instructions for new hire driver packet – · pdf filedriver packet csc transportation...

DRIVER PACKET CSC Transportation LLC Forms provided by Fleet Team Services of Wells Fargo Insurance Services USA, Inc.-2014

CSC TRANSPORTATION LLC

920 Second Ave South, Minneapolis, MN 55402

NEW DRIVER Name-

First,MI,Last

DOB: SSN:

Address-

street, city,

state, zip

DL Number: DL State issued in: DL CLASS

Date hire Started driving date: DL expiration date

EID #

Instructions for NEW Hire Driver Packet –Directions 1. First page – Required fill in your full legal name; First, MI, Last; Date of Birth, social security number.

Address- street, city, state, zip code. Driver’s license number and driver license state issued in, expiration date.

2. NH-2 - Fill in or verify your name and social security number. Supervisor: to fill in the date driver hired and date driver started driving. Company assigned (EID) employee identification number. Check off what type of driver DOT/NON-DOT and permanent or temporary driver.

3. Pre-employment testing information(40.25(j))-NH-3- by driver /applicant must be completed

4. DOT Application NH-4.1–4.4 - next 4 pages – must all be completed including 10 years (if CDL holder); 3 years (if non-CDL holder) of previous work history, addresses, & phone numbers. ** If there is any time frame for unemployment or self-employment please list. DOT is looking for a complete trail of information provided by the driver representing where they have been from date to date. Please complete this form and provide a signature/ date at bottom of page 4. Read “Driver Rights” provided by your company.

5. Record of Violations form NH-5 top – Fill in any moving traffic violations you have had within the past 3 years; provide a signature & date. If no violations check box. 3 years required review; at time of hire or start driving per FMCSA, thereafter complete at a minimum of one time per year.

6. Annual Review NH-5 bottom – (SKIP) to be completed by HR Department with a current MVR. MVR=Motor Vehicle Report

7. *Company is required to order and obtain a current MVR for driver prior to hiring or being moved into a driving position. Driver written authorization is required; NH-5 top half or DOT application (completed) or other company specified MVR ordering form.

8. Data Driver Sheet - NH-6 –fill in your name and SSN on top. On bottom half of form complete “hours of service” section, provide the last 7 days, total hours worked both full time and part time jobs. It doesn’t matter if you were driving or not, while being employed. Must be completed with zeroes and corresponding dates even if not working. Signature and date on bottom. Please follow other instructions on the NH-6 form.

9. Driver’s Road Test - NH-7 – Fill in name and SSN, Skip rest of page (Supervisor will complete either a road test will be performed or waived, depending on CDL class.)

10. Controlled Substance form NH-8 – signature and date at bottom. (if NON-CDL holder, also check the box in upper left corner.)

11. Certificate of Compliance - NH-9 – Read and fill in all information, signature and date required.

12. Previous Employer form - NH-10 – Only sign the top box on the first page where it states Applicant signature and date. Company / Supervisors will send out to the previous employers listed on driver’s application.

13. Provide/(attach) a clear & readable photocopy (both sides) of your current driver’s license (address needs to be current)

14. DOT medical card-verify medical provider is listed on the National Registry of Certified Medical Examiners as of the date of issuance of the medical examiner’s certificate for the named driver. Supervisor needs to complete a NH-14 showing verification and sign off of current medical card. Note website address: https://nationalregistry.fmcsa.dot.gov/NRPublicUI/home.seam Copy of valid/current DOT medical card from a NRCME provider issued after 5/20/2014 per FMCSA 391.51(b)(9). CDL holders may need to carry a valid medical card as determined by their SLA self-certification on file.

• For a CDL holder, company must also pull an additional MVR/SLA verification to show medical expiration compliance.

Thank you for your assistance in completing all this information. If forms are not completed as listed above they will be returned for further attention.

NH-1

Location:

Attention Supervisor: Prior to returning this packet to FLEET TEAM SERVICES please review the driver’s packet for accuracy of completion. Please refer to the color-coded packet or call FLEET TEAM SERVICES for clarification of any questions.

https://nationalregistry.fmcsa.dot.gov/NRPublicUI/home.seam


CSC TRANSPORTATION LLC 920 Second Ave South, Minneapolis, MN 55402

CHECKLIST FOR NEW DRIVER DOTover 10,001 lbs. NON-DOT under 10,000 lbs.

Permanent New Hire or transfer to active driver status Temporary Driver/Leasing Company

Legal Name of Driver:

*DATE HIRED

EID #

Social Security Number:

Started driving on:

Form ID # Date

Requested from driver

Date Completed

by driver and reviewed by management

Sent to Fleet Team Services

*Motor Vehicle Record §391.23 Company MUST obtain the motor vehicle record(s) from the states in which the driver has held a license for the past 3 years. Driver authorization required. Send driver request to your MVR provider first to obtain results prior to employment.

Immediately MVR results should be received prior to driver being hired.

*CDL holder’s negative pre-employment drug screen (completed- paperwork in hand (382.301)) + Testing info from driver (40.25(j)).

Immediately Results (Negative)- from MRO & completed NH-3

*Application for Employment as a Driver §391.21 **CDL= 10 years, NON-CDL= 3 years previous, minimum employment history required

NH-4.1-4.8 Prior to any driving allowed

*Request for Information from Previous Employer - (Send, or FAX copies to each previous employer) §382.413 and §391.23 **CDL= 3 years (minimum), NON-CDL= 3 years check. List previous employers below. Additional page may be added.

NH-10 Within 30 days of beginning employment

1.

2.

3.

