Application for CDL License

1. Start
2. EMPLOYMENT AND SAFETY PERFORMANCE HISTORY
3. COPY OF CDL
4. COPY OF SNN CARD
5. COPY OF MEDICAL CARD
6. COPY OF FMCSA MEDICAL VARIANCE
7. Previous Pre Employment Drug Test
8. PRE-EMPLOYMENT URINALYSIS NOTIFICATION
9. DRUG & ALCOHOL AWARENESS PROGRAM CERTIFIED RECEIPT
10. DIRECT DEPOSIT AGREEMENT FORM
11. EMERGENCY NOTIFICATION INFORMATION
12. REQUEST FOR CHECK OF DRIVING RECORD
13. EMPLOYEE DRUG & ALCOHOL CONSENT FORM
14. COMPANY POST ACCIDENT DRUG & ALCOHOL TEST REQUIREMENTS
15. DRIVER DATA SHEET
16. Form I-9
17. 2020 W-4 Form

COPY OF CDL

COPY OF CDL

Copy Of Commercial Driver's License (optional)

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COPY OF SNN CARD

COPY OF SNN CARD

Copy SNN Card (optional)

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COPY OF FMCSA MEDICAL CARD

COPY OF MEDICAL CARD

Copy of Medical Card (optional)

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COPY OF FMCSA MEDICAL VARIANCE

COPY OF FMCSA MEDICAL VARIANCE

If you have a medical variance, please ask for a paper copy of a Medical Examination Report for you and your doctor to complete.

Copy of FMCSA Medical Variance (optional)

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PREVIOUS PRE-EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT

PREVIOUS PRE-EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT

Sec. 40.25(j) As the employer, you must also 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. (see Sec. 40.25(b)(5) and (e))

Prospective Employee Name

Last Name

The prospective employee is required by Sec. 40.25(j) to respond to the following questions. (optional)

1) 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?

Yes

2) If you answered yes, can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements?

Yes

N/A

I certify that the information provided on this document is true and correct.

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

PRE-EMPLOYMENT URINALYSIS NOTIFICATION

PRE-EMPLOYMENT URINALYSIS NOTIFICATION

The Federal Motor Carrier Safety Regulations, Section 382.113– pre-employment testing requirements, apply to driver-applicants of this company.

Pre-employment testing requirements.

(a) A motor carrier shall require a driver-applicant who the motor carrier intends to hire or use, to be tested for the use of controlled substances as a prequalification condition.

(b) A driver applicant shall submit to controlled substance testing as a prequalification condition.

(c) Prior to collection of a urine sample a driver-applicant shall be notified that the sample will be tested for the presence of controlled substances.

As a condition of my employment, I agree to the urine sample collection and controlled substance testing.

I understand a positive test for controlled substances based on the Urinalysis Test will medically disqualify me from the operation of a commercial motor vehicle for this company.

The medical review officer will maintain the results of the Urinalysis Test. Negative and positive results will be reported to the company.

My written authorization is required for the Urinalysis Test results to be given to the other parties.

I have read and understand the above conditions for the Pre-Employment Urinalysis Notification.

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

DRUG & ALCOHOL AWARENESS PROGRAM CERTIFIED RECEIPT

DRUG & ALCOHOL AWARENESS PROGRAM CERTIFIED RECEIPT

This is to certify that I have been provided educational materials that explain the requirements of FMCSR 382.601 as well my employer’s policies and procedures with respect to meeting these requirements. The materials include detailed information on the following subjects: (optional)

1. The designated person to answer questions about the materials.

2. The categories of drivers subject to Part 382.

3. Safety sensitive functions.

4. Prohibited driver conduct.

5. Circumstances under which a driver will be tested.

6. Testing procedures for alcohol and controlled substances.

7. The requirement that a driver submit to tests administered in accordance with Part 382.

8. Refusal definition and consequences.

9. Consequences for drivers testing positive for controlled substances.

10. The consequences for a driver testing 0.02 or greater but less than 0.04 blood alcohol concentration (BAC).

11. Health effects regarding the misuse of alcohol and controlled substances, signs and symptoms of use, and available methods/resources of intervention.

Signature

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

DRIVER AGREEMENT

Driver Agreement

Please read each line. (optional)

BLS drivers must carry a valid CDL driver’s license
BLS drivers will move movement tractor trailers as needed
BLS drivers shall access public highways to fuel all equipment as needed
BLS drivers are classified as “driver” and are required to move movement and all DOT equipment in the BLS fleet
BLS equipment consist of DOT legal units that move interstate commerce on public highways
BLS shuttle service consist of a driver with loaded interstate commerce and will move interstate commerce as needed toward its final destination
BLS shuttle service includes many types of trailer such as lowboy, flatbed, drop back, RGN and standard trailers for state to state moves on interstate highways
BLS drivers will move empty trailers to offsite lots, parking lots and off-site yard locations as needed using interstate highways
BLS drivers will move movement all over the road (OTR) equipment to destinations by driving or hauling all equipment as requested and schedule by the onsite supervisor and/or manager
BLS drivers must comply with state and government DOT policies and procedures
BLS drivers must use ELD or paper logs as required by local and federal DOT regulations and FMCSA
BLS drivers shall perform pre-trip and post-trip inspections on all equipment as required by DOT
BLS drivers must complete each route as required by the local management supervisor or lead personnel
Routes will consist of local and interstate destinations
BLS drivers are required to haul move movements consisting of many lengths of trailers not limited to 28, 32, 34, 48, 53, dry van, flat beds, drop deck, RGN, landoll…etc.
BLS drivers shall be required to comply with all state and federal restrictions, inspections, weight stations, and chain down procedures as required by FMCSA

Your signature indicates you read and understood the Boone Logistics Services Driver Agreement.

