Index - OsterKampGroup

This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge.I hereby request and authorize Osterkamp Transportation Group and their agents or contractors that receive this application to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, mode of living, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. As part of our consideration of your application, the DOT requires companies to investigate your employment background. As part of this investigation, they may obtain consumer reports about you from various consumer reporting agencies including Gamino & Associates, CDTA/National Compliance Solutions (CRA) and PSP Reports. CRA does not make any decisions concerning your employment with these companies and will not know the specific reasons why they may decide not to hire you. In the event you are not hired based on information contained in your consumer report, the companies themselves will tell you. We will also advise you of your right to obtain a free copy of the consumer report from CRA and your right to dispute the accuracy or completeness of your report. Your consent for these companies to obtain the report from CRA is required. Although you have a right to withhold your consent, companies will not consider your application if you withhold your consent.

For California Applicants:
Under section 1786.22 of the California civil code, you have the right to request from CDTA, National Compliance Solutions or Gamino and Associates, upon proper identification, the nature and substance of all information in its files on you. including the sources of information and the recipients of any reports on you which CRA has previously furnished within the 2 year period preceding your request. You may view the file maintained on you by CRA during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying the costs of duplication services. Upon making a written request, you may receive a summary report via telephone.

A summary of your rights under the Fair Credit Reporting Act. Here is a summary of your major rights under the FCRA:

You must be told if information in your file has been used against you.
You have the right to know what is your file
You have the right to ask for a credit score
You have the right to dispute incomplete or inaccurate information
Consumer reporting agencies (CRA) must correct or delete inaccurate, incomplete, or under verifiable information
Consumer reporting agencies (CRA) may not report out dated negative information
Access to your file is limited
You must give your consent for reports to be provided to employers
You may limit "pre-screened" offers of credit and insurance, you get based on information on your credit report
You may seek damages from violators
Identity theft victims and actors duty personnel have additional rights
You must be told if information in your file has been used against you.

DRUG & ALCOHOL/ACCIDENT

I hereby authorize to release information from my Department of Transportation regulated drug and alcohol testing records including Accident information to the Requestor Gamiño & Associates, Inc., CDTA/National Compliance Solutions.

This release is in accordance with regulation FMCSA Part 391.23, Investigation and Inquiries. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests, also including any/all Accident information during the past three years:

1. Alcohol tests with a result of 0.04 or higher alcohol concentration;

2. Verified positive drug tests;

3. Refusals to be tested;

4. Other violations of DOT agency drug and alcohol testing regulations;

5. Documentation, if any, of completion of the return-to-duty process following a rule violation;

6. Information obtained from precious employers of a drug and alcohol rule violation;

7. Total number of accidents, DOT or NON-DOT.

In compliance with FMCSA regulation 391.23 part (i)(1) you have certain rights regarding the investigative information that will be provided to the Prospective employer: i) You have the right to review information provided by previous employers: ii) You have 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; iii) You have 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. (2) Drivers who have previous DOT regulated employment history in the preceding three years and time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information within five business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer, then the five-business day deadline will begin when the prospective employer receives the requested safety performance history information. 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 employer may consider you to have waived your request to review the records.

Part 391.23 (e) In addition to the investigations required by paragraph (d) of this section, the prospective motor carrier employers must

Investigate the information listed below in this paragraph 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.(e)(1) Whether, within the previous three years, the driver had violated the alcohol and controlled substances prohibitions under subpart B of part 382 of this chapter, or 49 CFR part 40.

*Desired Position:
*First Name:
Middle Initial:
*Last Name:
*Home Phone:
*Mobile/Cell:
Email Address:
*Current Address:
*City:
*State:
*Zip Code:
*Years At Current Address:
Check if you have lived at current address less than 3 years. *Enter previous addresses in the last 3 years.
Birthdate: (Required for DRIVERS only)
*Social Security Number:
*Driver's License Number:
*DL State:
*DL Expiration Date:
Check if you have any prior out-of-state driver's licenses *Enter state and driver's license number(s)
If you have CDL endorsement, please check any that apply: DBLS TRPS TANK HAZMAT
Referred By:
*How many years of driving experience do you have:

Current Employer
Start Date:
End Date:
Employer Name:
Address:
City:
State:
Zip Code:
Phone Number:
Position Held:
Type of Equipment Used (If Driving Position):

Previous Employer
Start Date:
End Date:
Employer Name:
Address:
City:
State:
Zip Code:
Phone Number:
Position Held:
Type of Equipment Used (If Driving Position):

Previous Employer
Start Date:
End Date:
Employer Name:
Address:
City:
State:
Zip Code:
Phone Number:
Position Held:
Type of Equipment Used (If Driving Position):

Previous Employer
Start Date:
End Date:
Employer Name:
Address:
City:
State:
Zip Code:
Phone Number:
Position Held:
Type of Equipment Used (If Driving Position):

Pre-Application Form

Employment History (Please list the last 3 years):

Current Employer

Previous Employer

Previous Employer

Previous Employer

Please Answer A Few Questions:

If you are applying for mobile mechanic or driving position, please answer the following questions: