Driver Employment Application

Start by telling us about you.

Personal Info Continued

Current Address
List any addresses in the last 3 years
Previous Address

COMMERCIAL EXPERIENCE

Training, Special Equipment, and Licenses.
Driver Training / Experience
Equipment Class Type
(Van, Tank, etc.)
Date Approx Miles
Driver Licenses
Date State License Type Endorsements Expiration

COMMERCIAL EXPERIENCE

Accident Records and Traffic Convictions.
Accident records for the last 7 years.
Date Nature Of Accident Fatalities Injuries Preventable?
Traffic convictions and forfeitures for the past 3 years.
(other than parking violations)
Location Date Charge Penalties

Employment History

Provide your employment information for the full past 10 years starting with most recent, include any unemployment as well.
Past Employer
Please review the following information and approve the included release forms by signing below.
DRIVER HIRING POLICY

For an individual to be considered to drive for RLT, Inc. they must meet the following requirements

  • Minimum Twenty-three (23) years of age.
  • A minimum of 1 year of recent interstate driving experience as a Heavy Duty Truck Driver.
  • Neat in appearance with hair, beard and/or mustache trimmed.
  • Clean DMV record with no DUI or test refusal, reckless driving, hit and run, leaving the scene of an accident or related citations on their driving record (391.15c2FMCR).
  • Capable of lifting 75 pounds or more.
  • Pass a physical assessment (agilities) test.
  • A current CDL Class A license in the State of your legal residence (where you pay your taxes).
  • No more than three (3) previous employers for the previous twelve (12) months.
  • Willing to work weekends and Holidays.
  • Pass a road test given by RLT, Inc.
  • Meet all Department of Transportation requirements as prescribed by part 391 of the Federal Motor Carrier Safety Regulations.
  • Pass the Federal Drug Screen and DOT physical test paid for by RLT, Inc.
  • TWIC Card. (If you do not have one, apply for one within 30 days of hire).

WE ARE REQUIRED BY CALIFORNIA LAW (CVC 14606B) TO REPORT TO THE DMV ANY DRIVER WHO FAILS PHYSICAL EXAMINATIONS

All candidates shall be given an Orientation to familiarize themselves with the company policy and procedures, including the Safety Program. All drivers under the directions of RLT, Inc. are required to comply with all Federal Motor Carrier Safety Regulations. Drivers are responsible to keep track of their activities using the Drivers Daily Log. Logging of incorrect hours is a violation of DOT regulations. Reporting and/or the recording of hours incorrectly will not be tolerated and can lead to disciplinary action up to and including termination.

If you terminate your employment with RLT, Inc., you must return your tractor to the RLT yard in Redding, California. If you abandon your tractor anywhere else, you will be assessed $150.00 for transportation of the tractor to the Redding yard.

I UNDERSTAND AND AGREE TO ABIDE BY RLT, INC. AND D.O.T. POLICIES IF HIRED.

If hired, I understand that nothing creates or is intended to create a promise or representation of continued employment the company and that my employment, position, and compensation with the company are at-will, and may be changed or terminated at the will of the company. I understand that I have the right to terminate my employment at any time, with or without cause or notice, and that the company has similar right. My signature below certifies that I understand the foregoing agreement that at-will status is the sole and entire agreement between the company and myself concerning the duration of my employment and the circumstances under which my employment may be terminated.

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. I understand that falsification on this application is grounds for termination.


IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with RLT, Inc. (“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 RLT, Inc. (“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.


APPLICATION NOTIFICATION AND RELEASE FORM

Part I CONSUMER REPORT DISCLOSURE AND RELEASE. I hereby give my consent to obtaining information, in connection with my application (including contract for services); and I understand that RLT Inc., or its affiliated companies will be requesting all information required by State and Federal Law, or is of concern to RLT Inc. and its affiliated companies, with regard to past employment and/or contract for services history, driving record, work experience, alcohol or controlled substance testing results, accidents, workers' compensation history, credit, bankruptcy proceedings, criminal records; as well as information and/or reports from USIS Commercial Services. This information and/or reports may include the following types of information: names and dates of previous employers and/or contract for services carriers, reason for termination of employment, work experience, accidents, academic history, professional credentials, and drugs/alcohol use. Such reports may contain public record information concerning your driving record, worker’s compensation claims, credit bankruptcy proceedings, criminal records, etc. from federal, state and other agencies which maintain such records, and that RLT or its affiliates may enlist the help from USIS Commercial Services, Tulsa, Oklahoma, or federal, state and other agencies or means to assist in obtaining the required information required by law to operate a commercial vehicle. I HEREBY AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY USIS, RLT, INC. OR ITS AFFILIATED COMPANIES TO FURNISH THE ABOVE MENTIONED INFORMATION TO THE EXTENT AUTHORIZED BY STATE AND FEDERAL LAW. I understand I have the right to review the information obtained from previous employers, to correct errors in that information and to rebut perceived incorrect information and to make a request to USIS, upon proper identification, to request the nature and substance of all information in it’s files on me, including their sources of information; and the recipients of any records on me which USIS has previously furnished within the three year period preceding my request. USIS may be contacted by mail at PO Box 33181, Tulsa,

