PLEASE READ AND SIGN BELOW
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if
employed, falsified statements on this on this application shall be grounds for my dismissal. I authorize investigation of all
statements contained herein and references listed to give you any and all information concerning my previous employment and
release all parties from liability for any damage that may result from furnishing same to you. I understand that this employment
application does not constitute a contract of employment, and that, if hired, my employment is for no definite period and may
be terminated at any time for any or no reason without notice. I authorize Grade A Site Works to request and obtain my law
enforcement and motor vehicle records fir considering my application for employment. I understand that as a DOT employer,
Grade A Site Works is required to obtain specific past employment and drug and alcohol-testing information as outlined below.
I acknowledge that any offer of employment is conditional upon my successful completion of a DOT physical examination and
drug screen as part of Grade A Site Works pre-employment policy. I further understand that if employed I will be subject to
alcohol and/or drug testing for random, post-accident, return to duty, and reasonable cause as part of Grade A Site Works
Substance Abuse Policy.
Grade A Site Works complies with Federal Motor Carrier Safety Regulations and, therefore, must investigate, at minimum,
information from all previous employers that employed you to operate a commercial motor vehicle within the previous three
years. The investigation request will contain general driver identification and employment verification information and data for
accidents as defined by the regulations in the three-year period preceding the date of the employment application. Grade A
Site Works must also request information from all previous DOT regulated employers that employed you within the previous
three years from the date of the employment application in a safety sensitive function that required alcohol and controlled
substance testing specified by 49 CFR part 40 of the regulations. The investigation request will include whether, within the
previous three years, you had violated the alcohol and controlled substances prohibitions under the regulations and whether
you failed to undertake or complete a rehabilitation program prescribed by a substance abuse professional (SAP) pursuant to
the regulations. If the previous employer does not know this information, Grade A Site Works must obtain documentation of
your successful completion of the SAP’s referral directly from you. For a driver who had successfully completed a SAP’s
rehabilitation referral, and remained in the employment of the referring employer, information on whether the driver had the
following testing violations subsequent to a completion of a referral must be obtained: alcohol tests with a result of 0.04 of
higher alcohol concentration; verified positive drug tests; refusals to be tested (including verified adulterated or substituted
drug test result).
The following are your rights regarding the investigative information outlined above that is obtained by Grade A Site Works:
- The right to review information provided by previous employers;
- The right to have errors in the information corrected by the previous employer and for that previous employer to
resend the corrected information to the prospective employer;
- 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.
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to
the best of my knowledge.