Requirements​


MUST HAVE AN ACTIVE CLASS A CDL

MUST BE 23 YEARS OR OLDER

18 MONTHS RECENT TRACTOR-TRAILER EXPERIENCE

18 MONTHS CLEAN DRUG AND ALCOHOL TESTING

18 MONTHS ACCIDENT FREE DRIVING
​

Commercial Driver Application

  
Date: _____________________
Positions applying for:  ____Contractor  ____Driver  ____Contractor’s Driver
Name: ________________________________________________________
Phone (      ) _____________________ Emergency Phone: (      ) __________________
Age: _________             Date of Birth: _______/______/_______
(The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 but less than 70 years of age.)

Physical Exam Expiration Date: _________/________/_________

Current & Previous Three Years Addresses:
1) ______________________________________________  From: _________ To _________
2) ______________________________________________  From: _________ To _________
3) ______________________________________________  From: _________ To _________

Have you worked for KOTH Transport Before?  _____Yes         _______No
If yes, give dates:  From ___________ To ___________
Reason for leaving? ______________________________________________________________________

Education History:
Please circle the highest grade completed:
Grade school: 1 2 3 4 5 6 7 8 9 10 11 12
College: 1 2 3 4                     Post Graduate: 1 2 3 4

Employment History:

Give a COMPLETE RECORD of all employment for the past three (3) years, including any unemployment or self-employment periods, and all commercial driving experience for the past ten (10) years.

Mo/Yr                     Mo/Yr                     Present or Last Employer
From__________To___________Name______________________________________________
PositionHeld_____________________________________________________________
Address___________________________________________________________________
Reason for leaving_______________________________________________
Company phone (     ) __________________
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?     ___________Yes ________________No

Mo/Yr                     Mo/Yr                     Present or Last Employer
From__________To____________Name_____________________________________________

PositionHeld________________________________________________________________
Address______________________________________________________________
Reason for leaving_______________________________________________
Company phone (     ) __________________
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?     ___________Yes ________________No

Mo/Yr                     Mo/Yr                     Present or Last Employer
From__________To____________Name____________________________________________
PositionHeld______________________________________________________
Address______________________________________________________________
Reason for leaving_______________________________________________
Company phone (     ) ___________________
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?     ___________Yes ________________No

Mo/Yr                     Mo/Yr                     Present or Last Employer
From__________To____________Name_____________________________________________
PositionHeld________________________________________________________________
Address___________________________________________________________________
Reason for leaving_______________________________________________
Company phone (     ) ___________________
Was your job designated as a safety-sensitive function in any DOT-regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40?     ___________Yes ________________No

Driving Experience

Class of Equipment                        From                       To              Approximate                                                                                                                    Number of Miles
Straight Truck                                 ___________       ___________       _______________
Tractor & Semi-Trailer                   ___________       ___________       _______________
Tractor & Double/Triple Trailer   ___________       ___________       _______________
Other                                                ___________       ___________       _______________

List of states operated in, for the last five (5) years: _____________________________________________________________________________
List any special courses/training completed (PTD/DDC, HAZMAT, etc) ______________________________________________________________________________
List any Safe Driving Awards you hold and from whom: ______________________________________________________________________________

Accident Record for past three (3) years: (attach sheet if more space is needed):

Date of        Nature of        Location of                  # of                            # of
Accident       Accident          Accident                  Fatalities             People Injured

_________    ____________    ___________________      _______                  ___________
_________    ____________    ___________________      _______                  ___________
_________    ____________    ___________________      _______                  ___________

Traffic Convictions and Forfeitures for the last three (3) years (other than parking violations):

Date                Location                      Charge                        Penalty
_________        ________________          _________________         ____________________      
_________        ________________          _________________         ____________________      
_________        ________________          _________________         ____________________      

Driver’s License (list each driver’s license held in the past three (3) years:

State      License          Type             Endorsement        Expiration Date
_____       ___________    _________      _______________      _______________
_____       ___________     ________       _______________      _______________
_____       ___________     _________     _______________      _______________

Have you ever been denied a license, permit or privilege to operate a motor vehicle?       ________Yes _______No
Have any license, permit or privilege ever been suspended or revoked? ________Yes _______No
Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?                           ________Yes _______No
Have you ever been convicted of a felony?   ________Yes _______No
If the answers to any of the questions listed above are ‘Yes’, give details ________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Job References

Names ____________________________   Address ________________________________ Phone (      ) _________________
Names ____________________________   Address ________________________________ Phone (       ) _________________
Names ____________________________   Address ________________________________ Phone (       ) ______________

To Be Read and Signed by Applicant:

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.

