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Now accepting applications for owner
operator and company drivers.

Atlantic Trucking Co, Inc.
7240 Cross County Road
Charleston, SC 29418
Ph: 843-767-1045





 Owner Operator Lease Driver Fleet Driver Company Driver












 Yes No



 Yes No



 Yes No

 Yes No

In the past 3 years have you: tested positive, or refused to test of any pre-employment drug/alcohol test administered by an employer that you applied to, but did not obtain, safety sensitive transportation work

 Yes No

 Yes No

months

LIST ALL ACCIDENTS AND INCIDENTS IN THE PAST 5 YEARS

  Date City State Commercial Fatalities Citation
1.  Yes No
  Description
2.  Yes No
  Description
3.  Yes No
  Description

LIST ALL TRAFFIC CONVICTIONS AND LICENSE SUSPENSIONS IN THE PAST 5 YEARS

  Date City State Commercial/Personal VEH Description/Explanation
1.
2.
3.

In case of emergency, please call

Phone

Application Agreement

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. In the event that my application is approved, I understand that false or misleading information given on this application or interview(s) may result in the termination of the qualification process and/or the lease agreement, I also understand that I am required to abide by all rules of the DOT and Atlantic Trucking Company (hereafter, as ATC) and that ATC hiring/leasing criteria may change at any time at it's discretion without prior notice.

Applicant's Signature Date

Please Read Carefully

Previous Employer/Carrier History

List previous 10 years of employment, including any periods of unemployment that exceeds 30 days. Start with the most recent job. You must also list the approximate amount of miles driven with each company.

Employer/Carrier

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 2

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 3

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 4

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 5

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 6

Name

Address

City

State

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 7

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 8

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 9

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No

Employer/Carrier 10

Name

Address

City

State

Phone Number

Employment Dates From: To:

Reason Left

Position

Supervisor

Check One  Tractor/Trailer Straight Truck Approximate Miles Driven

DOT regulated  Yes No

DOT Safety sensitive position that required drug and alcohol testing  Yes No


Request and Consent Form for Background Information

I authorize Atlantic Trucking Company, (hereafter, as ATC) to investigate my personal, employment, judicial, financial or medical history and all related matters necessary to arrive at a qualification decision. I hereby release ATC, employers, institutions, or persons from all liability in responding to inquires in regards to my work history or application. I hereby authorize procurement of my Motor Vehicle Record (MVR) for the purpose of employment or contract for services. If hired or contracted, this authorization shall remain on file and serve as an ongoing authorization for ATC to obtain my MVR at any time during my employment or contract period. I authorize any party or agency contracted by DAC to furnish the above information. I hereby authorize procurement of consumer reports. If hired or contracted, this authority will remain on file for ATC to obtain consumer reports at any time during my employment or contract period. I acknowledge my right (1) to review information provided by previous employers; (2) have errors corrected by the previous employers and resend to ATC; and (3) to have a rebuttal statement attached to the alleged erroneous information.

I further authorize previous employers and lessees to release all information on my Alcohol and Controlled Substances Testing records to ATC pursuant to 49 CFR Part 40. As an ATC applicant, I consent to a pre-employment drug-screen as required by federal regulations and ATC policy. I understand that, if qualified by ATC, I am subject to random and reasonable cause testing as required by federal regulations. I certify that I possess only one commercial driver's license as required by federal regulations and will abide by these requirements.

Applicant Signature Date

Applicant Name SS#


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 Atlantic Trucking Company (“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 Atlantic Trucking Company (“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.


Date: Signature:

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.