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

Today's Date

AUTHORIZATION AGREEMENT

AUTHORIZATION AGREEMENT

I hereby authorize Boone Logistics Services, LLC to initiate automatic deposits to my account at the financial institution named below. I also authorize Boone Logistics Services, LLC to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold Boone Logistics Services, LLC responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until Boone Logistics Services, LLC receives a written notice of cancellation from me or my financial institution, or until I submit a new direct deposit form to the Payroll Department.

ACCOUNT INFORMATION

ACCOUNT INFORMATION

Employee Name

Last Name

Name of Financial Institution (optional)

Routing Number (optional)

Type of Account (optional)

Checking

Savings

None

Account Number (optional)

Upload Voided Check (optional)

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I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

EMERGENCY CONTACT INFORMATION

EMERGENCY CONTACT INFORMATION

In the event of an emergency of an accident, who do you want us to notify?

1. Name

Last Name

Relationship

Phone

City

State

ZIP Code

2. Name

Last Name

Relationship

Phone

City

State

Zip Code

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

REQUEST FOR CHECK OF DRIVING AND CRIMINAL RECORDS

REQUEST FOR CHECK OF DRIVING AND CRIMINAL RECORDS

I hereby authorize you to release the following information to Boone Logistics Services, LLC (prospective employer) for purposes of investigation as required by Sections 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability which may result from furnishing such information.

I, the undersigned, do hereby authorize the above company to examine any and all criminal records and arrests on file in the counties in the state of Georgia or any other state. In doing so, I understand that I am waiving my right of confidentiality concerning my criminal history. I also hereby release any parties concerned from any actions whatsoever, arising out of or relating to the release of the requested information.

At this time, would your Criminal/Background History Report show any derogatory information at all?

Yes

Answering “yes” will not automatically disqualify you from employment consideration. If yes, please explain in detail. (optional)

Name

Middle Name (optional)

Last Name

Driver License Number

State You Are Licensed In?

SSN #

Address

Address Line 2 (optional)

City

State

Zip

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

Date (optional)

In accordance with the provisions of Sections 604 and 607 of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter 1 of Public Law 104-208), I hereby certify the following:

1. The consumer (applicant) has authorized in writing the procurement of this report;

2. The consumer (applicant) has been informed in a separate written disclosure that a consumer report may be obtained for

employment purposes;

3. The information requested below will be used for a "permissible purpose" (i.e. information for employment purposes) and

will be used for no other purpose;

4. The information being obtained will not be used in violation of any federal or state equal opportunity law or regulation; and

5. Before taking an adverse action based in whole or in part on the report the consumer (applicant) will receive a copy of the

requested report and the summary of consumer rights as provided with the report by the consumer reporting agency.

I also hereby certify that this report request and the above applicant's release notice meet the definition of "permissible uses" of state motor vehicle records under the provisions of the Driver's Privacy Protection Act of 1994 (Public Law 103-322, Title XXX, Sections 300002(a)).

EMPLOYEE DRUG & ALCOHOL CONSENT FORM

EMPLOYEE DRUG & ALCOHOL CONSENT FORM

I, the undersigned, hereby understand that, as a condition of my employment, I may be

subject to drug and/or alcohol testing for any of the following reasons:

Pre-employment

For Cause or Reasonable Suspicion

Post Hire

Random

Post Accident

Promotion

I understand that when I am requested to produce a specimen for drug and/or alcohol testing, I must comply

immediately. I also understand that a positive drug or alcohol test or that my refusal to produce a specimen

upon request can be cause for termination. I further understand that the illegal use, sale, possession, or

distribution of drugs or alcohol as well as any illegally obtained prescription medication, is a violation of

company policy and is cause for immediate termination.

I understand and accept the terms of this agreement as a condition of my employment.

I agree that my typed name below will be as valid as a handwritten signature to the extent allowed by local law

COMPANY POST ACCIDENT DRUG & ALCOHOL TEST REQUIREMENTS

COMPANY POST ACCIDENT DRUG & ALCOHOL TEST REQUIREMENTS

Any driver who is involved in a D.O.T. recordable accident is issued a citation for a moving violation as a result of that accident must submit to drug testing no later than (2) hours after the accident and must submit to alcohol testing no later than (2) hours after the accident.

