10895 171st Ave NW Elk River, MN 55330 (763) 441-2681  |  1-800-900-8157 toll-free

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APPLICATION FOR CONTRACT AND OWNER/OPERATORS

  1. Thank you for your interest in joining our team at LeFebvre Companies. Please take the time to thoroughly complete the application below and submit to be considered for employment.

    If you experience any issues please contact us so we may assist you.

    As an additional option to apply, you may also print this page and submit the application to us in the following methods:

    • Send Online: Print form, complete, and scan the application. Then return to this page, fill in only the required fields and attach the form to the document section of the online application then submit
    • Fax: Print form, complete, and fax application to 612-252-4699
    • Mail: Print form, complete, and mail application to LeFebvre Companies 10895 171st Ave NW Elk River, MN 55330

  1. THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability as a contractor. It is the policy of the company to provide an equal opportunity to all qualified persons without discrimination on the basis of sex, race, color, religion, age, national origin, citizenship, disability, veteran status, or any other status protected under local, state or federal law. It is also the policy of the company to have the option of conducting pre-contract screening before a contract offer is made. If a contract offer is made, the contract may be contingent upon the successful completion of a pre-employment drug screening and/or medical examination. This application will remain active for 3 years.

  2. First Name(*)
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  3. Middle Name
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  4. Last Name(*)
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  5. Email Address(*)
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  6. Phone Number(*)
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  7. Date of Birth(*)
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  8. Social Security Number(*)
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  9. Physical Exam Expiration Date
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Current & Three Years Previous Addresses

  1. CURRENT ADDRESS

  2. Current Address
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  4. Current State
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  6. Since (Mo/Yr)
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  1. PRIOR ADDRESS

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  1. PRIOR ADDRESS

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Education

  1. HIGH SCHOOL

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  1. UNDERGRAD SCHOOL

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  1. OTHER SCHOOL

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  7. Area of Study
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Employment

  1. EMPLOYMENT INFORMATION

  2. Position Applied For
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  3. Date You Can Start
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  4. Desired Salary ($)
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  5. Do You Prefer
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  6. Can you work
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  7. Available
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  8. Are you available for shift work?
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  9. Not Available
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  10. Please answer all of the following questions

  1. Are you at least 18 years of age and legally eligible to work for our company in the United States?
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  2. If you are under 18 years of age, can you provide required proof of your eligibility to work?
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  3. Have you worked for LeFebvre Companies before?
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  4. If yes, please provide dates and locations. Also include Reason for Leaving.
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  5. Are you on layoff and subject to recall?
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  6. Are you currently bound by a noncompetition, confidentiality or trade secret agreement?
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  7. If yes, please explain...
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  8. Have you ever been discharged or asked to resign from a job?
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  9. If yes, please explain...
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  10. Have you ever been convicted of or pled guilty to a felony or crime other than a minor traffic citation?
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  11. If yes, please explain...
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  12. Do any of your friends or relatives, other than spouse, work here?
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  13. If yes, state name and relationship...
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  1. Employment History

    Give a Complete Record of all employment for the past three years, including any unemployment of self-employment, and all commercial driving experience for the past ten years.

  2. Are you currently employed?
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  3. May we contact your present employer?
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  1. MOST RECENT EMPLOYER

  2. Employer
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  3. City
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  4. State
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  5. Phone
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  6. Position Held
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  9. Pay upon leaving
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  10. Supervisor
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  11. Duties
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  12. Reason For Leaving
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  13. Were you subject to the FMCSR’s while employed here?
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  14. Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?
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  1. PRIOR EMPLOYER 01

  2. Employer
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  9. Pay upon leaving
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  10. Supervisor
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  11. Duties
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  12. Reason For Leaving
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  13. Were you subject to the FMCSR’s while employed here?
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  14. Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?
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  1. PRIOR EMPLOYER 02

  2. Employer
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  9. Pay upon leaving
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  10. Supervisor
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  11. Duties
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  12. Reason For Leaving
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  13. Were you subject to the FMCSR’s while employed here?
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  14. Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?
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  1. PRIOR EMPLOYER 03