It is agreed and understood that the motor carrier and his agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and person named herein for all liability for any damages on account of his furnishing such information.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living.

I agree to furnish such additional information and complete such examinations as may be required to complete my application file.

It is agreed and understood that this Application in no way obligates KOTH Transport, LLC to employ or hire the applicant.

It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.

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.

Applicant Signature ________________________________  Date___________________

Remarks: (For office use only)
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________




                              Pre-Employment Drug Testing Requirements:

A pre-employment drug test is required for all applicants who are considering a CDL driving position with KOTH Transport.  The Federal Motor Carrier Association outlines these requirements for all U.S. carriers.

Controlled Substances and Alcohol Use and Testing Regulations
The drug and alcohol regulations in the Federal Motor Carrier Safety Regulations (FMCSRs) apply to drivers that are required to have a Commercial Driver’s License (CDL). In other words, if a driver operates a Commercial Motor Vehicle (CMV) that requires a CDL, the carrier (KOTH Transport, LLC) and the driver (You) must follow the controlled substances and alcohol regulations.

Controlled Substances Tested For
The drugs or classes of drugs tested for are marijuana, cocaine, amphetamines, opiates, and phencyclidine (PCP).

Alcohol and Drug Use by Drivers
In general, CMV drivers may not use controlled substances or alcohol. In particular the rules single out a CMV driver‟s blood-alcohol concentration (BAC), on-duty use of alcohol, pre-duty use of alcohol, use of alcohol following an accident, and general use of controlled substances.

Alcohol and Controlled Substance Testing
The regulations specify five different types of alcohol and drug tests. Some are required for all drivers and others are limited to those who have been in an accident or are returning to work after drug or alcohol abuse treatment.

Pre-Employment – required before a driver performs any “safety sensitive functions,” including driving a CMV. Pre-employment testing may not be required if a driver has been part of another carriers program and has been tested for drugs in the last six months or has participated in another employers random controlled substances testing program for the previous 30 days.

Post-Accident – a carrier must test a CMV driver for alcohol “as soon as practicable” after an accident. An accident qualifies for the testing requirement if it involves a loss of human life, the driver receives a citation for a moving violation within eight hours of the accident, bodily injury to any person that requires medical treatment away from the accident scene, or one or more of the vehicles involved in the accident is towed or transported away from the accident scene.

Random – carriers must randomly test drivers for alcohol and drugs. The company must randomly select and test 10 percent of its drivers for alcohol and 50 percent of its drivers for controlled substances each calendar year.

Reasonable Suspicion – carriers must require the testing of drivers that it suspects of violating the drug and alcohol regulations. A supervisor or company official must have a “reasonable suspicion” that is backed up by observations of the driver‟s behavior.

Return-to-Duty and Follow-up – these tests are performed after a driver has completed a drug or alcohol abuse treatment program and a substance abuse professional has determined that the driver may return to work. A carrier is not required to provide abuse and rehabilitation programs for drivers that violate the controlled substance and alcohol regulations.

I have read and understand the drug testing requirements for employment with KOTH Transport and to be in compliance with FMCSR highlighted in the above paragraphs.
Name: __________________________________  Date: _______________

Motor Carrier Safety Handbook
Please be familiar with the current Motor Carrier Safety Rules Handbook.  You can obtain the latest version from http://www.puco.ohio.gov , or you can request a copy by calling or writing to:
The Public Utilities Commission of Ohio
180 E. Broad Street
Columbus, Ohio 43215-3793
(800) 686-PUCO (7826)

John R. Kasich, Governor Todd A. Snitchler, Chairman
www.PUCO.ohio.gov
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