________Relationship________________________Phone_________________



Do you have the legal right to work in the United States?______________________________________

Date of Birth_______/________/________ Can you provide proof of age_________________________

Have you worked for Continuum Before?______________ Where?_____________________________

Dates: From:__________ To:________Rate of Pay_________ Position___________________________

Reason for leaving______________________________________________________________________

Are you now employed?________ If not, how long since your last employment____________________

Who referred you?______________________ Rate of pay expected_____________________________

Have you ever been bonded?______________Name of bonding company________________________

Have you ever been convicted of a felony?__________________________________________________
(If yes, please explain fully on a separate sheet of paper. Conviction of a crime is not an automatic bar to employment-all circumstances will be considered)

Is there any reason you might be unable to perform the functions of the job for which you have applied?______________
If yes, explain if you wish________________________________________________________________


                                               Continuum Transportation Services, LTD.
                                                        EMPLOYMENT HISTORY
All driver applicants to drive interstate commerce must provide the following information on all employers during the preceding 10
years. List complete mailing address, street number, city, state, and zip code.
(NOTE: List employers in reverse order starting with the most recent. Add another sheet if necessary.)



                                                            10 Year Employment History


                                            EMPLOYER                                            DATE
            NAME                                                                                FROM:           TO:
            ADDRESS                                                                             POSITION HELD
            CITY                                                                                WAGE
            STATE                             ZIP                                               REASON FOR LEAVING
            CONTACT PERSON
            PHONE NUMBER



                                            EMPLOYER                                            DATE
            NAME                                                                                FROM:           TO:
            ADDRESS                                                                             POSITION HELD
            CITY                                                                                WAGE
            STATE                             ZIP                                               REASON FOR LEAVING
            CONTACT PERSON
            PHONE NUMBER



                                            EMPLOYER                                            DATE
            NAME                                                                                FROM:           TO:
            ADDRESS                                                                             POSITION HELD
            CITY                                                                                WAGE
            STATE                             ZIP                                               REASON FOR LEAVING
            CONTACT PERSON
            PHONE NUMBER



                                            EMPLOYER                                            DATE
            NAME                                                                                FROM:           TO:
            ADDRESS                                                                             POSITION HELD
            CITY                                                                                WAGE
            STATE                             ZIP                                               REASON FOR LEAVING
            CONTACT PERSON
            PHONE NUMBER
                    10 Year Employment History (continued)


                 EMPLOYER                     DATE
NAME                                          FROM:           TO:
ADDRESS                                       POSITION HELD
CITY                                          WAGE
STATE             ZIP                         REASON FOR LEAVING
CONTACT PERSON
PHONE NUMBER



                 EMPLOYER                     DATE
NAME                                          FROM:           TO:
ADDRESS                                       POSITION HELD
CITY                                          WAGE
STATE             ZIP                         REASON FOR LEAVING
CONTACT PERSON
PHONE NUMBER



                 EMPLOYER                     DATE
NAME                                          FROM:           TO:
ADDRESS                                       POSITION HELD
CITY                                          WAGE
STATE             ZIP                         REASON FOR LEAVING
CONTACT PERSON
PHONE NUMBER



                 EMPLOYER                     DATE
NAME                                          FROM:           TO:
ADDRESS                                       POSITION HELD
CITY                                          WAGE
STATE             ZIP                         REASON FOR LEAVING
CONTACT PERSON
PHONE NUMBER



                 EMPLOYER                     DATE
NAME                                          FROM:           TO:
ADDRESS                                       POSITION HELD
CITY                                          WAGE
STATE             ZIP                         REASON FOR LEAVING
CONTACT PERSON
PHONE NUMBER
                       ACCIDENT RECORD AND FORFEITURES FOR THE PAST
                                         3 YEARS

               NATURE OF ACCIDENT(HEAD-ON, REAR-                                                      HAZ-MAT
    DATES      END,ETC.)                                                FATALITIES        INJURIES    SPILLS
    LAST