*Copy of Driver’s current Medical Card—Medical

Examiners Certificate (From Doctor) §391.43(d). *CDL HOLDERS- additional MVR showing FMCSA compliance is required. = CDL/Medical/MVR or SLA

Medical card/ physical Prior to any driving allowed

*CDL-Medical NR-Motor Carrier Verification-391.51(b)(9)-A note verifying medical examiner is listed on the National Registry of Certified Medical Examiners required by §391.23(m).

NH-14-Medical-NRV required for all medical exams (5/20/2014)

*Photocopy of Driver License (Both Sides) If you are waiving the road test you must have a legible copy of the driver’s license. §391.33

Copy of DL Prior to any driving allowed

*Record of Road Test §391.31(g) See §391.33 for waiver.

NH-7 Prior to any driving allowed

*Annual Review / *Record of Violations §391.25,391 27 Must complete a MVR and driver review prior to hiring the driver on this form. w/ sign off. Send in MVR results to Fleet Team Services with NH-5 form.

NH-5- All Prior to any driving allowed include MVR results

*Truck Driver Data Sheet and Employment Status Form-- §395.8(j)(2) NH-6

Prior to any driving allowed *Controlled Substance and Alcohol Policy and Training Verification §382.601Company DOT D&A Policy & training given to driver- need sign off.


Subpart E- Entry Level Training: 380.503 **Applies to CDL DRIVERS ONLY Found in office use form section plus company may need to supply additional training to satisfy requirements.

NH-12 =a completed training certificate

*Driver Notice/Certificate of Compliance Commercial Motor Vehicle Act of 1986 this is an optional form but recommended-driver form


Federal Motor Carrier Safety Regulation Pocketbook Receipt this is an optional form ( found in front page of FMCSR- pocketbook)

Inside cover of FMCSR handbook

*DATE HIRED- The date the employee is hired "as a driver" or an employee returns or transfers to a driving position after a period of being inactive as a driver is considered the date of hire.

NH-2

Location:



RELEASE & DOCUMENTATION OF PRE-EMPLOYMENT TESTING INFORMATION BY DRIVER / APPLICANT - Part 40.25(j).

Date: ___________________ To be completed by driver / applicant. During the past (2) two years, have you tested positive on a pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by the Department of Transportation (DOT) drug and alcohol testing rules?

Yes No During the past (2) two years, have you refused to test on a pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by the Department of Transportation (DOT) drug and alcohol testing rules?

Yes No If you answered yes to either of the questions above, please provide documentation of your successful completion of the return-to-duty process. ______________________________________________________________________ ______________________________________________________________________ Print Legal Name of driver: _______________________________________ Signature of driver:_____________________________________________ Social Security Number:__________________________________________ Witness/Management signature:___________________________________ Witness/Management printed name:________________________________

(This form is used to fulfill the requirement of Part 40.25(j)). An employer must ask the driver whether he/she has tested positive, or refused to test on any pre-employment drug or alcohol test administered by an employer to which the driver applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past 2 years.

NH-3

Location:



APPLICATION FOR EMPLOYMENT AS A TRUCK DRIVER (§391.21)

Full Legal Name: ______________________________________ SSN___________________ Address:_____________________________________________________________________ (Present address, include street, city, state & zip code) PLEASE PRINT CLEARLY

*How long at this address:_______ Phone #:________________ Cell Phone #: _______________________

Date of Birth: ______________Position applied for: ________________________ Date Available: ______________

*Previous addresses for 3 years preceding the date of this application Dates (list) Street Address City ST. Zip

DRIVER LICENSE INFORMATION List DRIVER’S LICENSE NUMBER & following information Please include your CURRENT, valid license plus past 3 years including permits. REQUIRED INFORMATION

State Driver’s License Number Class and Endorsements

CDL Class Y/ N (Put X) required

Expiration Date

YES NO YES NO

DRIVING EXPERIENCE & CDL DATE REQUIRED Need date the CDL license (Commercial A or B or C) was first obtained. The nature and extent of your experience in the operation of motor vehicles, including the type of equipment (such as buses, trucks, truck tractors, semitrailers, full trailers, and pole trailers) which you have operated.

MY CDL(Commercial A or B or C) LICENSE was FIRST OBTAINED ON: MONTH DAY YEAR

Type of Equipment Period of Time Nature and Extent

MOTOR VEHICLE ACCIDENTS List all motor vehicle accidents in which you were involved during the 3 years preceding the date that the application is submitted. Please include the date, location, nature of accident, fatalities or personal injuries. (Use additional paper if necessary.) If NONE-check box No-accidents in past 3 years. Date incident occurred: Location

:

Details:

Date incident occurred: Location

:

Details:

NH-4.1

Location:


SAFETY-SENSITIVE FUNCTION §382.107 ***safety sensitive subject to 49 CFR Part 40 is required information on the application under past employment history - must be completed for each previous employer The FMCSA originally determined that “safety-sensitive” functions (382.107) were functions performed as part of on-duty time. However, the FMCSA amended the rule to remove this complex link with on-duty time.

Safety-sensitive function – means all time from the time a driver begins to work or is required to be in readiness to work until the time he/she is relieved from work and all responsibility for performing work. All time at an employer or shipper plant, terminal, facility, or other

property, or on any public property, waiting to be dispatched, unless the driver has been relieved from duty by the employer; This includes employees who are “eligible” at work to drive a CMV at anytime, e.g., salesperson, clerks, secretaries, supervisors.