A D.O.T. recordable accident is defined as an occurrence involving a commercial motor vehicle that results: 1) A FATALITY 2) BODILY INJURY to a person, who, as a result of the injury, immediately receives medical attention away from the scene of the accident 3) DISABLING DAMAGE to one or more motor vehicles causing it (them) to be towed from the scene.

Any driver of the truck that is the property of or leased to Boone Logistics Services, LLC or any person driving a truck that is under contract to Boone Logistics Services, LLC who is involved in an accident shall immediately report the accident to IMMEDIATE SUPERVISOR.

In the event that the accident has been designated a D.O.T. recordable accident the driver must follow all instructions given to him or her by Boone Logistics Services, LLC management personnel for compliance with Federal Post Accident Drug or Alcohol Test requirements. The driver then must submit to the appropriate testing within the required time limits.

Any driver who refuses to submit to the Drug and Alcohol Test or does not comply with all Post Accident testing Drug/Alcohol regulations may be disqualified from operating a commercial motor vehicle for a period of one (1) year. Failure to report any accident within 24 hours may result in termination.

I understand the above regulation and will comply with it.

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

DRIVER DATA SHEET

DRIVER DATA SHEET

EMPLOYMENT CHECKLIST FOR INTERMITTENT, CASUAL OR OCCASIONAL DRIVER (optional)

The qualification file for an intermittent, casual, or occasional driver employed under the rules in Sec. 391.63 must include the following forms as per section 391.51 (d) Federal Motor Carrier Safety Regulations.

1. Medical Examiner’s Certificate – The medical examiner’s certificate of his physical qualifications to drive a motor vehicle or a legible photographic copy of the certificate pursuant to Sec. 391.43.

2. Certificate of Driver’s Road Test – The certificate of driver’s road test issued to the driver pursuant to Sec. 391.31 (e), or a copy of the license or certificate which the motor carrier accepted as equivalent to the driver’s road test pursuant to Sec. 391.31.

3. Certificate of Written Examination, Questions and Answers – The questions asked, the answers the driver gave, and the certificate of written examination issued to him as pursuant to Sec. 391.35 (G), or a copy of a certificate which the motor carrier accepted as equivalent to a written examination pursuant to Sec. 391.37.

Instructions: Motor carriers when using a driver for the first time or immediately shall obtain from the driver a signed statement giving the total time on duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395.8(j)(2) Federal Motor Carrier Safety Regulations.

Please provide the dates and hours you worked in the past 7 days:

I hereby certify that the information given is correct to the best of my knowledge and belief, and I was last relieved from work at:

Current Date and Time (optional)

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

FORM I-9

FORM I-9

EMPLOYMENT ELIGIBILITY VERIFICATION DEPARTMENT OF HOMELAND SECURITY (optional)

U.S. CITIZENSHIP AND IMMIGRATION SERVICES

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,

during completion of this form. Employers are liable for errors in the completion of this form.

ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which

document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ

an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)

Last Name

First Name

Middle Initial (optional)

Other Name Used (optional)

Address (Name and Street Number)*

Address Line 2 (optional)

City

State

Zip

Date Of Birth

U.S. Social Security Number

Employee's Email Address (optional)

Employee's Telephone Number

I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.

I attest, under penalty of perjury, that I am (check one of the following boxes):

A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):

3. Alien Registration Number/USCIS Number: (optional)

4. Allien Authorized to Work until (Expiration Date, if applicable): (optional)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

1. Alien Registration Number/USCIS Number (optional)

2. Form I-94 Admission Number (optional)

3. Foreign Passport Number and Country of Issuance (optional)

I agree that my typed initials below will be as valid as a handwritten signature to the extent allowed by local law

Today's Date (optional)

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2021 W-4 Form

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Please Sign Here (Docu Sign)

_________________________________________________

Date

Application for CDL License

DRIVER'S APPLICATION FOR EMPLOYMENT Boone Logistics Services, LLC

Boone Logistics Services, LLC

150 2nd Avenue N, Suite 660 St. Petersburg, FL 33701

EMPLOYMENT AND SAFETY PERFORMANCE HISTORY

I hereby authorize the list of previous employers to release and forward the information requested by section 4 of this document concerning my

Alcohol and Controlled Substances Testing records within the previous 3 years for this application.

ACCIDENT RECORD

EDUCATION

COPY OF CDL

COPY OF SNN CARD

COPY OF MEDICAL CARD

COPY OF FMCSA MEDICAL VARIANCE

PREVIOUS PRE-EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT

PRE-EMPLOYMENT URINALYSIS NOTIFICATION

DRUG & ALCOHOL AWARENESS PROGRAM CERTIFIED RECEIPT

Driver Agreement

AUTHORIZATION AGREEMENT

ACCOUNT INFORMATION

EMERGENCY CONTACT INFORMATION

REQUEST FOR CHECK OF DRIVING AND CRIMINAL RECORDS

EMPLOYEE DRUG & ALCOHOL CONSENT FORM

COMPANY POST ACCIDENT DRUG & ALCOHOL TEST REQUIREMENTS

DRIVER DATA SHEET

FORM I-9

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)

Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.

After you complete the W4 please hit the blue send button then click the next send black button below.

2021 W-4 Form