    PREVIOUS

    PREVIOUS




       TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS(OTHER THAN PARKING VIOLATIONS) IF NONE
       WRITE NONE
       DATE            LOCATION                                                     CHARGE           PENALTY




                       (ATTACH SHEET IF MORE SPACE IS NEEDED)


                             EXPERIENCE AND QUALIFICATION – DRIVER
                                (LIST ALL LICENSES OR PERMITS HELD IN THE PAST 3 YEARS)


                        STATE          LICENSE NUMBER                    TYPE                Expiration Date



            DRIVER



            LICENSES




     A. HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT OR PRIVELEGE TO OPERATE A MOTOR
         VEHICLE?              YES__________ NO___________
     B. HAS ANY LICENSE, PERMIT OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED?
                                YES__________ NO___________
If the answer to either A or B is Yes, give details_____________________________________________
 ______________________________________________________________________________________

______________________________________________________________________________________
                                                 DRIVING EXPERIENCE

                                                                                                             APPROX# OF
     CLASS OF EQUIPMENT                              TYPE OF EQUIPMENT             DATES                     MILES
                                         YES   NO                                  TO           FROM
     STRAIGHT TRUCK                                  VAN/CONTAINER/FLAT/DUMP
     TRACTOR & SEMI-TRAILER                          VAN/CONTAINER/FLAT/DUMP
     TRACTOR & TWO TRAILERS                          VAN/CONTAINER/FLAT/DUMP
     TRACTOR & THREE
     TRAILERS                                        VAN/CONTAINER/FLAT/DUMP
     MOTORCOACH/SCHOOL
     BUS
     OTHER

LIST STATES OPERATED IN FOR THE LAST 5 YEARS: _________________________________
______________________________________________________________________________________

LIST SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER:
______________________________________________________________________________________

WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM: ___________________




                                  EXPERIENCE & QUALIFICATIONS – OTHER

SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP YOU WORK FOR THIS
COMPANY ______________________________________________________________________________________

______________________________________________________________________________________

LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION.
_______________________________________________________________________



LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH. ______


                                                        EDUCATION
CIRCLE HIGHEST GRADE COMPLETED: 1 2 3 4 5 6 7 8           HIGH SCHOOL: 1 2 3 4          COLLEGE: 1 2 3 4

LAST SCHOOL ATTENDED (NAME)_______________________(CITY,STATE)_________________________

                                   TO BE READ AND SIGNED BY APPLICANT
This certifies that this application was completed by me, and that all entries on it and information in it are truthful and
complete to the best of my knowledge.


Signature:_____________________________________________ Date:___________________________
                SAFETY PERFORMANCE HISTORY RECORDS REQUEST
SECTION 1:                                  ...   TO BE COMPLETED BY PROSPECTIVE APPLICANT...
 I, (print name) ________________________________________________                                                    ____________________
                                                                                                                     Social Security Number
                                  First, M.I. Last
                                                                                                                              ___________
                                                                                                                              Date of Birth


HEREBY AUTHORIZE

Previous Employer: _____________________________________________________________ _

Email: _______________

Street:______________________________________________________________

Tele#: _______________
City, State, Zip _____________________ ___________________________________________________________Fax #:
To release and forward the information requested by section 3 of this document concerning my Alcohol and Controlled Substances Testing records
within the previous 3 years from ____________________________ _
                                        (date of this application)
To:
 Continuum Transportation Services, LTD.                                        In compliance with Section 40.25 and 391.23(h), release of this information
 Attn: Safety Department / Driver Qualification                                 must be made in a written form that ensures confidentiality, such as fax,
 4500 Lee Rd. Suite 138                                                         email or letter.
 Cleveland, Ohio 44128

 P-216-518-4000
 F-216-518-4030




                                         _________________________________________
                                         Applicants Signature
This information is being requested in compliance with Section 40.25 and Section 391.23

SECTION 2:                                        …TO   BE COMPLETED BY PREVIOUS EMPLOYER...
The applicant named above was employed by us. Employed as
from (m/y) __________________________________ to (m/y) _________________________ _
 1. Did he/she drive motor vehicles for you? (yes) (no) If yes, what type? Straight truck(__) Tractor-semi trailer (__) Bus (__ ) Cargo Tank(__)
     Doubles/Triples (__) Other: __________                                                                                             -
2. Reason for leaving your company: Discharged (__) Resignation (__) Layoff (__) Military Duty (__) If there IS no
safety performance history to report, check here (__), sign below and return.

