CDL Employment Application

Choose from list below.

Skip this question if not referred by a Spike Enterprise employee.

Enter as: street address, city, state, zip code.
Skip this question if you have lived at your current address for at least three years.

Skip this question if you did not choose "Other".

The Federal Motor Carrier Safety Regulations ("FMCSA") (49 CFR 391.21) requires that all applicants wishing to drive a commercial motor vehicle list all employment for the last three years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for and additional 7 years (for a total of ten years). Any gaps in employment in excess of one month must be explained.

Start with the last or current position, including any military experience, and work backwards. You are required to list the complete mailing address, including: street number, city, state, zip, and complete all other information and questions.

* Any gaps in employment in excess of one month and/or unemployment must be explained *

Employment history for jobs #2 through #4 are required only if your most recent employment was less than three years.

Provide additional information if you meet any of these criteria:

1) If you have previously driven a motor vehicle, you must provide employment history for an additional seven years (for a total of 10 years).

2) If you have had more than 3 jobs in the three years prior to this application, you must provide your employer information for these additional jobs.

3) If you have had any gaps in employment in excess of one month in the three years (or 10 years, if applicable) prior to this application, you must explain.

Select the CDL endorsements that apply to you.

List any driver's licenses held in the last three years.
Include:
State, license number, type, expiration date for each commercial motor vehicle or CDL license or permit issued to you.

Skip question if no Straight Truck experience.

Skip question if no Tractor and Semi Trailer experience.

Skip question if no Tractor and Two Trailers experience.

Skip question if no Tractor and Tanker experience.

Skip this question if you did not choose "Other" as a class of equipment driving experience.

Skip this question if you did not choose "Other" as a class of equipment driving experience.

Skip this question if you did not choose "Other" as a class of equipment driving experience.

Select years below.

Select number of accidents below.

Select number of fatalities below.

Select number of injuries below.

Skip question if you have not had any accidents in the three years preceding this application.

Select number of violations below.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Skip this question if you have not had any violations with three years of this application.

Have you ever had a license, permit, or privilege to operate a motor vehicle denied, revoked or suspended?

Skip this question if your license, permit or privilege has never been revoked or suspended.

The Federal Motor Carrier Safety Regulations (49 CFR 391 Subpart E) require that all driver applicants pass certain medical examinations before they are hired to drive a motor vehicle.

Please enter your date of last Department of Transportation medical examination below.

Can you provide a copy of your last D.O.T. medical examination?

Have you ever been granted a waiver under section 391.49 of the Federal Motor Carrier Safety Regulations pertaining to the loss of a limb (i.e, foot, leg, hand, or arm)?

The Federal Motor Carrier Safety Regulations (49 CFR 40.25) requires all persons applying for a driving position requiring a commercial driver's license to answer the following question:

Within the last two years, have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work?

Within the last two years, have you ever tested positive, or refused to test, on any type of drug or alcohol test administered by an employer for which you performed safety-sensitive transportation work?

In connection with your employment or application for employment (or contract for services) and any future employment (or contract for services) with Spike Enterprise, Inc. ("Spike Enterprise") and any subsidiary, you may have information requested about you from a consumer reporting agency in connection with your application, employment, promotion, reassignment or retention as an employee, for employment purposes. This information may be obtained in the form of background reports and/or investigative reports. These reports may be obtained at any time after receipt of your signed authorization and, if you are hired by Spike Enterprise, throughout your employment if permissible under applicable Spike Enterprise policy and/or state law.

These reports may contain information about your character, general reputation and/or mode of living. The types of information that may be obtained include, but are not limited to: social security number verifications, address history, criminal records checks, public court records checks, driving records checks, employment history verifications: and professional licensing/certification checks. This information may be obtained from private and/or public records sources, including, as appropriate, governmental agencies and courthouses: educational institutions: former employers; or other information sources.