All time inspecting equipment as required by 392.7 and 392.8 of this subchapter or otherwise inspecting, servicing, or conditioning any commercial motor vehicle at any time;

All time spent at the driving controls of a commercial motor vehicle in operation;

All time, other than driving time, in or upon any commercial motor vehicle except time spent resting in a sleeper berth (a berth conforming to the requirements of 393.76 of 393.76 this subchapter);

All time loading or unloading a vehicle, supervising, or assisting in the loading or unloading, attending a vehicle being loaded or unloaded, remaining in readiness to operate the vehicle, or in giving or receiving receipts for shipments loaded or unloaded; and

All time repairing, obtaining assistance, or remaining in attendance upon

a disabled vehicle. NOT-Safety-Sensitive All time spent providing a breath sample or urine specimen, including

travel time to and from the collection site, in order to comply with the random, reasonable suspicion, post-accident or follow-up testing required by part 382 when directed by an employer.

Performing any other work in the capacity of or in the employ or service of a common, contract or private employer.

GUIDE-1


EDUCATION Type of School

Attended School name and location Did you

graduate YES/ NO

Diploma/ Degree

Major Course of Study

High School: circle highest grade completed

9 10 11 12

Technical or Vocational

College or University

Graduate School

Professional Seminars, or Additional Training

EMPLOYMENT EXPERIENCE List names and addresses where you were employed during the last 10 years “This is a DOT requirement. (391.21(10&11)

**You must include the complete address including street, city, state, zip code and phone number**

PRINT CLEARLY. ANSWER EACH SAFETY SENSITIVE QUESTION (YES OR NO ) UNDER EACH EMPLOYER RECORDED 1. Past Employer

Dates Employed From / TO

(mm/dd/yyyy)

Work Performed

Address

from

To

Phone #:

Fax #:

Hourly Rate/ Salary

Starting | Final

Job Title:

Supervisor Name:

I was subject to FMCSR rules while employed at this company:

YES

NO

Reason for Leaving

My job was designated as a safety sensitive subject to 49 CFR Part 40

YES

NO

2. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To

Phone #: Fax #: Hourly Rate/ Salary

Starting | Final

Job Title:

Supervisor Name: I was subject to FMCSR rules while employed at this company:

YES

NO

Reason for Leaving


YES

NO

3. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

4. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

NH-4.2


EMPLOYMENT EXPERIENCE CONTINUED

List names and addresses where you were employed during the last 10 years. **You must include the complete address including street, city, state, zip code and phone number**

5. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

6. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

7. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

8. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

9. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

10. Past Employer


(mm/dd/yyyy)

Work Performed

Address

from To


Starting | Final

Job Title:


YES

NO

Reason for Leaving


YES

NO

NH-4.3


TRAFFIC VIOLATIONS- LAST 3 YEARS List all motor vehicle laws or ordinances (other than violations involving only parking) of which you were convicted or forfeited bond or collateral during the 3 years preceding the date of this application. If NONE: check box No-violations in past 3 years. Date Violation Location-City and State In CMV-

( check box)

Yes No

Yes No

Yes No

Yes No

REVOCATIONS AND SUSPENSIONS Have you had a license, permit or privilege to operate a motor vehicle denied, revoked or

suspended? No Yes If yes, give facts and circumstances in detail.

Date Violation Explanation

Date Violation Explanation

SPECIAL SKILLS AND QUALIFICATIONS Summarize special job-related skills and qualifications acquired from employment and other experience.

Note: Previous employer(s) may be contacted and information provided may be used to investigate the applicant’s background. Per 391.23(i), (due process rights) the employee can request information received as part of the background investigations completed.

(i)(1)(i) The right to review information provided by previous employers; (i)(1)(ii) 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 the prospective employer; (i)(1)(iii) 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. (For a more detailed explanation of the driver’s rights please see FMCSR 391.23)

“This certifies that the application was completed by me, and that all entries on it and information contained in it are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in dismissal. I authorize CSC Transportation LLC to make an investigation of any of the facts set forth in this application.” All offers of employment are conditional upon satisfactory reference checks. Successful completion of a physical exam and drug test is required for certain classifications. By signing this form I authorize CSC Transportation LLC to obtain a Motor Vehicle Report pursuant to §391.23 requirements. __________________________________________ __________________ Applicant’s Signature Date

NH-4.4



RECORD OF VIOLATION (§391.27) & REVIEW OF MOTOR VEHICLE RECORD (§391.25)

Each motor carrier shall 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/she has forfeited bond or collateral during the preceding 3 years (at the time of employment) and then at least once every 12 months thereafter. By signing this form I authorize CSC Transportation LLC to obtain a Motor Vehicle Report pursuant to §391.25 requirements.

COMPLETED BY DRIVER - CERTIFICATION OF VIOLATIONS

Legal Name of driver (please print)

Employee ID Number & SSN

Birth Date

Driver’s License Number

License Expiration Date Hire Date State

Check box if you have no violations in the past twelve months *If new driver applicant or transfer to active-need to complete for the past 3 years including last year. Date Offense Location Type of Vehicle

I certify, by not listing any violations above, that I have not been convicted, forfeited bond, or collateral on account of any violation.

Driver’s Signature: ______________________________________ Date: _____________________

COMPLETED BY COMPANY – ANNUAL & INITIAL REVIEW OF MVR RECORD

CSC Transportation LLC, shall, review the motor vehicle record of each driver employed to determine if that driver meets minimum requirements for safe driving. In reviewing a driving record, CSC Transportation LLC must consider any evidence that the driver has violated applicable provisions of the FMCSR. CSC Transportation LLC must also consider the driver’s accident record and any evidence that the driver has violated laws governing the operation of motor vehicles, and must give great weight to violations, such as speeding, reckless driving, and operation while under the influence of alcohol or drugs, that indicate that the driver has exhibited a disregard for the safety of the public. The review shall determine if the driver is disqualified to drive a motor vehicle pursuant to §391.15 or §383.51 of the FMCSR. This review should occur at the time of employment (for the last 3 years of driving history) and at least once every twelve months thereafter.. (Please include a copy of the MVR results with this review process.)