Accidents: Complete the following for any accidents inc1uded on your accident register (section 390.I5(b) that involved the applicant in the 3 years prior to the
application date shown above, or check here ( ) If there IS no accident register date for this driver.
       Date                                          Location                                No. Injuries          No. Fatalities       Hazmat Spill

1. _____________________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________________

3. _____________________________________________________________________________________________________________________
Please provide information concerning any other accidents involving the Applicant that were reported to government agencies or insures or retained under internal
policies:
___________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________
Any other remarks:
___________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Signature: ______________________________________________________ Date _______/________/_______

Title:___________________________________________________________
SECTION 3:                                     …TO BE COMPLETED BY PREVIOUS EMPLOYER…
                                                           DRUG & ALCOHOL HISTORY
      If the driver was not subject to Department of Transportation testing requirements while employed by this employer, please check here (_), fill in

the dates of employment from __________                       to_________________ , complete bottom of Section 3, sign, and retum.
1.    Has this person had an alcohol test with a result of 0.04 or higher alcohol concentration?                                                 YES       NO
2.    Has this person tested positive or adulterated or substituted a test specimen for controlled substances?                                   (     )   (   )
3.    Has this person refused to submit to a post-accident, random, reasonable suspicion, or follow-up alcohol or controlled sub-                (     )   (   )
      stance test?
4.    Has this person committed other violations of Subpart B of Part 382, or Part 40?                                                           (   )     (   )

5.    If this person has violated a DOT drug and alcohol regulation, did this person complete a SAP prescribed rehabilitation                    (     )   (   )
      program in your employ, including return-to-duty and follow-up tests? If yes, please send documentation back with this
      form.
6.    For a driver who successfully completed a SAP's rehabilitation referral and remained in your employ, did this driver                       (     )   (   )
      subsequently have an alcohol test result of 0.04 or greater, a verified positive drug test, or refuse to be tested?
In answering these questions, include any required DOT drug or alcohol testing information obtained from prior previous em-
ployers in the previous 3 years prior to the application date shown on page 1
Name:

Company: __________________________ __________________________________________________________________________

Street: _____________________________ ________________________________

City, State, Zip: _____________________                                                                                     Tele #: __________

Section Completed by: ________________                                                                                      Date: __________
                    (signature)

SECTION 4a:                                         ... TO BE COMPLETED BY Continuum Transportation Services, LTD.…

This form was (check one) (__) Faxed to previous employer (__) Mailed (__)Emailed) (__)Other: _________________________________
By: __________________________________________________________________________________Date: _______________________________ _
SECTION 4b:                                         … TO BE COMPLETED BY Continuum Transportation Services, LTD....

Complete below when information is obtained. Information received from: _____________________________________________________________
Recorded by: _________________________________________________

Date: __________________________
                                                                                           METHOD ( ) Fax ( ) Mail ( ) Email ( ) Telephone ( ) Other

                                                                                           If Other, Please explain: _________________________________

     ..INSTRUCTIONS TO COMPLETE THE SAFETY PERFORMANCE HISTORY RECORDS REQUEST …
 SECTION 1: Prospective Applicant                                                        SECTION 2: Previous Employer
     •   Complete the information required in this section                                   •   Complete the information required in this section
     •   Sign and date the form                                                              •   Sign and Date the form
     •   Submit to Continuum Transportation Services, LTD.                                   •   Complete Section 3

 SECTION 3: Previous Employer                                                            SECTION 4a: Continuum Transportation Services, LTD.
     •   Complete the information required in this section                                   •   Complete the information & send to previous employer
     •   Sign and Date the form
     •   Return form to Continuum Transportation Services, LTD.                          SECTION 4b: Continuum Transportation Services, LTD.
                                                                                             •   Record receipt of information and retain file the form

                                                          Continuum-Safety Dept
                      Request for Check of Driving Record
I hereby authorize you to release the following information to Continuum Transportation Services, LTD for purposes of
investigation as required by Section 391.23 of the FMCSR. You are released from any and all liability which may result
from furnishing such information.