  2. Employer
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  3. City
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  5. Phone
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  6. Position Held
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  7. From (Mo/Yr)
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  8. To (Mo/Yr)
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  9. Pay upon leaving
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  10. Supervisor
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  11. Duties
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  12. Reason For Leaving
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  13. Were you subject to the FMCSR’s while employed here?
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  14. Was your job designated as a safety sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49CFR Part 40?
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Driving Experience

  1. CLASS OF EQUIPMENT

  1. STRAIGHT TRUCK
  2. From (Mo/Yr)
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  3. To (Mo/Yr)
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  4. Approximate Number of Miles (Total)
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  1. TRACTOR AND SEMI-TRAILER
  2. From (Mo/Yr)
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  4. Approximate Number of Miles (Total)
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  1. TRACTOR-TWO TRAILERS
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  4. Approximate Number of Miles (Total)
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  1. TRACTOR-THREE TRAILERS(triples)
  2. From (Mo/Yr)
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  3. To (Mo/Yr)
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  4. Approximate Number of Miles (Total)
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  1. OTHER
  2. From (Mo/Yr)
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  3. To (Mo/Yr)
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  4. Approximate Number of Miles (Total)
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  1. List states operated in, for the last five years
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  2. List special courses/training completed (PTD/DDC, Haz Mat, etc.)
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  3. List any Safe Driving Awards you hold and from whom
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  4. ACCIDENT RECORD

    for past three years (attach sheet if more space is needed)
  1. ACCIDENT 01
  2. Date of Accident
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  3. Nature of Accidents
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    (Head on, rear end, upset, etc.)
  4. Location of Accident
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  5. # of Fatalities
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  6. # of People Injured
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  1. ACCIDENT 02
  2. Date of Accident
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  3. Nature of Accidents
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    (Head on, rear end, upset, etc.)
  4. Location of Accident
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  5. # of Fatalities
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  6. # of People Injured
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  1. ACCIDENT 03
  2. Date of Accident
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  3. Nature of Accidents
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    (Head on, rear end, upset, etc.)
  4. Location of Accident
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  5. # of Fatalities
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  6. # of People Injured
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  1. TRAFFIC CONVICTIONS AND FORFEITURES

    for the last three years (other than parking violations)
  1. TRAFFIC CONVICTION 01
  2. Date
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  3. Location
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  4. Charge
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  5. Penalty
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  1. TRAFFIC CONVICTION 02
  2. Date
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  3. Location
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  4. Charge
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  5. Penalty
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  1. TRAFFIC CONVICTION 03
  2. Date
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  3. Location
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  4. Charge
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  5. Penalty
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  1. DRIVERS LICENSES

    list each driver’s license held in the past three years)
  1. LICENSE 01
  2. State
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  3. License #
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  4. Type
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  5. Endorsements
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  6. Expiration Date
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  1. LICENSE 02
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  3. License #
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  4. Type
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  5. Endorsements
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  6. Expiration Date
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  1. LICENSE 03
  2. State
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  3. License #
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  4. Type
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  5. Endorsements
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  6. Expiration Date
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  1. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
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  2. Has any license, permit or privilege ever been suspended or revoked?
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  3. Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the job description)?
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  4. Have you ever been convicted of a felony?
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  5. If the answers were “YES” to the above questions, give details
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  6. Please use this space to list any special skills you may have that relate to the position applied for
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  7. Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.
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Personal References

List three persons for references, other than family members who have knowledge of your safety habits.

Limit references to 1 family member.
  1. REFERENCE 01

  2. Name
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  3. Address
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  4. Phone
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  5. Relationship
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  6. Years Acquainted
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  1. REFERENCE 02

  2. Name
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  5. Relationship
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  6. Years Acquainted
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  1. REFERENCE 03

  2. Name
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  3. Address
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  4. Phone
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  5. Relationship
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  6. Years Acquainted
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Documents

  1. Upload File
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    Attach a file to your application submission (Permitted File Types: doc,docx,pdf,txt - Max file size: 1045876 bytes)

Applicant Certification Agreement

  1. TO BE READ AND ACKNOWLEDGED BY APPLICANT

    It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty.