On _________________, 20___, I reviewed the driving record of the above name driver in accordance with Section §391.25 of the FMCSR and find that this driver; (Check One):

Meets minimum requirements for safe Driving

Is disqualified to drive a motor vehicle pursuant to Section §391.15 or §383.51 of the FMCSR.

Reviewed

by: Signature Date

Printed name Title

NH-5

Location:



TRUCK DRIVER DATA & EMPLOYMENT STATUS- DRIVER DATA SHEET

Driver’s Legal Name:

Effective

Date of

Change:

Location: License

Number License

Type Issuing

State: SSN

Home

Address

City: State Zip Code:

Person Completing Form:- Management Phone: Fax:

Please check reason for preparation of this form and include location above: * Upon return new forms may be needed; to bring driver back into compliance.

New HireDOT Driver: Pre-employment drug-screening is necessary. Fill in hours of service below ++. HR Define check: NOT added to DOT D&A Program ADDED to CDL DOT Random D&A Program

Re-Employed Driver*: Pre-employment drug screening is necessary. Fill in hours of service below++. HR Define check: NOT added to DOT D&A Program ADDED to CDL DOT Random D&A Program

Transfer TO Driver Status*: Transferred from other duties. Pre-employment drug screening is necessary. HR Define check: NOT added to DOT D&A Program ADDED to CDL DOT Random D&A Program Fill in hours of service below ++New Location Transferred to: ___________________________________

Transfer FROM Driver*: Not presently driving; performing other duties within CSC Transportation LLC employment; HR Define check; Was NOT subjected to DOT D&A Program REMOVED driver from CDL Random D&A Program

Termination of Driver: Permanent Layoff* Suspension* until _______________________

Medical Leave*: Driver on long term medical leave until _________________. HR Define check; Was NOT subjected to DOT D&A Program REMOVED driver from CDL Random D&A Program *Upon return new forms may be needed; to bring driver back into compliance.

Military Leave*: Driver on active military duty until _____________________. HR Define check; Was NOT subjected to DOT D&A Program REMOVED driver from CDL Random D&A Program *Upon return new forms may be needed; to bring driver back into compliance.

Other*:

HOURS OF SERVICE (§395.8(j)(2)) ⋆ Complete all sections below if the above named employee starts driving and/or returns to driver status for our company. ⋆⋆ All hours worked, (Includes all paid employment/compensation time) and dates in any employment status during the past 7 consecutive days must be recorded. ++Please record below the information for the 7 days prior to becoming (or beginning driving) for this employer. If your employment hours were zero for some reason please note reason under employer’s name.++

**Total hours worked last seven days (7 consecutive) - prior to driving for company initially or returning to driver status- REQUIRED DAY 1 2 3 4 5 6 7 TOTAL Hours DATE (00/00/00)

XXXXXXXXXXXXXXXXX

HRS WORKED

List employers name below for the hours listed for the last 7 days. If no employer name applies: write in reason (example) unemployed.

Employer’s name:

Address:

City, State, Zip I hereby certify the information provided above is correct to the best of my knowledge and belief. Driver Signature: _____________________________________ date: _____________________ Supervisor/Witness: ____________________________________ date ______________________

NH-6



DRIVER’S ROAD TEST EXAMINATION/ CERTIFICATE OF ROAD TEST

CHECK THIS BOX WHEN COMPANY WAIVES-ROAD TEST REQUIREMENT (§391.33) **Driver MUST HAVE A CDL License for this exception: with a copy of DL license must be attached Plus: (Signature & Date required below- by company management in order to waive requirement)

Driver’s Legal Name Social Security #:

Driver’s License Number: License Class: State Issue:

Straight Truck Tractor Trailer School Bus Coach Other___________________

Power Unit Type and # : __________________________Trailer Type and #: ______________

If passenger carrier, type of bus: __________________________________________ Capacity:______ **Fill in passed or unsatisfactory for each category.

RATING OF PERFORMANCE

PLACE AN -P- FOR PASSED AND A -U- FOR UNSATISFACTORY. ALL UNSATISFACTORY PERFORMANCES MUST BE DETAILED IN THE REMARKS SECTION.

The pre-trip inspection (As required by Section §392.7)

Coupling and uncoupling of combination units, if applicable.

Placing the equipment in operation.

Use of vehicle’s controls and emergency equipment.

Operating the vehicle in traffic and while passing other vehicles.

Turning the vehicle.

Braking, and slowing the vehicle by means other than braking.

Backing, and parking the vehicle.

**More detailed road test next page- use as guidance to determine if driver meets all requirements. Remarks: Mileage started: __________ Mileage ended:__________ TOTAL Miles Traveled*_____________*

CERTIFICATE of ROAD TEST 391.31 This certifies that the above-named driver completed a road test under my supervision on date (as printed below) consisting of approximately *__________ miles of driving. It is my considered opinion that this driver possesses sufficient driving skill(s) to operate safely the type of commercial motor vehicle listed above for our company, CSC Transportation LLC. PRINTED name of examiner OR PRINTED name of Management with authorization to waive road test

*DATE –fill in date

ROAD TEST EXAM CERTIFIED

Miles traveled are REQUIRED to be filled in

DATE –fill in date WAIVING ROAD TEST CDL

ID LICENSE PROOF REQUIRED

SIGNATURE __________________________________________ TITLE_____________________

NH-7

Location:


PART 1: PRE-TRIP INSPECTION yes no n/a

checks general condition as approaches unit looks for leakage of fuel, oil, and coolants checks fluids, steering, all under hood conditions checks horn, windshield wipers, lights, body, doors, brake & electrical lines, flashers, trailer connections tests all brakes, tractor protection valve checks for jacks, tools, chains, spare fuses, warning triangles, fire extinguisher, first aid kit checks instruments checks windows, windshield, lights, mirrors etc.