                          _____________________________/___/_____
                          Applicants Signature         Date


In accordance with the provisions of Section 604 and 607 of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II,
Subtitle 0, Chapter I, of Public Law 104-208),1 hereby certify the following:
       I.    The applicant has authorized in writing the procurement of this report;
       2.    The applicant has been informed in a separate written disclosure that a consumer report may be obtained for driver qualification purposes;
       3.    The information requested below will be used for a "permissible purpose" (i.e., information for qualification purposes) and will be used for no other purpose;
       4.    The information being obtained will not be used in violation of any federal or state equal opportunity law or regulation; and
       5.    Before taking an adverse action based in whole or in part on the report, the applicant will receive a copy of the requested report and the summary of consumer rights as
             provided with the report by the consumer reporting agency.
I also hereby certify that this report request and the above applicant's release notice meet the definition of "permissible uses" of state motor vehicle records under the provisions of the
Driver's Privacy Protection Act of 1994 (Public Law 103-322, Title XXX, Section 300002(a».

                                       __________________
                                                                                            __/___/_____
                          Applicants Signature                                              Date

TO:
_________________________________________________________________________________________________________
_______________________________________________________________________________________
To Whom It Man Concern:
The following named person has made application with our company for the position of INDEPENDENT
CONTRACTOR/TRUCK DRIVER. As in accordance with Section 391.23 of the FMCSR, please furnish the undersigned with
the applicant's record for the past three years.

NAME OF APPLICANT: _____________________________________________________________________

ADDRESS: ________________________________________________________________________________

CITY/STATE: ________________________________________

Date of Birth: _____/______/_____

Social Security #: ______-_____-________

CDL#: _____________
____________ STATE _____________________ _
REQUESTED BY
                                                                                                     Name: ____________________________
                Continuum Transportation Services, LTD.
                                4500 Lee Rd. suite 138                                               Title: _____________________________
                               Cleveland, Ohio 44128                                                 Signature: _________________________
                                ANNUAL REVIEW of DRIVING RECORD

DRIVER NAME-________________________________________________________________________________
DRIVER ADRESS-______________________________________________________________________________
CITY-_________________________ STATE-____________________ZIP-________________________________
SOCIAL SECURITY # -_______________________________
START DATE-_______________________________________

INSTRUCTIONS TO CARRIER: Review the driving record of the truck driver/independent contractor in accordance with Section
391.25 and as outlined below. Complete the Certificate of Review as listed. Any remarks may be shown on the reverse side.

         In accordance with the Department of Transportation's Section 391.25 a motor carrier shall, at least once every 12 months,
review the driving record of each driver to determine whether that driver meets minimum requirements for safe driving or is
disqualified to drive a motor vehicle pursuant to Section 391.15.

         In reviewing a driving record, the motor carrier must consider any evidence that the driver has violated applicable
provisions of the Federal Motor Carrier Safety Regulations and the Hazardous Materials Regulations. The motor carrier must also
consider the driver's accident record and any evidence that the driver has violated laws governing the operation of motor vehicles,
and must give great weight to violations, such as speeding, reckless driving, and operating while under the influence of alcohol or
drugs, that indicate that the driver has exhibited a disregard for the safety of the public.