    It is agreed and understood that the LeFebvre Companies Inc. or their agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of their furnishing such information.

    It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508; I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics and mode of living.

    I agree to furnish such additional information and complete such examinations as may be required to complete my application file.

    It is agreed and understood that this Application for Qualification in no way obligates LeFebvre Companies Inc. to employ or hire the applicant.

    It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse.

    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 knowledge.


    DRIVER’S RIGHTS PERTAINING TO RELEASE OF DRIVER INFORMATION UNDER REGULATION 391.23

    Motor carriers have the responsibility to make the following investigations and inquiries with respect to each driver employed, other than a person who has been a regularly employed driver of the motor carrier for a continuous period which began before January 1, 1971.

    • (a)(1) An inquiry into the driver’s driving record during the preceding three years to the appropriate agency of every State in which the driver held a motor vehicle operator’s license or permit during those three years; and
    • (a)(2) An investigation of the driver’s employment record during the preceding three years.
    • (b) A copy of the driver record(s) obtained in response to the inquiry or inquiries to each State driver record agency as required must be placed in the Driver Qualification File within 30 days of the date the driver’s employment begins and be retained in compliance with 391.51.
    • (c) Replies to the investigations of the driver’s safety performance history must be placed in the Driver Investigation History File within 30 days of the date the driver’s employment begins. This goes into effect after October 29, 2004.
    • (d) Prospective motor carrier must investigate the information from all previous employers of the applicant that employed the driver to operate a CMV within the previous three years. This information must cover general driver identification and employment verification information, data elements as specified in 390.15 for accident involving the driver that occurred in the three-year period preceding the date of the employment application, and any accidents the previous employer may wish to provide.
    • (e) Prospective motor carrier must investigate the information from all previous DOT regulated employers that employed the driver 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.

    Drivers have the following rights:

    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 the prospective employer.
    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.

    Drivers who wish to review previous employer-provided investigative information must submit a written request to the prospective employer when applying or as late as 30 days after employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five business days of receiving the written request. If the driver has not arranged to pick up or receive the requested records within 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.

    Drivers wishing to request correction of erroneous information in records must send the request for the correction to the previous employer that provided the records. After October 29, 2004, 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 the driver’s request to correct the data that it does not agree to correct the data. Drivers wishing to rebut information in records must send the rebuttal to the previous employer with instruction to include the rebuttal in the driver’s Safety Performance History.


    IMPORTANT DISCLOSURE
    REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

    In connection with your application for employment with LeFebvre Companies (“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.


    AUTHORIZATION

    If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

    I authorize LeFebvre Companies (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

    I further understand that 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. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.

    I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.


    PRE-EMPLOYMENT STATEMENT

    CFR Part 40.25(j) requires the employer to ask any applicant, whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol rules during the past two years. If the potential employee admits that he or she had a positive test or refusal to test, we must not use the employee to perform safety-sensitive functions, until and unless the potential employee provides documentation of successful completion of the return-to-duty process. (See Section 40.25(b)(5) and (e).

    As an applicant, applying to perform safety-sensitive functions for our company, you are required by CFR Part 40.25(j) to respond to the following questions.

  2. Have you 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 covered by DOT agency drug and alcohol testing rules during the past two years?(*)
    Invalid Input
  3. If you answered yes, to the above question, can you provide proof that you have successfully completed the DOT return-to-duty requirements?
    Invalid Input
  4. APPLICATION AGREEMENT

    I have read and reviewed the information provided in this application and the above statements. By signing this application for qualification, I certify that I understand all parts of it and have answered all questions completely and fully.

    I understand that by typing my name in the signature box below and submitting this application electronically, this becomes a legal and binding contract.

  5. Type Name in Signature Box(*)
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