PART 2: PLACING THE VEHICLE IN MOTION yes no n/a Motor: starts motor without difficulty utilizes proper warm-up period comprehends instrumentation maintains proper engine speed under load know what type of fuel to use: gas or diesel does not abuse the engine yes no n/a Transmission: starts loaded unit smoothly uses clutch properly shifting is smooth & timely uses proper gear sequence yes no n/a Brakes: tests brakes before starting drive understands principle of air brakes knows use of tractor protection valve understands low air warning yes no n/a Lights: knows lighting regulations uses proper headlight beam dims lights when meeting/following adjusts speed to range of headlights proper use of auxiliary lights controls the steering wheel maintains good posture and grip on the wheel

PART 3: BACKING AND PARKING yes no n/a Backing: gets out and checks first looks back and uses mirror gets out and rechecks conditions on long backs signals when backing controls direction and speed while backing yes no n/a Parking (city driving): does not hit objects proper distance from curb sets parking brake, puts in gear, turns off, chocks checks traffic and signals upon existing parks in safe, legal location yes no n/a Parking (rural): parks off pavement avoids soft shoulder uses emergency warning signals secures unit properly

PART 4: COUPLING AND UNCOUPLING yes no n/a (tractor/ trailer) lines up tractor and trailer connects brake and electrical lines secures trailer from movement backs under trailer slowly checks hookup visually tests hookup with power handles landing gear properly proper hookup of full trailer secures tractor against moving

Must Complete- road test form and certificate-NH--7

PART 5: SLOWING & STOPPING yes no n/a

uses ascending gears properly uses descending gears properly stops and restarts without rolling backwards tests brakes at the top of hills before going down uses brakes properly on grades uses mirrors to check following traffic signals intentions to following traffic avoids sudden stops stops smoothly stops before exiting an alley or driveway stops clear of pedestrian crosswalks

PART 6: OPERATING IN TRAFFIC yes no n/a Turning: gets into proper lane well in advance signals intentions well in advance checks traffic conditions and turns only when safe does not cut short or swing wide in turns yes no n/a Traffic signs & signals approaches signal ready to stop as needed obeys all traffic signals uses good judgement on yellow lights watched for pedestrians smooth start on green light observes and obeys traffic signs comes to full halt at "STOP" signs yes no n/a Intersections: allows an adequate clear space for a safe pass does not attempt passing in unsafe areas does not tailgate signals before changing lanes to pass does not impede other traffic with a slow pass does not exceed the speed limit during a pass allows adequate clearance when returning yes no n/a Passing: adjusts speed to allow stopping if needed checks for cross-traffic yields right-of-way as needed for safety keeps to the right and in own lane uses the horn only when necessary

PART 7: MISCELLANEOUS yes no n/a General Driving Ability & Habits consistently alert and attentive adjusts driving to meet changing conditions keeps eyes on road during routing functions checks instruments regularly while driving accepts suggestions and instructions self-confident in his/her driving skills other drivers frustrate or cause issues *Cell phone use during operating vehicle *Vehicle pulled to a safe location-for cell phone use

PART 8: POST-TRIP INSPECTION yes no n/a Completes Post-trip Inspection

service brakes, including trailer brake connections parking brake steering mechanism lighting devices and reflectors tires horn windshield wipers rear vision mirrors coupling devices wheels and rims emergency equipment

Results: PASSED FAILED RETEST date _________

Signature of evaluator_______________________________

NH-7.2



PART §382CONTROLLED SUBSTANCES AND ALCOHOL USE TESTING & WRITTEN POLICY RECEIPT

CHECK BOX IF DRIVER DOES NOT OPERATE A COMMERCIAL MOTOR VEHICLE AS DEFINED BY PART §382

§382.107 Commercial motor vehicle means a motor vehicle or combination of motor vehicles used in commerce to transport passengers or property if the motor vehicle

(1) Has a gross combination weight rating of 11,794 or more kilograms (26,001 or more pounds) inclusive of a towed unit with a gross vehicle weight rating of more than 4,536 kilograms (10,000 pounds); or

(2) Has a gross vehicle weight rating of 11,794 or more kilograms (26,001 or more pounds); or

(3) Is designed to transport 16 or more passengers, including the driver; or

(4) Is of any size and is used in the transportation of materials found to be hazardous for the purposes of the Hazardous Materials Transportation Act and which require the motor vehicle to be placarded under the

Hazardous Materials Regulations (49 CFR part 172, subpart F).

I completed the Controlled Substances and Alcohol Use and Testing-training program provided by my employer, CSC Transportation LLC, in accordance with the provisions outlined in CFR 49, Part 40 and Part §382. I reviewed the Controlled Substances and Alcohol Use Policy of CSC Transportation LLC. As required by §382.601(b)(1-11) the following items were discussed: • Abbreviations and definitions • Who is covered by the Alcohol and Drug rules found in Part §382? • What is a safety sensitive function? • What are the Alcohol and Drug prohibitions? • Which tests are required and when will I be tested?

1. pre-employment 2. post-accident 3. random 4. reasonable suspicion 5. return-to-duty and follow-up

• What happens if I refuse to be tested? • How is Alcohol and Drug testing done? • What are the consequences of violating the Alcohol or Drug prohibitions--test positive? • Where can I go for help? Who can answer my questions about Alcohol and Drugs? • What are the effects of Alcohol and Drugs use on health, work and personal life?

