Have you ever completed a driving course?
If Yes, Please specify
Have you ever received a safe driving award?
if yes, please specify employer
To Be Read and signed by applicant
I hereby authorize KING AIR TRANSPORTATION INC. to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also that I am required to abide by all rules and regulations of the company.
"I understand that information I provide regarding current and/or previous employers may be used and those employer(s) will be contacted for the purpose of investigating my safety performance history as required by 49 CFR 391.32(d) and (e). I understand that I have the right to:
- 1. Review information provided by current/previous employers:
- 2. Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
- 3. Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information".
KING AIR TRANSPORTATION INC.
1. Is the employment record with your company correct as stated above?
If No, Provide dates: From-To
2. What kind(s) of work did the applicant do?
3. Did he/she drive commercial vehicles for you?
If Yes, What type
4. If there is no Safety Performance history to report, check here
5. Accident History: Complete the following for any accidents included an your accident register ( Reg. 390.15(b)) that Involved the applicant in the 3 years prior to the application date shown above, or check here if there no accident register data for this driver
Please provide information concerning any other accidents involving the applicant that were reported to government agencies or insurers or retained under internal company policies
6. DRUG AND ALCOHOL HISTORY
If driver was not subject to Department of Transportation testing requirements while employed by this employer, please check here, fill in the dates of employment
A. Has this person had an alcohol test with the result of 0.04 or higher alcohol concentration?
B. Has this person tested positive or adulterated or substituted a test specimen for controlled substances?
C. Has this person refused to submit to a post-accident, random, reasonable suspicion, or follow-up alcohol or controlled substance test?
D. Has this person committed other violations of Subpart B of Part 382, or Part 40?
E. 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?
F. 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?
7. Reason for leaving your employ:
8. Was the applicant a Safe and efficient driver?
9. Was the applicant's general conduct satisfactory?
10. Is the applicant competent for the position sought?
11. Did the applicant drink any alcoholic beverages while on duty?
12. Would you rehire this person?
King Air Transportation Inc
CERTIFICATION OF COMPLIANCE WITH DRIVER
Motor Carrier Instructions: The requirements in Part 383 apply to every driver who operates in Intrastate, Interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding.
The requirements in Part 391 apply to every driver who operates in Interstate commerce and operates a vehicle weighing 10,001 pounds or more, car transport more than 15 people, or transports hazardous materials that require placarding.
DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, 1987. They are as follows:
1. You, as a commercial vehicle driver, may not possess more than one license. If you currently have more than one license, you should keep the license from your state of residence and return the additional licenses to the states that issued them. Destroying a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, you should close your record by notifying the state of issuance that you no longer want to be licensed by that state.
2. Part 392.42 and Part 383.33 of the Federal Motor Carrier Safety Regulations require that you notify your employer the Next Business Day of any revocation or suspension of your driver's license. In addition, Part 383.31 requires that any time you violate a state or local traffic law (other than parking), you must report it to your employer motor carrier and the state that issued your license within 30 days.
DRIVER CERTIFICATION: I certify that I have read and understand the above requirements:
The following license is the only one that I possess:
King Air Transportation Inc
Motor Vehicle Driver's
CERTIFICATION OF VIOLATIONS
MOTOR CARRIER INSTRUCTIONS: Each motor Carrier shall, at least once every 12 months, require each driver it employs to prepare and furnish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted, or on account of which he has forfeited bond or collateral during the preceding 12 months. (Section 391.27)
Drivers who have provided information required by Section 383.31 need not repeat that information here.
DRIVER REQUIREMENTS: Each driver shall furnish the list as required by the motor carrier above. If the driver has not been convicted of, or forfeited bond or collateral on account of any violation which must be listed, they shall so certify. (Section 391.27)
I certify that the following is a true and complete list of traffic violations required to be listed (other than those I have provided under Part 383) for which I have been convicted or forfeited bond or collateral during the past 12 months.
If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violations (other than those I have provided under Part 383) required to be listed during the past 12 months.
King Air Transportation Inc
PRE - EMPLOYMENT URINALYSIS NOTIFICATION
The Federal Motor Carrier Safety Regulations, Section 391.103 — pre-employment testing requirements, apply to driver-applicants of this company.
391.103 Pre-employment testing requirements.
- a) A motor carrier shall require a driver-applicant who the motor carrier intends to hire or use to be tested for the use of controlled substances as a pre-qualification condition.
- b) A driver-applicant shall submit to controlled substance testing as a pre-qualification condition.
- c) Prior to collection of a urine sample under b391.107 of this subpart, a driver-applicant shall be notified that the sample will be tested for the presence of controlled substances.
As a condition of my employment, I agree to the urine sample collection and controlled substance testing.
I understand a positive test for controlled substances based on the Urinalysis Test will medically disqualify me from the operation of a commercial motor vehicle for this company.
The Medical Review Officer will maintain the results of the Urinalysis Test. Negative and positive results will be reported to the company.
My written authorization is required for the Urinalysis Test results to be given to other parties.
I have read and understand the above conditions for the Pre-Employment Urinalysis Notification.
Driver Statement Of On-Duty Hours
Driver's License Information:
Total On-Duty Hours of last 14 days
I hereby certify that the information given above is correct and to the best of my knowledge and belief. I was last relieved from work at:
Instruction: When using a driver for the first time or intermittently, motor carriers are required to obtain a signed statement giving the driver's total on-duty during the immediately preceding 14 days and time at which the driver was last relieved from duty prior to beginning work for such carrier. On-duty time includes both compensated and uncompensated time working at a motor carrier and compensated work for non-motor carriers.