Application FORM
READ THE FOLLOWING BEFORE submitting FORM
1) | hereby authorize the above-mentioned employer/school to release all information as to my character, work habits, performance, experience, fitness, together with reasons for termination concerning my employment to Yeden, Inc. (or their authorized agents) which may request such information in connection with my application for employment with Yeden, Inc.
2) In conformity with 49 CFR part 40, I hereby authorize the above-mentioned employer/school and their agents to furnish Yeden, Inc. the above-requested information concerning D.O.T. drug and alcohol tests including pre-employment tests during the previous 3 years; the dates when I tested positive; the dates when I tested .04 or greater; the dates when I refused (including a verified adulterated or substituted result) to be tested for drugs and alcohol; and any other violations of 49 CFR part 40 and any information the above-mentioned employer/school and/or their authorized agents have received regarding violations of 49 CFR part 40 from my previous employers covered by D.O.T.
3.) | hereby release the above-mentioned employer/school and their authorized agents from any and all liability of any type as a result of providing the above-requested information to Yeden, Inc.
By signing below, I certify that I have read and fully understand Parts 1, 2, and 3 of this release and that I executed this release voluntarily, with the knowledge that any and all information released could affect my being employed with Yeden, Inc.
It is expressly acknowledged, understood and agreed that the information provided by the applicant regarding the applicant's employment during the previous three (3) years in accordance with Section 391.21(b)(10) of the Federal Motor Carrier Safety Regulations ("FMCSR") may be used, and the applicant's prior employers may be contacted, for the purpose of investigating the applicant's safety performance history information as required by paragraphs (d) and (e) of Section 391.23 of the FMCSR. The applicant has certain due process rights under the FMCSR regarding the information received as a result of these investigations, as described below.
Applicant's Due Process Rights: 1) The right to review information provided by previous employers; 2) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to Yeden, Inc.; and 3) The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.
Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information, must submit a written request to the Safety Compliance Manager of Yeden, Inc., which may be done at any time, including when applying, or as late as thirty (30) days after being employed or being notified of denial of employment Yeden, Inc. will provide this information to the applicant within five (5) business days after receiving the written request. If, however, Yeden, Inc. has not yet received the requested information from the previous employers), then it will provide the information to the applicant within five (5) business days after it receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of Yeden, Inc. making them available, Yeden, Inc. will consider the driver to have waived the request to review the records.
By clicking 'PROCEED TO FORM,' you acknowledge that you have read and agreed to the terms and conditions, and understand that you will be required to sign this agreement at the end of the employment form.