CHECK BOX DRIVER RECEIVED A COPY OF THE COMPANY’S, CSC Transportation LLC, WRITTEN DRUG POLICY Part

§382.601(d)

___________________________________________________________________________________________________________ Driver’s Legal Signature

_______________________________________________ _ Driver Printed Name

_________________________________________________ Date –acknowledgement & completing D&A training and receipt of company policy

NH-8

Location:



CERTIFICATE OF LICENSE COMPLIANCE AND DRIVER NOTICE Instructions: All drivers must read the notice and complete the certificate of compliance at time of hire. The completed certification is a permanent item of driver qualification file. NOTICE TO DRIVERS

1. No driver may possess more than one license, and no motor carrier may use a driver having more than one license.

2. A driver convicted of a traffic violation (other than parking) must notify the motor carrier AND the state that issued the license to that driver of such conviction within 30 days.

3. If your driver’s license is suspended, revoked, or canceled, you must notify your supervisor no later than the end of the next working day following notification of driver’s license suspension, revocation, or cancellation. Failure to do this may result in termination. You must never drive a company vehicle without a valid driver’s license, if you do so, you may be terminated.

4. Any person applying for a job as a commercial vehicle driver must inform the prospective employer of all previous employment as a driver of any and all commercial motor vehicle (over 10,000 lbs.) for the past 10 years, in addition to any other required information about the applicant’s employment history.

5. You are responsible for renewing your driver’s license so that you never drive a company vehicle with an expired driver’s license. You must notify your supervisor immediately if your license expires and is not renewed.

CERTIFICATION BY DRIVER

I hereby certify that I have read and understand the above driver provisions and agree to comply with all aspects of this notice per our company policy.

By signing this form, I further certify that the vehicle license listed below is the only one (license) I currently hold.

driver’s legal name: (print)

social security number or EID

driver’s address Present address, Include street, city, state & zip code PLEASE PRINT CLEARLY

license state: license type/ class license number:

driver’s signature: date:

Any additional licenses held, have been surrendered to the states listed below.

surrendered license to: state type/class license number

surrendered license to: state type/class license number

NH-9

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EMPLOYEE AUTHORIZATION AND COMPANY REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER (§382.413, §383.35, §390.15, §391.23)

** REQUESTS FOR INFORMATION ARE TO ALL PREVIOUS EMPLOYERS IS MANDATORY PER FMCSR FOR THIS APPLICANT, RESPOND TO THIS REQUEST FOR INFORMATION WITHIN 30 DAYS. FAILURE TO COMPLY WITH REQUEST IS IN VIOLATION OF 49CFR391.23 AND 40.25, FOR WHICH YOU MAY BE PROSECUTED.

I hereby authorize you to provide CSC Transportation LLC with the following information regarding my Alcohol and Controlled Substances Testing results, services, character, and conduct while in your employ. You are released from any and all liability, which may result from furnishing such information. A photocopy of this authorization is to be considered as valid as the original.

________________________________________________________________ ____________________________ Applicant signature Date To: From:

CSC Transportation LLC Attn: Doreen Dintelman

10733 Sunset Office Drive, Suite 260 Sunset Hills, MO 63127

FAX #_________________________________________ Return FAX#____________________________________

Applicant name:

SSN: The above referenced individual has made application to CSC Transportation LLC, as a company driver. To comply with §382.413,

§390.15; §391.23, and §383.35 of the Federal Motor Carrier Safety Regulations, we must investigate the employment record, accidents and Alcohol and Controlled Substance Testing record of the applicant. Your reply will be held in strict confidence

*Did the applicant work for you as __________________? From ___/____/___ to ____/_____/____ **YES NO (check one) if NO, please explain____________________________________

*Did applicant drive a motor vehicle(s) for you? YES NO

(check one) Passenger Van Bus Straight Truck Tractor-Trailer Other: ____________

*Was applicant involved in any accidents? (check one) YES NO IF yes, please provide a

short description of accident(s) w/ dates_____________________________________________.

*Reason for leaving your employ: Discharged Laid Off Resigned Other_____________

*Would you rehire this employee at a later date? (check one) YES NO ==================================================================================== INQUIRY FOR ALCOHOL AND CONTROLLED SUBSTANCES INFORMATION DURING THE PAST 3 YEARS-(by past employer) Information about the above named applicant YES NO IF YES, PLEASE PROVIDE DATE:

*Alcohol test with a result of 0.04 or greater?

* Verified positive controlled substances test results?

*Refusals to be tested?

*Was rehabilitation completed as required?

Our company did not complete Drug and Alcohol testing per FMCSA DOT – Part 40 and 382 requirements; during the past 3 years, on this former employee.

If you answered yes to any of the above questions, please provide the name, address and telephone number of the Substance Abuse Professional on the back of this form. Also, please use the back of the form for any additional information you would like to provide. Signature: ____________________________ Position: ____________________ Date: ____________

To be completed by the present employer after completion by previous employer

CSC Transportation LLC representative (name/date) that closed this background check is on

CSC Transportation LLC received and closed this background check – form needs to include signature and date from previous employer completed above.

After “good faith effort” by CSC Transportation LLC this form was not received from the previous employer. (include documentation showing attempts)

NH-10

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DOCUMENTATION FOR GAP-IN-TIME FOR PREVIOUS EMPLOYMENT CHECK VERIFICATION

Applicant Name:_________________________ Social Security #: _______________________

The above referenced individual has made application to CSC Transportation LLC as a truck driver. To comply with §382.413, , §390.15; §391.23, and §383.35 of the Federal Motor Carrier Safety Regulations, we must investigate the employment record, accidents and Alcohol and Controlled Substance Testing record of the applicant. Due to the information provided by this driver on their application and/or the time period from a completed previous employer check did not reflect the information as provided on the application, the employment history shows a “GAP IN TIME”.

