NOTICE: Every section MUST be complete or it will not be processed.
If the response to any section is "none", you must enter "NONE"
Applicant: Read and sign the following notification prior to submitting this Application for Employment.
· The information you provide in this Application, including but not limited to the information required by 49 CFR 391.21(b)(10)(11) below may be used, and your previous employer(s) will be contacted, for the purpose of investigating your safety performance history as required by 49 CFR 391.23(d)(e) and 49 CFR 40.25 (re: drug and alcohol information).
· As the prospective employer, STAGELINE EXPRESS, INC. notifies you that you have the following rights regarding the investigative information that will be provided to us pursuant to 49 CFR 391.23(d)(e):
o The right to review information provided by previous employers;
o The right to have errors in the information corrected by the previous employer and for that previous employer to resend the corrected information to STAGELINE EXPRESS, INC.
o The right to have a rebuttal statement to the alleged erroneous information, if the previous employer and you cannot agree on the accuracy of the information.
· EQUAL OPPORTUNITY EMPLOYER: In compliance with Federal and State employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age and disability.
· I understand that if I have a protected handicap that affects my ability to perform the position, I may ask STAGELINE EXPRESS, INC. to attempt to make accommodations as required by law. I must make my request in writing to STAGELINE EXPRESS, INC. as soon as possible and no later than 182 days after the date I know or reasonably should know that accommodation is needed.
· In accordance with the provisions of Section 604(b) (2) (A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title 11, Subtitle D, Chapter 1, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations.