NMC GLOBAL FREIGHT – job_APPLICATION

1Join our team! Start now!

2Please complete the fields below to register and begin the application.

3Application For Employment - Your general application information.

4Upload Driver License

5Upload Medical Card Copy

6Upload Forfeiture Documents

7Pre-Employment Employee Alcohol & Drug Test Statement

8Safety Performance History Investigation

9PSP Driver Disclosure & Authorization

10Drug & Alcohol Clearinghouse Consent

11Alcohol & Drug Testing Policy

12General Work Policy

13Fair Credit Reporting Authorization

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Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Please complete the fields below to register and begin the application.

Warning! Your application is not sent or visible to the employer until it is 100% complete.

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Social Security Number *

Please complete the fields below to register and begin the application.

Repeat Social Security Number *

Please complete the fields below to register and begin the application.

How did you hear about us? *

Please complete the fields below to register and begin the application.

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Applicant Information

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First Name *

Middle Name *

Last Name *

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Date of Birth *

Social Security Number *

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Main Phone Number *

Alt Phone Number

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Email Address *

Confirm Email

Address *

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City *

State *

Country *

Postal Code *

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Do you have a TWIC Card? *

Do you have a passport? *

Residences Previous 3 Years

List residence for the previous 3 years if you lived at the above address for less than 3 years.

Adress 1

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Address *

City *

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State *

Country *

Postal Code *

Adress 2

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Address

City

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State

Country

Postal Code

Adress 3

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Address

City

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State

Country

Postal Code

Drivers License Information

List all driver's licenses held within the last 3 years. Please enter your first and last name exactly as it appears on your license. WARNING! Triple-check the license information for accuracy. Failure to enter accurate license information may result in non-consideration and a rejected application! If you enter the wrong information, all documents relating to your license will have to be discarded and completed again.

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First Name *

Last Name *

Issued *

Expires *

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State *

Country *

Class *

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License Number *

Endorsements *

H - Placarded Hazmat
N - Tank Vehicles
P - Passengers
T - Double/Triple Trailers
S - School Bus
X - Placarded Hazmat & Tank Vehicles
None of all

Drivers License Information 2

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First Name

Last Name

Issued

Expires

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State

Country

Class

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License Number

Endorsements

H - Placarded Hazmat
N - Tank Vehicles
P - Passengers
T - Double/Triple Trailers
S - School Bus
X - Placarded Hazmat & Tank Vehicles
None of all

Medical Certificate

Medical Certificate Expiration Date *

Experience

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Straight Truck - Experience *

Experience

Straight Truck - Date From

Date From

Straight Truck - Date To

Date To

Straight Truck - Approx Miles

Approx Miles

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Truck-Tractor - Experience *

Experience

Truck-Tractor - Date From

Date From

Truck-Tractor - Date To

Date To

Truck-Tractor - Approx Miles

Approx Miles

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Semi-Trailers - Experience *

Experience

Semi-Trailers - Date From

Date From

Semi-Trailers - Date To

Date To

Semi-Trailers - Approx Miles

Approx Miles

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Doubles/Triples - Experience *

Experience

Doubles/Triples - Date From

Date From

Doubles/Triples - Date To

Date To

Doubles/Triples - Approx Miles

Approx Miles

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Flatbed - Experience *

Experience

Flatbed - Date From

Date From

Flatbed - Date To

Date To

Flatbed - Approx Miles

Approx Miles

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Bus - Experience *

Experience

Bus - Date From

Date From

Bus - Date To

Date To

Bus - Approx Miles

Approx Miles

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Other - Experience *

Experience

Other - Date From

Date From

Other - Date To

Date To

Other - Approx Miles

Approx Miles

Accidents/Crashes Previous 3 Years

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Accidents/Crashes Previous 3 Years *

Have you had any accidents/crashes in the last 3 years?

Date

Location City/State

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Number Of Injuries

Number Of Fatalities

Hazmat Spill?

If you have had other accidents in the last 3 years, please fill in this field with the same data as above

Moving Traffic Violations Previous 3 Years

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Have you had any traffic violations in the last 3 years? *

Date

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Location City/State

Offense

Vehicle Type

If you have had other Traffic Violations in the last 3 years, please fill in this field with the same data as above

Forfeitures Previous 3 Years

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A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? *

B. Has any license, permit or privilege ever been suspended or revoked? *

C. If yes to either question above, briefly describe the circumstances

Employment Record Previous 3 Years

List all employers for the previous 3 years and an additional 7 years if you were employed as a DRIVER.

How many employers have you had in the last 3 years? Or in the last 7 years ONLY FOR DRIVERS *

Employment Record Previous 3 Years / 7 years for drivers - Employer 1

List all employers for the previous 3 years and an additional 7 years if you were employed as a DRIVER.

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Employer Name *

Address *

City *

State *

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Country *

Postal Code *

Phone *

Fax *

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Email *

Confirm Email

Position Held *

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Date From *

Date To *

Reason For Leaving *

Were you subject to the DOT/FMCSA regulations while employed by this carrier? *

If you were a driver, choose Yes.

Was your job designated as a safety sensitive function, in any DOT regulated mode, subject to the alcohol and controlled substances testing requirements required by 49 CFR Part 40? *

If you were a driver, choose Yes.

Employment Record Previous 3 Years - 2

List all employers for the previous 3 years and an additional 7 years if you were employed as a DRIVER.

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Employer Name

Address

City

State

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Country

Postal Code

Phone

Fax

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Confirm Email

Position Held

Date From

Reason For Leaving

Were you subject to the DOT/FMCSA regulations while employed by this carrier?

If you were a driver, choose Yes.

Was your job designated as a safety sensitive function, in any DOT regulated mode, subject to the alcohol and controlled substances testing requirements required by 49 CFR Part 40?