                                           CERTIFICATE OF REVIEW


I have hereby reviewed the driving record of the above named driver in accordance with Section 391.25 and find them: (Check
One)

__________
 Date           Name of Person Reviewing                                    Meets Minimum             Is Disqualified to Drive a
                                                                          Requirements for Safe       Motor Vehicle per 391.15
                                                                                Driving




                    REMARKS TO BE MADE ON REVERSE SIDE CONCERNING DISQUALIFICATION




                                        Continuum Transportation Services, LTD.
                                                   Cleveland, Ohio
                        UBSTANCE ABUSE COMPANY POLICY
                             STATEMENT OF POLICY
       Continuum Transportation Services, LTD (hereinafter referred to as “Company”), because it is in the transportation business,
       has a compelling interest to eliminate the use of drugs and alcohol from its workplace. Since December 21st, 1989 for illegal
       drugs and January 1st, 1996 for alcohol, the company has a legal duty to prohibit employees who abuse these substances from
       working. This legal duty arises from the Department of Transportation regulations, specifically 49 CFR parts 382 and 391 and
       49 CFR part 40. These employees are the Company’s employee drivers and independent contract drivers under contract with
       the Company for 90 days or more in any period of 365 days. These employees and independent contractors shall hereinafter be
       referred to as “drivers”.

       Illegal drug use, drug abuse and alcohol abuse jeopardizes the health and safety of the user, the user’s fellow drivers and the
       safety of the general public. A truck driver who uses or abuses drugs or alcohol is more likely to become involved in serious
       accidents. Thus, drug and alcohol abuse directly or indirectly increases absenteeism and reduces productivity. The adverse
       effects of illegal drug use, drug abuse and alcohol abuse result in increased insurance premiums. Finally, this company owes
       an obligation to its customers to handle their cargo safely, efficiently and on schedule, and drug and alcohol abuse undermines
       the accomplishment of this goal.

       While the Company has no intention of intruding into private lives, drivers are expected to be in condition to perform their
       duties throughout their workday. The Company recognizes that driver involvement with alcohol and drugs, off-the-job as well
       as on-the-job can have an impact on the workplace and on our ability to accomplish or goal of a work environment free from
       the effects of \alcohol and drug abuse.

       We have developed a substance abuse policy to help us combat illegal drug use, drug abuse and alcohol abuse in the
       workplace. This plan calls for administering urine/drug tests and alcohol breath tests to our drivers and drug tests to job
       applicants and to eliminate from our work force those drivers who abuse these substances. Equally important is our
       commitment to preserve the privacy and personal dignity of each driver and applicant as the Company reaches its goal of a
       drug and alcohol free workplace.

       The Company’s substance abuse policy is, specifically, as follows:

       USE PROHIBITED

       No driver will use alcohol or a Schedule 1 drug of the schedule of Controlled Substances of the Drug Enforcement Agency or
       an amphetamine, narcotic or any other habit forming drug except where permitted by the Federal Motor Carrier Safety
Regulations. The schedule of drugs includes opiates, opium derivatives, hallucinogenic substances, depressants, and stimulants. This
means that the driver shall not consume any controlled substances while off duty or on duty or alcohol while on-duty. No driver shall
perform a safety sensitive function within four (4) hours after using alcohol. Any violation of the policy may result in discharge.

IMPAIRMENT PROHIBITED

No driver will report for work or will drive while impaired by any drug, controlled substance or alcohol. A driver may use a substance
administered by or under the instructions of a physician who has advised the driver that the substance will not affect the driver’s
ability to safely operate a motor vehicle. Impaired means under the influence of a substance such that the driver’s senses (i.e. sight,
hearing, balance, and reaction, reflex) judgment either are or may be presumed affected. Any violation of the policy may result in
discharge.

POSSESSION PROHIBITED

No driver at any work site will possess alcohol or any quantity of any controlled substance, lawful or unlawful, which in sufficient
quantity could result in impaired performance, with the exception of substances administered by or under the instructions of a
physician. “Work site” means any motor vehicle, office, building, yard or other property operated by a motor carrier, or any other
location at which the driver is to perform work. “Possession” does not include possession of a substance, which is manifested and
transported as part of a shipment.