Part II DOT DRUG AND ALCOHOL RELEASE. In compliance with 49 C.F.R. Part 40 and 382, I hereby authorize the carriers (Company/School) listed as my prior work history to furnish to USIS, RLT, Inc., or its affiliated companies the following information concerning drug and alcohol tests: DOT drug and alcohol testing violations including pre-employment test during the past three years: (i) the dates on which I tested positive for drugs and the drugs involved; (ii) the dates on which I tested .04 or greater for alcohol and the test result levels; (iii) the dates on which I refused (including a verified adulterated or substituted result) to be tested for drugs and/or alcohol; (iv) and other violations of DOT drug and alcohol testing regulations; and (v) any information the carriers have received regarding violations of drug/alcohol testing regulations from my previous employers covered by DOT. I fully understand that the information I authorize RLT, Inc., its affiliated companies or USIS to receive involves tests which were required by the Department of Transportation (DOT). If any carrier (company/school) below furnishes RLT, Inc., its affiliated companies or USIS with information concerning items (i) through (v) above, I also authorize that carrier (company/school) to release and furnish (vi) the dates of my negative drug and/or alcohol tests and/or tests with results below .04 during the three-year period; and (vii) the name and phone number of any substance abuse professional who evaluated me during the past three years. If you have more employers, please list on a separate sheet.

Company City State Phone

Part III CERTIFICATION AND ACKNOWLEDGEMENT. By signing below, I certify that I have read and fully understand this release, that prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction, and that I executed this release voluntarily and with the knowledge that the information being released could affect my being hired. Any false, misleading or incomplete statement of the information requested in this application shall be sufficient grounds for discharge from employment. I, further, certify that all of the information that I have furnished on this form is true and complete, and that I have listed on my application every company for which I worked as a driver and every company for which I took a pre-employment drug and/or alcohol test during the past


CALIFORNIA NOTICE OF INVESTIGATIVE CONSUMER REPORT

In connection with your application for employment, we have ordered an investigative consumer report (as defined by California law). This report may contain information on your character, general reputation, personal characteristics and mode of living.

This report has been or will be ordered from Total Information Services, Inc., d/b/a DAC Services, 4500 South 129th East Avenue, Suite 200, Tulsa, Oklahoma 74134. The consumer department telephone number is 1-800- 381-0645.

The scope of the report may include the following: names and date of previous contract/lessees and/or employers, reason for termination of lease contract and/or employment: work experience, accidents, drugs/alcohol use. Such report may also contain public record information concerning your driving record, workers, compensation claims, credit, bankruptcy proceedings, criminal records from federal, state and other agencies that maintain such records.

You have the right under Section 1786.22 of the California Civil Code to contact DAC during reasonable hours (8:00 a.m. to 5:00 p.m. CTZ Monday through Friday) to obtain all information in your file for your review. You may obtain such information as follows:

1. In person at DAC's offices listed above. You can have someone accompany you to DAC's offices. DAC may require this third party to present reasonable identification. You may be required at the time of such visit to sign an authorization for DAC to disclose to or discuss your information with this third party.

2. By certified mail, if you have previously provided proper identification in a written request that your file be sent to you or to a third party identified by you.

3. By telephone, if you have previously provided proper identification in writing to DAC.

DAC has trained personnel to explain any information in your file to you and if the file contains any information that is coded, such will be explained to you.

I understand my rights and I have been given a copy of these rights along with this application.


CALIFORNIA CONSUMER RIGHTS

You have rights when an investigative consumer report is obtained on you. The following are some of your rights:

1. Whoever obtained the report is required to give you a free copy upon request.

2. You have the right to contact the agency that made the report. You can do this in one of the following ways:

(a) You can go to the agency in person during the normal business hours. You can bring someone with you. That person may be required to present identification. You may be required to sign a paper allowing the agency to discuss your file with or to show your file to this person.

(b) You may receive your file by certified mail, if you have given written notice to the agency that you want information mailed to you or to another person you want to receive the file. You will be required to provide identification when you write for your file.

