Driver Application - Alcohol and Controlled Substance Disclosure -

Truck Driver Application STEP 2

Online completion of the Alcohol and Controlled Substance Disclosure Form

Full Name*

first name, middle initial, last name
Social Security Number*
Your Email*
Your Phone*
hereby authorize that:
Previous Employer 1
Address
Street Address City State ZIP Code
Telephone
Fax
Previous Employer 2
Address
Street Address City State ZIP Code
Telephone
Fax
Previous Employer 3
Address
Street Address City State ZIP Code
Telephone
Fax
may release and forward information requested by Section 2 (below) of this document concerning my Alcohol and Controlled Substances Testing records to: 7 Hills Transport, Inc. ~ Attention: Cory Sharpless 2 Dean Drive, Cartersville, GA 30120 Telephone 800-741-0777 ~ Fax 678-721-6626
Consent (check box)*
I certify that the above information is true and correct, and I hereby give consent for this information to be used for the purpose of processing my employment application.
Signature Pin*
Enter a 5-digit Consent Pin Code
Electronic Signature*
Use your finger or mouse to sign your application form
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Comments
This field is for validation purposes and should be left unchanged.

SECURE PAGE

TO APPLY ONLINE:

STEP 1 – MVR Request Form

STEP 2 – Alcohol and Controlled Substance Disclosure Form

STEP 3 – Notice Regarding Background Reports

STEP 4 – Truck Driver Employment Application

TO APPLY OFFLINE:
Download employment application

This is in compliance with §382.405(f) and (h), which states: (f) Records shall be made available to a subsequent employer upon receipt of a written request from a driver. Disclosure by that subsequent employer is permitted only as expressly authorized by the terms of the driver’s request. (h) An employer shall release information regarding driver’s records as directed by the specific, written consent of the driver authorizing release of the information to an identified person. Release of such information by the person receiving the information is permitted only in accordance with the terms of the employee’s consent. §382.405(a)(b)(c)(e)(f) further states: (a) An employer may obtain, pursuant to a driver’s written consent, any of the information concerning the driver which is maintained under this part by the driver’s previous employers. (b) An employer shall obtain, pursuant to a driver’s consent, information on the driver’s alcohol tests with a concentration result of 0.04 or greater, positive controlled 0.04 or greater, positive controlled substances test results, and refusals to be tested, within the preceding two years, which are maintained by the driver’s previous employers under §382.401(b)(1)(i) through (iii).(c) The information in paragraph (b) of this section must be obtained and reviewed by the employer no later than 14 calendar days after the first time a driver performs safety-sensitive functions for an employer.(e) The prospective employer must provide to each of the driver’s employers within the two preceding years the driver’s specific written authorization for release of the information in paragraph (b).(f) the release of any information under this part may take the form of personal interviews, telephone interviews, letters, or any other method of obtaining information that ensures confidentiality. Each employer must maintain a written, confidential record with respect to each past employer contacted.

Section 2:
Information to be completed by the previous employer

Has this person ever tested positive for a controlled substance in the last two years?
Has this person ever had an alcohol test with a Breath Alcohol Concentration of 0.04 or greater in the last two years?
Has this person ever refused (includes a verified adulterated or submitted result) a required test for drugs or alcohol in the last two years?
In the last two years, has this person violated any DOT agency drug and alcohol testing regulations?
Have you received information from a previous employer that this individual violated DOT drug or alcohol regulations?
If this person violated a DOT drug and alcohol regulation in the last two years, please provide documentation of the employee’s successful completion of DOT return-to-duty requirements (including follow-up tests).

Driver Application – Alcohol and Controlled Substance Disclosure