(End of disclosure statement)

I have carefully read, and understand, this Authorization of Background Investigation form and further acknowledge receipt of the separate document entitled "A Summary of Your Rights under the Fair Credit Reporting Act" (a copy provided by Spike Enterprise or at https://www.comsumer.ftc.gov/articles/pdf-0096-fair-credit-reporting-act.pdf) and the "Applicant FCRA Disclosure Statement" and certify that I have read and understand both documents. By my signature below, I consent to the release of background reports and/or investigative background reports prepared by a consumer reporting agency, to Spike Enterprise and its designated representatives and agents for the purposes of determining my eligibility for employment, retention, or other lawful employment purposes. I further consent to the release of such background reports and/or investigative background reports to essential partners of Spike Enterprise, including but not limited to: industrial safety councils, and owners and/or operators of industrial facilities for which I may be asked to work on the premises of such industrial facility. I understand that if Spike Enterprise offers me a conditional offer of employment, my consent will apply, and Spike Enterprise may obtain background reports throughout my employment if permissible under applicable Spike Enterprise policy and consistent with applicable state and federal law.

I understand that information contained in my employment application, or otherwise disclosed by me before, or during, my employment, if any, may be used for the purpose of obtaining background reports and/or investigative background reports. I also understand that nothing herein shall be construed as an offer of employment. I hereby authorize law enforcement agencies, educational institutions (including public and private schools/universities), information service bureaus, consumer reporting agencies, record/data repositories, courts (federal, state, and local), motor vehicle records agencies, my past or present employers, the military, and other information sources to furnish any, and all, information on me that is requested by the consumer reporting agency.

California Applicants Only:
I acknowledge receipt of a copy of California Civil Code 1786.22.
Pursuant to Section 1786.22 of the California Civil Code, you may view the file maintained on you by the consumer reporting agency during normal business hours. You may also obtain a copy of this file, upon submitting proper identification by appearing at the consumer reporting agency's offices in person, during normal business hours and on a reasonable notice, or by mail. You may also receive a summary of the file by telephone, upon submitting proper identification. The consumer reporting agency will have trained personnel available to explain your file to you, including any coded information. By signing below, you acknowledge receipt of California Civil Code 1786.22, available from Spike Enterprise Human Resources Department or
http://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=CIV&sectionNum=1786.22

New York Applicants Only:
I acknowledge receipt of a copy of Article 23-A of New York Correction Law.
By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law, available from Spike Enterprise Human Resources Department or at
https://www.labor.ny.gov/formsdocs/wp/correction-law-article-23a.pdf

By my signature below, I certify the information I provided on, and in connection with, this form is true, accurate, and complete. I agree that this Authorization form in original, facsimile, photocopy, or electronic (including electronically signed) formats, will be valid for any reports that may be requested by, or on my behalf of, Spike Enterprise.

California, Oklahoma and Minnesota:
You have the right to receive a copy of your background/investigative report by checking the box on the Authorization of Background Investigation form.

Massachusetts and New Jersey:
If we request an investigative background report, you have the right, upon written request, to a copy of the report.

Minnesota and Washington State:
If Spike Enterprise requests an investigative background report, you have the right, upon written request made within a reasonable period of time after your receipt of this disclosure, to receive from Spike Enterprise a complete and accurate disclosure of the nature and scope of the investigation requested by Spike Enterprise. Spike Enterprise will provide the disclosure of the nature and scope of the investigation either in five days after receiving your request or after requesting the investigative consumer report, whichever is later.

New York Applicants Only:
You have the right to request whether Spike Enterprise requested an investigative consumer report and, if so, Spike Enterprise will give you the name and address of the report's provider if other than the consumer reporting agency identified above. You have the right to inspect and receive a copy of any investigative consumer report requested by Spike Enterprise by contacting the consumer reporting agency identified above (or another organization identified by Spike Enterprise as the provider of an investigative consumer report) directly.

Washington State:
If Spike Enterprise requests an investigative background report, you have the right, up written request made within a reasonable period of time after your receipt of this disclosure, to receive from Spike Enterprise a complete and accurate disclosure of the nature and scope of the investigation requested by Spike Enterprise. You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

California, Minnesota or Oklahoma applicants may receive a free copy of any consumer report or investigative consumer report obtained on you if you check the box below.

To receive a free copy of any consumer report or investigative consumer report obtained on you enter your first name, middle initial, and last name below.

To receive a free copy of any consumer report or investigative consumer report obtained on you enter your street address, city, state, and zip below.

To receive a free copy of any consumer report or investigative consumer report obtained on you enter your social security number below.

To receive a free copy of any consumer report or investigative consumer report obtained on you enter your date of birth below.

To receive a free copy of any consumer report or investigative consumer report obtained on you enter your driver's license number followed by state of issue below.

To receive a free copy of any consumer report or investigative consumer report obtained on you enter your email address below.