(c) You may be able to discuss your file over the telephone if you have given written instructions to the agency and have provided identification.

3. You have the right to receive a copy of your file or your investigative consumer report at the agency. You may be charged up to $8.00 to obtain a copy of your report or file. However, you may receive a free copy if:

(a) Once during a twelve month period if you are unemployed and intend to seek employment within sixty (60) days or you receive public welfare assistance or you believe your file contains inaccurate information because of fraud.

(b) If you are receiving a copy from the agency relating to an investigation into the accuracy of information you have disputed or if information is put back into your file.

The agency must describe these rights to you in English and Spanish. You have the right to know the following information:

(a) The names of the persons and companies who have received a report about you in the last three (3) years. You may request their addresses and telephone numbers.

(b) Explanations of any codes or abbreviations used in your report, so you can understand the report.

4. You have the right to dispute any information in your file. You must contact the agency directly to do so. The person who ordered a report is required to give you the name and address of the agency.

(a) The agency has thirty (30) days from the day it receives your dispute to complete the investigation.

(b) When the agency is done with the investigation, it must tell you of any changes made in the report as a result of the investigation.

(c) If the investigation does not remove the information disputed by you, you have the right to place your statement of the facts in your file. The agency has people to help you write the statement. The agency may limit your statement to five hundred (500) words.

(d) If information is removed or you add a statement to your file, you can request the agency to send the report, as changed or with your statement, to anyone who received the information in the last two (2) years.

(e) If information that is removed from your files is placed back in your file, you are entitled to receive written notice of that fact and you have the right to dispute the information added.

(f) You also have rights under federal law in regard to your report. A copy of those rights are given to you with this California statement of consumer rights. Many of these rights are also included within California law. Under federal law, your report is a consumer report, not an investigative consumer report


WASHINGTON RESIDENT RELEASE OF INTEREST

Employer, prospective employer, or volunteer organization name: RLT, Inc. Agent business name if acting on behalf of the company for employment purposes: SambaSafety

This is an authorization of:

  1. Employee. for release of my driving record for employment purposes, at my employer’s discretion for the full term of my employment; or
  2. Prospective employee. for release of my driving record for employment purposes, not to exceed 30 days from date signed; or
  3. Volunteer. for release of my driving record for a position applied for that requires me driving at the direction of the volunteer organization.

I , am an employee, prospective employee, or volunteer of the company named above and I request DOL release a copy of my official driving record in the state of Washington to my employer, prospective employer, volunteer organization, or their agent.

No employer, prospective employer, or their agent may use information contained in a driving record related to the sealed juvenile record of an employee or prospective employee for any purpose unless required by federal law. The employee or prospective employee must furnish a copy of the court order sealing the juvenile record to the employer, prospective employer, or their agent.

The company listed below agrees to, and shall indemnify and hold harmless the state of Washington, Department of Licensing (DOL), the DOL Director, and all DOL employees from any and all suits at law or equity, and from any and all claims, demands or loss of any nature, including but not limited to all costs and attorney’s fees, arising from any incorrect or improper disclosure of individual names or addresses under this “Release of Interest;” any defects in any of Company’s procedures followed or omitted or arising from the failure of Company or its officers, employees, customers, contractors or agents to fulfill any of its obligations under this contract; or arising in any manner from any negligent act or omission by the company or its officers, employees, customers, contractors, or agents.

I hereby certify:

  1. The company named below is an employer, prospective employer, or volunteer organization of the abovenamed individual.
  2. The information contained in the driving record obtained from DOL shall be used in accordance with the requirements and in no way violate the provisions of RCW 46.52.130. No information contained therein will be divulged, sold, assigned, or otherwise transferred to any third person or party. The driving record shall be used exclusively for Employment.

RLT, Inc 4301 Eastside Road, Redding, CA 96001


INFORMATION VERIFICATION

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. I understand that falsification on this application is grounds for termination.


Sign Above

You must check the box indicating you agree to continue.

You must sign in the signature area below to continue.

We would prefer to see 10 years of employment history listed.

COME & JOIN A Great Fleet


Our success is based on a commitment to the simple philosophy that our product is service, but our business is people. Our commitment to the highest standards of safe highway transportation is evidenced by the many annual awards won over the last 43 years.

RLT's home office and terminal in Redding, CA is well-positioned for transporting loads North and South along I-5. Our company Class A drivers live up and down the I-5 Corridor making it possible for more frequent home time. Our company culture is safety first, friendly, family oriented, and an open door policy with our original owner. Our good business practices and exceptional customer service provides consistent miles for our drivers. Give us a call today and find out if RLT, Inc. is for you.

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