Please have the driver fill out this form to address the time period in question. ***************************************************************************************

GAP IN TIME VERIFICATION TO BE COMPLETED BY DRIVER ONLY

(ONLY 1 SET OF DATES PER FORM)

DATES NEED VERIFIED:

FROM - TO

REASON FOR GAP-IN-TIME IS DUE TO THE FOLLOWING INFORMATION: ________________________________________________________ ________________________________________________________

________________________________________________________

DATE FORM COMPLETED :_________________________________

DRIVER NAME(printed) : _______________________________ DRIVER SIGNATURE:__________________________________

************************************************************************************* *Management has reviewed the above information - this driver has provided for Good Faith Effort requirements.

SUPERVISOR SIGNATURE : ______ __________________________

SUPERVISOR -DATE COMPLETED : _____________________________

NH-11

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•√ SEND IN THESE REQUIRED FORMS WITH NEW HIRE PACKET

CHECK BOX (Pre-employment results) Reminder to attach a copy of the Negative Results for the Pre-employment Drug Test

CHECK BOX (MVR-motor vehicle report) Reminder to attach a copy of the MVR (motor vehicle report) for initial driving review with the NH-5 form and then yearly thereafter.

CHECK BOX (Driver’s License-both sides)

Reminder to attach a legible copy of your Current Driver’s License (both sides)

CHECK BOX (DOT Medical Card) Reminder to attach a legible copy of your Current FMCSR D.O.T. Medical Card showing the date of the exam and the expiration date for the physical. NH-14 verification of National medical doctor confirmation completed. *CDL HOLDERS- additional MVR/SLA confirmation documentation showing FMCSA compliance is required. Please mark top of MVR CDL-MEDICAL-MVR this is separate from MVR for driving record review and initial compliance of NH-5 form. Some states are issuing separate SLA forms. CHECK BOX (FMCSR receipt) Reminder to attach a copy of FMCSR Handbook Receipt Thank you for your assistance. Please review your packet at this time to make

sure you have signed and dated all necessary paperwork. If the paperwork is not completed correctly it will be returned for additional information.



Medical Examiner’s National Registry Verification

Motor Carrier Instructions: The requirement to include verification of the medical examiner’s National Registry listing in the driver qualification file was published in the Federal Register on April 20, 2012. Effective May 21, 2014, motor carrier must verify the medical examiner who signed the driver’s (as name listed below) medical card is listed on the National Registry; as of the date listed below –signed by this carriers’ representative. This requirement is prescribed in §391.23 (m)(1) and §391.51(b)(9) §391.23(m)(1) The motor carrier must obtain an original or copy of the medical examiner’s certificate issued in accordance with §391.43, and any medical variance on which the certification is based, and, beginning on or after May 21, 2014, verify the driver was certified by a medical examiner listed on the National Registry of Certified Medical Examiners as of the date of issuance of the medical examiner’s certificate, and place the records in the driver qualification file, before allowing the driver to operate a CMV. 391.51(b)(9) A note relating to verification of medical examiner listing on the National Registry of Certified Medical Examiners required by §391.23(m). Motor Carrier Verification: The following medical examiner has been verified as being listed as being listed on the National Registry of Certified Medical Examiners as of the date of issuance of the medical examiner’s certificate for the named driver. Note website address: https://nationalregistry.fmcsa.dot.gov/NRPublicUI/home.seam

Drivers Name: ________________________________________________________

Driver Identification Number (found on card): _______________________________

Medical Examiner: _____________________________________________________

Medical Examiner National Registry Number: _____________________________

Motor Carrier: CSC TRANSPORTATION LLC

Motor Carrier Address: 920 Second Ave South, Minneapolis, MN 55402

Verified By: _________________________________Date: _____________________

Motor Carrier Representative Signature (This information is required for DOT Compliance)

**Please send this NH-14 form along with the new medical card for all CMV drivers.**

Carriers: For any CDL holder; please request a new separate MVR/SLA report to verify CDL MEDICAL compliance has been completed by CDL driver and state, (mark top of form;CDL-MVR) send this separate MVR/SLA report along with this NH-14 into Fleet Team Services for data entry. **Carriers this NH-14 form and the additional MVR/SLA report form must be completed within 15 days of the issue date of the DOT medical exam.

Check this box showing proof carrier representative verified and asked the above named CDL holder if the CDL driver updated their new medical card at their state licensing agency (SLA) (within 10 days of examination date)

Carrier/Management add your initials showing a new motor vehicle (MVR) or SLA report has

been processed and shows new medical card expiration date on the current MVR or SLA paperwork attached to this form. Send in new Medical card, NH-14 and MVR/SLA report to Fleet Team Services.

NH-14-Medical-NRV

Location:

ONLY FOR CDL HOLDERS (below)-must complete additional requirements for compliance

https://www.kelleronline.com/Reference/%20%20%20%20%20%20%20%20%20%20%20%20javascript:DoLink('r49CFR391.43');

https://www.kelleronline.com/Reference/%20%20%20%20%20%20%20%20%20%20%20%20javascript:DoLink('r49CFR391.23-m-1');

https://nationalregistry.fmcsa.dot.gov/NRPublicUI/home.seam


CSC TRANSPORTATION LLC ***Driver keep this copy for your records- not part of the DQ file.**

YOUR DRIVER’S RIGHTS – DUE PROCESS RIGHTS

FMCSA Rules -Any DRIVER/APPLICANT hired by your company, can if desired, request to review the information provided by his/her previous employer(s) and can contest the information.