Utah:
The Company will obtain written authorization from you before each time the Company obtains a separate or new consumer or investigative consumer report.

Authorization Form

I hereby authorize Spike Enterprise and its affiliates, its employees, collectively to release to my employer Spike Enterprise, Inc., my personal health information maintained by your office (e.g., information relating to the diagnosis, treatment, physical, drug and alcohol testing results, and health care services provided or to be provided to me and which identifies my name, address, social security number, Member ID number).

This authorization is valid from the date of my signature below and shall expire the day of my separation from employment with Spike Enterprise, Inc.

I understand that I have the right to revoke this authorization by providing written notice to your company or agency. I also understand that I have a right to have a copy of this authorization.

I further understand that this authorization is voluntary and that I may refuse to sign this authorization.

Employee drivers who are regulated by the Department of Transportation ("DOT") in the three (3) years preceding this Application have the following rights regarding the investigative information that will be provided to Spike Enterprise pursuant to FMCS Regulations:

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 Spike Enterprise or other prospective employers;
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.

If you have DOT regulated employment history in the previous three (3) years and wish to review previous employer-provided investigative information, you must submit a written request to Spike Enterprise, no later than thirty (30) days after your date of denial of employment or date of hire. Spike Enterprise will provide the information within five (5) business days of receiving the request. If the Company has not yet received the requested information, the five (5) business days does not begin until receipt of the information from your former employer. If you do not receive or pick up the requested records within thirty (30) days of the Company making the records available, your request to review the records will be deemed waived.

In accordance with the provisions of the Fair Credit Reporting Act (Public La 91-508) as amended by the Consumer Credit Reporting Act of 1996. I have been informed the Company will procure a motor vehicle report (MVR), criminal background check and reference checks, all of which are defined as a consumer report regarding my driving and background record to determine my suitability for work at the Company.

I understand that I have rights to request, in writing, the information pertaining to the nature and scope of the inquiry and a written summary of my rights under the Fair Credit Reporting Act. I understand that I may have additional rights under applicable state and federal laws.

I hereby authorize the Company to obtain this information. This authorization shall remain on file and shall serve as ongoing authorization for the Company to procure a motor vehicle report (MVR) and a criminal check which is defined as a consumer report at any time during my employment period. Any copy of this authorization shall have the same authority as the original.

Provision of employment restricting employee from divulging employer's trade secrets, vendor, customer, financial, and any other employee's confidential information.

I, (Employee) agree that any and all knowledge or information that may be obtained in the course of my employment with Spike Enterprise, Inc. with respect to the conduct and details of the business including all trade secrets, vendor, customer, financial, and any other employee's confidential information and including but not limited to the secret processes, formulas, machinery, etc. used by Spike Enterprise, Inc. in manufacturing its products will be forever held in confidence and be concealed from any competitor and all other person. That I, Employee, will not impart the knowledge acquired during my employment to anybody if I should at any time leave Spike Enterprise, Inc. If I, Employee, do so in violation Spike Enterprise, Inc. shall be entitled to an injunction by any competent court of equity enjoining and restraining him [her] and each and every other person concerned from continuance of employment, services or other acts in aid for the business of the rival company or concern. Nothing shall prevent him [her], upon the termination of the employment, in engaging in any occupation in which the processes, formulas, and other secrets of the employer will not be directly or indirectly involved.

In the event that the applicant agrees to accept a position with Spike Enterprise, Inc., the applicant and Spike Enterprise, Inc. agree that the employment relationship between Spike Enterprise, Inc. and the employee is in at "at will" relationship and that the employment relationship and compensation can be terminated, with or without cause, and with or without notice at any time, at the option of either Spike Enterprise, Inc. or the employee.

It is the policy of Spike Enterprise that after making a conditional offer of employment, but prior to an offer of employment the corporate office will check and verify the following information is correct and all necessary tests have been passed:
Pre-hire medical physical
Drug screen
Breathe alcohol test
Professional references
Education credentials
Employment history and past performance
Professional license or certification (if required)

Following records will be checked:
Criminal background check for last 7 years
Driving record
Commercial driver's license (if applicable)

Any material misrepresentation or omission on any employment application materials, including but not limited to the job application, or resume may be grounds for rejection of the application or termination of any subsequent employment with Spike Enterprise.

You are required to enter your social security number in this location as part of the Applicant Certification process.