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APPLICATION
Application
Step
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Name
(Required)
First
Address
(Required)
Street Address
City
Albama
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Residence 3 years or longer
(Required)
Yes
No
SSN/SIN
(Required)
Date of birth
(Required)
MM slash DD slash YYYY
Primary phone
(Required)
Email
(Required)
Would you like to receive communication from Amg Logistics Inc via email or other commercial electronic communications?
Yes, I agree to receive information concerning future opportunities or promotions from Amg Logistics Inc by email or other commercial electronic communications.
Would you like to receive communication from Amg Logistics Inc via text message?
Yes
No
By participating, you consent to receive text messages sent by an automatic telephone dialing system, which may contain recruiting/advertising messages. Consent to these terms is not a condition of being hired, contracted, or leased. You may opt out at any time by texting STOP to unsubscribe. You also agree that Amg Logistics Inc's service provider receives in real time and logs your text messages with Amg Logistics Inc.
What position are you applying for?
(Required)
Company Driver
Owner Operator
Fleet Owner
EQUIPMENT DESCRIPTION (TRACTOR):
Type
Year
Make
Model
Color
VIN
Weight
Mileage
Fifth Wheel Height
Are you legally eligible for employment in the United States?
(Required)
Yes
No
Are you currently employed?
(Required)
Yes
No
If No, what date did your last employment end?
MM slash DD slash YYYY
Do you read, write, and speak English?
(Required)
Yes
No
Have you ever worked for this company before?
(Required)
Yes
No
If Yes, enter start and end dates, location, position, and reason for leaving
Do you have a current TWIC card?
(Required)
Yes
No
If Yes, enter expiration date:
MM slash DD slash YYYY
Have you ever been known by any other name?
(Required)
Yes
No
If Yes, enter name:
MM slash DD slash YYYY
How did you hear about us?
Driver Referral
Other
If "Driver Referral", please enter the driver's name:
If "Other", please explain
For each class of equipment, select years of experience. If no experience in a class, select "None".
Straight Truck
(Required)
None
Less than a year
1-2 years
2-3 years
3-5 years
5+ years
Tractor and Semi-Trailer
(Required)
None
Less than a year
1-2 years
2-3 years
3-5 years
5+ years
Tractor - Two Trailers
(Required)
None
Less than a year
1-2 years
2-3 years
3-5 years
5+ years
Other
At least 3 years of employment history is required.
Company
(Required)
Start date
(Required)
MM slash DD slash YYYY
End date
(Required)
MM slash DD slash YYYY
Company Address
Street Address
City
Albama
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company phone
Position held
Reason for leaving
Were you terminated/discharged/laid off?
Is this your current employer?
(Required)
Yes
No
May we contact this employer at this time?
(Required)
Yes
No
Did you operate a commercial motor vehicle?
(Required)
Yes
No
Were you subject to the Federal Motor Carrier or Transport Canada Safety Regulations while employed/contracted by this employer/contractor?
(Required)
Yes
No
Did you perform any safety sensitive functions in this job subject to drug and alcohol testing?
(Required)
Yes
No
Areas driven
Miles driven weekly
(Required)
Pay range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
(Required)
Company 2
Company
Start date
MM slash DD slash YYYY
End date
MM slash DD slash YYYY
Company Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Company Phone
Position held
Reason for leaving
Were you terminated/discharged/laid off?
Is this your current employer?
Yes
No
May we contact this employer at this time?
Yes
No
Did you operate a commercial motor vehicle?
Yes
No
Were you subject to the Federal Motor Carrier or Transport Canada Safety Regulations while employed/contracted by this employer/contractor?
Yes
No
Did you perform any safety sensitive functions in this job subject to drug and alcohol testing?
Yes
No
Areas driven
Miles driven weekly
Pay range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
TRUCKING SCHOOL
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
School
School address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
School phone
Did you graduate?
Yes
No
Were you subject to the Federal Motor Carrier or Transport Canada Safety Regulations while attending this truck school?
Yes
No
Did you perform any safety sensitive functions at this truck school, regulated by DOT, and subject to drug and alcohol testing?
Yes
No
GPA
Hours of instruction
Border crossing
Yes
No
Log Books
Yes
No
Federal Motor Carrier Regulations
Yes
No
Hazardous materials
Yes
No
FMCSR
Under FMCSR 391.15, are you currently disqualified from driving a commercial motor vehicle?
(Required)
Yes
No
Has your license, permit or privilege to drive ever been suspended or revoked for any reason?
(Required)
Yes
No
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
(Required)
Yes
No
Within the past two years, have you tested positive, or refused to test, on a pre-employment drug or alcohol test by an employer to whom you applied, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules?
(Required)
Yes
No
In the past three (3) years, have you ever been convicted of any of the following offenses?