DUE PROCESS RIGHTS 1) The right to review information provided by previous employers (§391.23(i)(2)); 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 the prospective employer; (§391.23(j)(1) 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. (§391.23(j)(3)

The prospective motor carrier must investigate, at a minimum, the information listed in this paragraph from all previous employers of the applicant that employed the driver to operate a CMV within the previous three years. The investigation request must contain specific contact information on where the previous motor carrier employers should send the information requested.

1) The prospective employer will still have only 30 days to complete ALL previous employer checks. The following information must be on each previous employer check.

2) Previous employers must respond to the request within 30 days, and MUST KEEP A RECORD OF THE RESPONSE FOR ONE YEAR. If a previous employer does not RESPOND within 30 days they risk being reported to the FMCSA per 386.12.

3) If the prospective employer does not receive a response within this 30 Days from the past employer there needs to be a written record and documentation showing the actual attempts to receive the information.

Exception: For a drivers with no previous employment experience working for a DOT regulated employer during the preceding three years, documentation that no investigation was possible must be placed in the driver history investigation file, after October 29, 2004, within the required 30 days of the date the driver's employment begins.

Definition of previous employer: Previous employer means any DOT regulated person who employed the driver in the preceding 3 years, including any possible current employer.

**§ 391.23(g) previous employers must: (1) Respond to each request for the DOT defined information in paragraphs (d) and (e) of this section within 30 days after the request is received. If there is no safety performance history information to report for that driver, previous motor carrier employers are nonetheless required to send a response confirming the non-existence of any such data, including the driver identification information and dates of employment. (2) Take all precautions reasonably necessary to ensure the accuracy of the records. (3) Provide specific contact information in case a driver chooses to contact the previous employer regarding correction or rebuttal of the data. (4) Keep a record of each request and the response for one year, including the date, the party to whom it was released, and a summary identifying what was provided. The prospective employer must expressly notify the driver of their “DUE PROCESS RIGHTS” regarding the investigative information provided by previous employers prior to any hiring decision.

HOW DOES A DRIVER OBTAIN A COPY TO REVIEW THE PREVIOUS EMPLOYER- INFORMATION? Drivers who wish to review previous employer-provided investigative information must submit a written request to the prospective employer which may be done at any time, including when applying or as late as 30 days after being employed or being notified of denial of employment.

The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business days deadline will begin when the prospective employer 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 the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records.


***Driver keep this copy for your records- not part of the DQ file.** WHAT HAPPENS WHEN THE DRIVER AND THE PREVIOUS EMPLOYER DISAGREE WITH THE INFORMATION RECEIVED BY THE PROSPECTIVE EMPLOYER?

DRIVERS wishing to request correction of erroneous information in records received must send the request for the correction to the previous employer that provided the records to the prospective employer.

The previous employer must either correct and forward the information to the prospective motor carrier employer, or notify the driver within 15 days of receiving a driver's request to correct the data that it does not agree to correct the data.

IF THE CORRECTIONS ARE MADE BY THE PREVIOUS EMPLOYER THEN:

1) Previous employer corrects and forwards the data as requested. 2) Previous employer must also retain the corrected information as part of the PAST driver's safety performance history record. 3) Previous employer must provide this same information to any future prospective employers when requests for this information are received. 4) If the previous employer corrects the data and forwards it to the prospective motor carrier employer, there is no need to notify the driver.

IF THE CORRECTIONS MADE ARE STILL AN ISSUE WITH THE DRIVER THEN:

DRIVERS wishing to rebut the previous employer corrections of the information must send the rebuttal to the previous employer with instructions to include the rebuttal in that driver's safety performance history.

Within five business days of receiving a rebuttal from a driver, the previous employer must: 1) Forward a copy of the rebuttal to the prospective motor carrier employer; 2) Append the rebuttal to the driver's information in the carrier's appropriate file, to be included as part of the response for any subsequent investigating prospective employers for the duration of the three-year data retention requirement. 3) The driver may submit a rebuttal initially without a request for correction, or subsequent to a request for correction. 4) The driver may report failures of previous employers to correct information or include the driver's rebuttal as part of the safety performance information, to the FMCSA following procedures specified at § 386.12.

(k)(1) The prospective motor carrier employer must use the information described in paragraphs (d) and (e) of this section only as part of deciding whether to hire the driver.

(2) The prospective motor carrier employer, its agents and insurers must take all precautions reasonably necessary to protect the records from disclosure to any person not directly involved in deciding whether to hire the driver. The prospective motor carrier employer may not provide any alcohol or controlled substances information to the prospective motor carrier employer's insurer. (l)(1) No action or proceeding for defamation, invasion of privacy, or interference with a contract that is based on the furnishing or use of information in accordance with this section may be brought against? (i) A motor carrier investigating the information, described in paragraphs (d) and (e) of this section, of an individual under consideration for employment as a commercial motor vehicle driver, (ii) A person who has provided such information; or (iii) The agents or insurers of a person described in paragraph (l)(1)(i) or (ii) of this section, except insurers are not granted a limitation on liability for any alcohol and controlled substance information. (2) The protections in paragraph (l)(1) of this section do not apply to persons who knowingly furnish false information, or who are not in compliance with the procedures specified for these investigations.

PRIVACY AND SECURITY: To protect drivers’ privacy and security, the file must be maintained in “a secure location with controlled access.” (§391.53(a)) This is the same phrase used to describe recordkeeping requirements for drug/alcohol files, and means that the files must be secured against access by unauthorized persons.

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