SUBSTANCE SCREENING

For purposes of assuring compliance with the Federal Motor Carrier Safety Regulations and the Company’s policy, both current and
new applicants for positions as drivers will be subject to drug and alcohol screening, whichever is applicable, under the circumstances
described below. Substances screening means testing or urine for drugs and breath for alcohol to determine use or impairment.
Applicants: Prior to assuming a driving position, any applicant will be subject to drug screening, Refusal to submit to such a
screening will make it impossible to medically qualify the applicant, and the applicant will not be hired or leased. The substance
screening of active drivers (including contract drivers) will be in accordance with the circumstances described below.

Reasonable Cause Testing: When there is reasonable evidence to suspect a driver has reported to work or is working impaired, the
driver may be subject to substance screening by a supervisor whom has been trained in drug and alcohol detections required by federal
regulations. Refusal to submit to such screening will be considered as a positive test and result in termination of services.

Post Accident Testing: Any driver in a “recordable accident” as defined by the Regulations of the U.S. Department of Transportation
must submit to substance screening. Refusal to submit to a drug screen within 32 hours and an alcohol screen within 8 hours of a
recordable accident will place the driver in violation of the Federal Motor Carrier Safety Regulations. No driver shall use alcohol for
eight (8) hours following an accident if, the driver, is required to be tested because of the accident. If a fatal accident is involved, the
driver will be disqualified to drive, for a one-year period, following a refusal to give a urine and breath sample. If the test results are
positive, the driver is also disqualified to drive for one year.

Random Testing: Drivers will be subject to substance screening at any time on a random basis, as a term and condition of holding a
position as a driver. Any refusal by a driver to random screening will be treated as a positive test and the driver will not be qualified
to drive with attendant consequences. After notification of a random test the driver has two (2) hours in which to complete the test.
Failure to comply within this time frame will be treated as a positive test and result in termination of services.

Alcohol testing may take place immediately prior to performing a safety-sensitive function, while performing a safety-sensitive
function or immediately after performing a safety-sensitive function. Refusal to submitted alcohol testing, will be considered a
positive test and result in termination of services.

Test Results: The test results are reviewed to determine whether there is any indication of controlled substance or alcohol abuse. The
results are confidential. The Company’s Medical Review Officer and designated company representative will be the only custodians
of the individual test results.

Assistance Program: When applicable, a choice of assistance Programs will be referred to help drivers solve drug or alcohol
problems by providing educational information concerning the effects and consequences of drug or alcohol use on personal health,
safety and work environment. The cost of this program will be the responsibility of the driver.

Disciplinary Action (49 CFR 391.95)

    1.        Any driver who refuses to submit to a drug and alcohol test will not be permitted to operate a motor vehicle for the
              company. Further more such refusal will be treated as a positive test result and the service of the driver will be
              TERMINATED.
    2.        When a driver’s drug or alcohol screen test result is positive and the test was performed as either, reasonable cause or
              random testing, the following shall occur:
              a. The driver will be relieved of his/her duties immediately.
              b. The driver shall be suspended without pay.
              c. The driver shall be referred, “in confidence, to a choice of an assistance programs.
              d. The driver must have a “negative” return-to-duty test results and continuous “negative” follow-up test results (if
                  applicable).
              e. If a driver fails to complete the suggested rehabilitation program or test positive in any future drug test. His lease
                  will be terminated or employment terminated.
              f. Until a “negative” test result is achieved, the driver cannot perform any safety sensitive functions
              g. Drivers found to have an alcohol concentration of .02 or greater but less than .04 will be immediately removed from
                  any safety-sensitive function and suspended, without pay, for 48 hours.
              h. .04 Or above will result in a suspension without pay and will be required to attend a session with a drug abuse
                  professional.

Driver Signature

_________________________________________________
Designated Company Representative

                   Name__________________________________

                 Location________________________________
*Training information on drugs and alcohol is available to any driver upon request.

								
To top