Personal Information Name *
Phone * Street Address * Street Address Line 2 City * State * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Social Security Number * Date of Birth *
Next Personal History Do you have any moving violations in the last 3 years? * Do you have any DUI/DWI convictions in the past 5 years? * Have you ever been convicted of a Felony? * If Yes, explain below. Conviction of a crime is NOT an automatic disqualification of employment Are you authorized to work in the U.S.? * Have you EVER been convicted for driving under the influence of alcohol or drugs? * Have you EVER been convicted for possession, sale, or use of a controlled substance? * Pursuant to DOT regulations, have you, within the three (3) years preceding the date of this application: Undergone an alcohol test in which a concentration of 0.04 or greater has been indicated * Undergone a controlled substance test in which a positive result has been verified? * Refused to undergo either an alcohol or drug test or had an adulterated or substituted drug test verified? * Had any other violations of Federal Motor Carrier Safety Administration drug or alcohol regulations? * *
GodfreyTrucking will use a third party agency to conduct background checks. The background check will consist of a consumer report(s) and/or investigative consumer report(s) in connection with an application for employment. In all circumstances, background information will be reviewed and employment decisions will be based on an individual assessment. Full Disclosure regarding your rights under federal and state law regarding background checks will be provided to you during the application process, prior to any action by GodfreyTrucking.
Next Work History
It is a DOT requirement for applicants to provide their most recent 10 years of work history. If you are unable to complete the entire 10 years at this time, provide the most recent 3 years of work history.
Employment Record Employer Name
Equipment Driven Select Motorcoach/School Bus (15+) Motorcoach/School Bus (8+) Straight Truck Tractor - Three Trailers Tractor - Two Trailers Tractor - Semi-Trailer Non-Driving Position Held Select OTR Experienced Driver Owner Operator Student Student with experience Team Driver CDL Straight Truck Non-Driver Start Date
Please provide at least 3 years previous work history. Click below to add another employer.
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Next Driver License # License Type Select Class A Class B Class C Class D State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Expiration Date
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Next Background Release Introduction
As part of the hiring process at GODFREY TRUCKING, you will need to complete this background questionnaire. Before you may begin the background questionnaire, you need to electronically sign Disclosure, Acknowledgment and Authorization Forms ("Authorization Form") to authorize our background screening agency, SimpliVerified (
https://www.simpliverified.com/), to verify the information you provide to us and conduct a background check on you.
To ensure that your Authorization Form is not altered after its submission, Peopletrail uses secure encryption technology. In addition, to ensure that a signature is unique and to safeguard you against unauthorized use of your name, your IP address has been recorded and will be stored along with your electronic signature. Also, please note that Peopletrail requires applicants wishing to submit their Authorization Form electronically to include their social security number. All of your information will be encrypted and sent over secure websites.
At the end of this process, you will have the opportunity to print your completed Authorization Form. If you do not wish to complete the Authorization Form online, you may print it out and send it to GODFREY TRUCKING. This may delay processing.
I consent to signing this form electronically. I understand that Peopletrail uses computer technology to ensure that my Authorization Form is not altered after its submission. I agree to allow Peopletrail to monitor my electronic Authorization Form in this way.
Para informacion en Español, visite
www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. A Summary of Your Rights Under the Fair Credit Reporting Act Click here for "Fair Credit Reporting Act Rights & Background Disclosure, or if applying from CA or NY * California Resident Notice Are you an applicant applying to work in California or a resident of California? * * New York Resident Notice Are you an applicant applying to work in New York or a resident of New York? * * ACKNOWLEDGMENT AND AUTHORIZATION
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING ACKNOWLEDGMENT]
I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the procurement of "consumer reports" and/or "investigative consumer reports" at any time after receipt of this authorization and, if I am hired, throughout my employment. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by Peopletrail, 65 E Wadsworth Park Drive, Suite 102, Draper, UT 84020, Phone: 801-307-4100 / 866-223-8822, Fax: 888-759-7037 / 888-759-7037, http://www.peopletrail.com, another outside organization acting on behalf of the Company, and/or the Company itself. I authorize these agencies to provide you with consumer and investigative consumer reports. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.
I understand that by checking the "I AGREE" box, typing my name and the last four digits of my Social Security Number or User ID, and clicking on the "SIGN ACKNOWLEDGMENT" button below, constitutes my electronic signature, dated as of when I click on the "SIGN ACKNOWLEDGMENT" button, and that by doing so:
I am authorizing Peopletrail to conduct the background check(s) described above
I am consenting to use electronic means to sign this form and have read and understand the above disclosure
I acknowledge I may request a hard copy of this Disclosure and Authorization form after agreeing to the background check electronically by calling Peopletrail at Phone: 801-307-4100 / 866-223-8822, Fax: 888-759- 7037 / 888-759-7037.
￼By Submitting this application I agree to the terms outlined in Background Release Noted Above:
Next Release Forms Background Check
I hereby authorize Godfrey Trucking and its representatives to investigate the responses contained in this application and specifically, to obtain information concerning my motor vehicle operating record, criminal convictions, employment history, educational history, and except as may be limited by applicable law, other matters reasonably related to my employment candidacy. In addition, I hereby release the Nagle Companies, my current and former employers, and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
DOT Safety Performance History Record Request
I hereby authorize Godfrey Trucking and its representatives to preform the DOT Safety Performance History Record Request.
Medical Exam Release
I understand that any offer of employment is contingent on my passing a pre-employment controlled substances test, a pre-employment physical examination, and the background checks referred to above. I also understand, that if hired, I voluntarily consent to undergo such periodic physical exams and substance testing as required to maintain compliance with all regulatory agencies governing the transportation industry and company policy. I further understand that refusal to submit to a substance screen will be considered a voluntary resignation of employment.
PSP Driver Consent Document
I authorize Godfrey Trucking to obtain from the Federal Motor Carrier Safety Administration’s (FMCSA) Pre-Employment Screening Program (PSP) my crash report for the last 5 years and my last three years of inspection history
I understand that nothing contained in the application or conveyed to me during any interview which may be granted is intended to create an employment contract, implied, or explicit, between me and the Nagle Companies. I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement on this application or on any documents used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
I hereby authorize and sign the documents listed above: * Prev