If you were a driver, choose Yes.

If you have had other Employment Record in the last 3 years, please fill in this field with the same data as above

Fair Credit Reporting Act

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize this company and its designated agents and representatives to conduct a comprehensive review of my background through any consumer report for employment. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

Sign Document

Sign Document *

I confirm and sign that I have correctly entered the above Social Security Number. 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.

Document: Application For Employment

This document is a DOT compliant Application For Employment.

Signature: Applicant Signature

The signature of the applicant confirming submission of the Application For Employment.

Date & Time of sign *

Date

Time

Repeat Social Security Number *

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Upload Driver License

Please upload a copy of the drivers license specified above. (Supported Formats: .jpg, .png, .gif)

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FRONT copy - File Upload *

Click or drag a file to this area to upload.

Please upload a copy of the driver's license specified above. (Supported Formats: .jpg, .png, .gif)

Back copy - File Upload (copy) *

Click or drag a file to this area to upload.

Please upload a copy of the driver's license specified above. (Supported Formats: .jpg, .png, .gif)

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Upload Medical Card Copy

Please scan and upload a copy of your medical card. (Supported Formats: .jpg, .png, .gif)

Please scan and upload a copy of your MEDICAL CARD. (Supported Formats: .jpg, .png, .gif) *

Click or drag a file to this area to upload.

Please upload a copy of the MEDICAL CARD specified above. (Supported Formats: .jpg, .png, .gif)

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Upload Forfeiture Documents

ONLY IF YOU HAVE BEEN DENIED/OR BEEN REVOKED OF YOUR LICENSE, PERMIT OR PRIVILIGES TO OPERATE A MOTOR VEHICLE. IF NOT, CLICK NEXT BUTTON.
Please upload a statement setting forth the facts and circumstances. (Supported Formats: .jpg, png, gif)

Please scan and upload a copy of your Forfeiture Documents . (Supported Formats: .jpg, .png, .gif)

Click or drag a file to this area to upload.

Please upload a copy of the Forfeiture Documents specified above. (Supported Formats: .jpg, .png, .gif)

ONLY IF YOU HAVE BEEN DENIED/OR BEEN REVOKED OF YOUR LICENSE, PERMIT OR PRIVILIGES TO OPERATE A MOTOR VEHICLE. IF NOT, CLICK NEXT BUTTON.

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Pre-Employment Employee Alcohol & Drug Test Statement

49 CFR Part 40.25(j) states, as the employer, you must ask the employee 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 testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process required in 49 CFR Subpart O.

As the prospective employee, have you:

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 testing rules during the past two years. *
Yes
No

If you answered yes to the above question, can you provide documentation of successful completion of DOT return-to-duty requirements (including follow-up tests). *
Yes
No
N/A

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Safety Performance History Investigation

I hereby authorize release of information to this prospective employer from my employment file and my Department of Transportation regulated drug and alcohol testing records. This release is in accordance with DOT Regulation 49 CFR Parts 40.25/382.413/391.23. I understand that information to be released, by my previous employer, is limited to the previous three years. You are released from any and all liability which may result from releasing such information. Pursuant to the federal Fair Credit Reporting Act, I hereby authorize this company and its designated agents and representatives to conduct a comprehensive review of my background through any consumer report for employment. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

I understand that it is my right to review information provided by previous employers; to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information; as well as the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot agree on the accuracy of the information. I understand that if I wish to review previous employer-provided investigative information, I must submit a written request, 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. I understand that if I have not arranged to pick up or receive the requested records within thirty (30) days of them becoming available, it may be considered that I have waived my request to review the record(s).

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

PSP Driver Disclosure & Authorization

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with NMC Global Freight 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.

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

I authorize NMC Global Freight Inc. (“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.

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 2/11/2016

Sign Document
Sign Document *
I confirm and sign that I have correctly entered the above Social Security Number. 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.

Signature: Prospective Employee Signature

The signature of the prospective employee authorizing the PSP report.

Document: PSP Authorization

This document allows the applicant to give authorization to the prospective employer to obtain on Pre-Employment Screening Program (PSP) report.
Notice
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 2/11/2016
Date & Time of sign *
Date
Time
Repeat Social Security Number *

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

I, hereby provide consent to NMC Global Freight Inc. to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.

I am consenting to multiple unlimited queries and for the duration of employment with NMC Express Inc..

I understand that if the limited query conducted by NMC Express Inc. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to NMC Express Inc. without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for NMC Express Inc. to conduct a limited query of the Clearinghouse, NMC Express Inc. must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Alcohol & Drug Testing Policy

Please review the company alcohol and drug testing policy below. Once finished, electronically sign to confirm receipt, understanding and agree. Upon completion of the online application, you will be emailed a copy of this policy. You may also click the Download button in the top right corner of the viewer to save a copy of the policy now.

Download Now!

Accept *
I have read, fully understand and agree to all terms as set forth in the company alcohol and drug testing policy.

General Work Policy

Please review the company general work policy below. Once finished, electronically sign to confirm receipt, understanding and agree. Upon completion of the online application, you will be emailed a copy of this policy. You may also click the Download button in the top right corner of the viewer to save a copy of the policy now.

Download Now!

Accept *
I have read, fully understand and agree to all terms as set forth in the company general work policy.

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com

Fair Credit Reporting Authorization

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize NMC Global Freight Inc. and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

I, authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish NMC Express Inc. or its designated agents with any and all information in their possession regarding me in connection with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.

I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me.

GDPR Agreement *
I consent to having this website store my submitted information so they can respond to my inquiry.

Need Help? Call (222) 222-2222 or email nmcglobalfreight@gmail.com