Company Drivers

Employment History:

Please state all employment history in the past 3 years and Commercial Driving Experience for the past 10 years.

Background Screening Disclosure

A22, INC. (the “Company”) may request a comprehensive review of your background information from a consumer reporting agency in connection with your employment application and for employment purposes, including promotion, reassignment, or retention as an employee. Your background information may be obtained in the form of consumer reports and/or investigative consumer reports. These reports may be obtained at any time after receipt of your authorization and, if you are hired by the Company, throughout your employment. ESupervision.com, and its designated agents and representatives or another consumer reporting agency will prepare or assemble the reports. The scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: consumer credit, names and dates of previous/current employment, worker's compensation claims, criminal history records (from local, state, federal, international and other law enforcement agencies' records), sexual offender's lists, wants and warrants records, motor vehicle records, military records, educational verification, license verification, civil cases, OIG/GSA, OFAC/patriot act, any sanction lists, finger printing and drug testing. These reports may include information as to your general reputation, character, personal characteristics, mode of living, work habits, job performance and experience along with reasons for termination of past employment from previous employers. You may request more information about the nature and scope of any investigative consumer reports by contacting the Company. A summary of your rights under the Fair Credit Reporting Act is also being provided to you.

Authorization and Release

authorize the complete release of these records or data pertaining to me which an individual, company, firm, corporation, institution, school or university, law enforcement or public agency may have. I authorize the full release of the information described above, without any reservation, throughout any duration of my employment at the Company. I certify that all information provided below is true and accurate to the best of my knowledge. This authorization and consent shall be valid in original, facsimile (“fax”), or copy form. I understand that ESupervision's privacy practices can be found at https://esupervision.com.

IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with
A22, 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.

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.
LAST UPDATED 12/22/2015

Disclosure About a Background Check

A22 Inc may obtain one or more "consumer reports" about you from a consumer reporting agency for employment purposes. A "consumer report" is a background screening report that may include information about your criminal history, sex offender registry status, credit history, driving history, education history, employment history, professional licenses, name, social security number and other information about you. The information in a "consumer report" may bear on your character, general reputation, personal characteristics, and/or mode of living. "Employment purposes" includes evaluating you for employment, promotion, reassignment, or retention. The Federal Trade Commission's staff has said that the term may apply to employees, independent contractors, independent agents, and volunteers.

Authorization For Background Check

By signing below, you acknowledge that: (a) you received the following separate documents, (b) they are clear, conspicuous, and separate from any other documents, (c) you read and understood them, and (d) we may rely on them for one or more background investigations and resulting reports:

• Disclosure About Background Check on You
• Additional Notice About Investigative Consumer Reports
• A Summary of Your Rights Under the Fair Credit Reporting Act
• Additional Notice About Medical Information
• Additional Notices Under State Law (including any other documents it identifies)

By signing below, you (a) authorize and permit us (A22 Inc) to obtain "consumer reports" and "investigative consumer reports" about; (b) authorize any consumer reporting agency from whom we request those reports to obtain information about your from any public or private information source; (c) authorize anyone to provide information about you to that consumer reporting agency; (d) authorize and instruct that consumer reporting agency to provide those reports to us; (e) consent to those reports including results of fitness-for-duty assessments, drug tests, and alcohol tests; and (f) authorize us to share those reports with others for legitimate business purposes related to your application or relationship with us.

By signing below, you acknowledge that a fax, image, or copy of this authorization Is as valid as the original.

By signing below, you make these acknowledgments and authorizations to be valid for the duration of your application or relationship with us.

The following information is required by law enforcement agencies and other entities for identification purposes when checking records. It is confidential and will not be used for any other purpose. PLEASE PRINT LEGIBILY:

Hiring Process

First, we submit your information to our insurance for approval and it usually takes 1 business day before we receive an answer from them.

After receiving confirmation from the insurance, we will contact you to schedule an In-person interview. During the interview we will be performing road test, pre-trip inspection test and hours of service test. Next step would be pre-employment drug test. It usually takes 1-2 business days to receive results. After results are received you will receive a 2-3hours orientation course and will fill out required forms and documents. Finally, we will assign you a truck and then you will finally be ready for open road.

Usually, the hiring process takes 1-3 business days.

Please note: We only hire safe, professional and responsible drivers. You must have a smart phone with a camera so that you are able to professionally communicate with customers and company personal.

Submitting this application certifies that this form was completed by me and all entries and information on it are true and complete to the best of my knowledge. I authorize A22, Inc. to make investigations and inquires of my driving history and past employment. I hereby authorize A22, Inc. to check my MVR from DMV for review as part of the process of hiring me as a driver.