Driving a commercial motor vehicle with a blood alcohol concentration ("BAC") of .04 percent or more
(Required)
Yes
No
Driving under the influence of alcohol, as prescribed by state law
(Required)
Yes
No
Refusal to undergo drug and alcohol testing as required by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations
(Required)
Yes
No
Driving a commercial motor vehicle under the influence of any 21 C.F.R. 1308.11 Schedule I identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug
(Required)
Yes
No
Transportation, possession, or unlawful use of a 21 C.F.R. 1308.11 Schedule I identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while you were on duty driving for a motor carrier
(Required)
Yes
No
Leaving the scene of an accident while operating a commercial motor vehicle
(Required)
Yes
No
Or any other felony involving the use of a commercial motor vehicle
(Required)
Yes
No
VEHICLE ACCIDENT RECORD
Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?
(Required)
Yes
No
Accident/Incident 1
Type of Accident/Incident
Injury
Non-Injury
Date of Accident/Incident
MM slash DD slash YYYY
Hazmat Accident/Incident
Yes
No
Was the vehicle towed away?
Yes
No
City
State/Province
Were you in a commercial vehicle?
Yes
No
If yes, was this a Department of Transportation recordable accident?
Yes
No
Were you at fault?
Yes
No
Were you ticketed?
Yes
No
Description
TRAFFIC CONVICTIONS/VIOLATIONS
Have you had any moving violations or traffic convictions in the past 3 years?
(Required)
Yes
No
Conviction/Violation 1
Violation date
MM slash DD slash YYYY
Charge/Description
Violation State/Province
In commercial vehicle?
Yes
No
Fined?
Yes
No
License suspended?
Yes
No
License Revoked?
Yes
No
Perform community service?
Yes
No
Other penalty?
Yes
No
Fine amount (if any)
Comments
CRIMINAL RECORD
Have you ever been convicted of a crime?
Yes
No
Conviction 1 (comment)
Conviction 2 (comment)
Conviction 3 (comment)
Do you have any deferred prosecutions?
(Required)
Yes
No
Do you have criminal charges pending?
(Required)
Yes
No
Have you ever pled "guilty" to, been convicted of, or pled "no contest" to a felony?
(Required)
Yes
No
Pled 1 (comment)
Pled 2 (comment)
Pled 3 (comment)
If you have any felony convictions, do you currently hold a minister's permit to enter or exit Canada?
Yes
No
Have you, within the last five years, pled "guilty" to, been convicted of, had prosecution deferred in connection with, or pled "no contest" to a misdemeanor?
Yes
No
SIGNATURE
Signature (full name)
(Required)
IP address
Signature Date
(Required)
MM slash DD slash YYYY
Signature Time
Hours
:
Minutes
AM
PM
AM/PM
IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
(Required)
I (a) acknowledge that I have read and understand the PSP Disclosure and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.
In connection with your application for employment with AMG Logistics Inc. (“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
(Required)
I (a) acknowledge that I have read and understand the PSP Authorization and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.
If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize AMG Logistics Inc. (“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.
Printed name
(Required)
Signature
(Required)
Signed date
(Required)
MM slash DD slash YYYY
DISCLOSURE FOR CONSUMER REPORTS
(Required)
I (a) acknowledge that I have read and understand Disclosure for consumer reports and also have been given the opportunity to copy/print it, and (b) agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature.
In connection with your employment or owner-operator (independent contractor) application, Amg Logistics Inc may order one or more consumer report(s) (commonly known as "background reports" or "background checks") about you from one or more consumer reporting agencies. If you are hired or engaged as an owner-operator (independent contractor), additional consumer reports may be obtained in connection with and throughout your employment for employment purposes or for the legitimate business purpose of evaluating you as an owner-operator. To the extent allowed by law, the consumer reports may include information concerning your character, general reputation, personal characteristics, mode of living, drug and alcohol test results, motor vehicle records, driving records, criminal history, public court records, employment history (including names and dates of previous employers, reason for termination of employment, work experience, and accidents), social security number validation, education, licensure, or verification of other information supplied by you. Such reports may be obtained from private and public record sources, including sanctions databases, CDLIS (including but not limited to CDLIS Central Site, CDLIS Master Pointer Record data and your driver record from the jurisdiction identified in the CDLIS data, in accordance with applicable state law and the Driver Privacy Protection Act), former employers, public court records, and federal, state, and other government agencies that maintain such records.
Printed name
(Required)
Signature
(Required)
Signature
(Required)
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
(Required)
Social Security Number
(Required)
Signed date
(Required)
MM slash DD slash YYYY
Authorization for previous employers, contractors (if owner-operator) and trucking schools
(Required)
I, the above mentioned signer, hereby authorize my previous employers, contractors (if owner-operator), and trucking schools, as applicable to release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Amg Logistics Inc.
CONSENT FOR LIMTED QUERIES OF THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION (FMCSA) DRUG AND ALCOHOL CLEARINGHOUSE
(Required)
I hereby provide consent to Amg Logistics Inc to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for Amg Logistics Inc to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent. I understand that if I refuse to provide consent for Amg Logistics Inc to conduct a limited query of the Clearinghouse, Amg Logistics Inc is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle. I understand that if the limited query conducted by Amg Logistics Inc indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Amg Logistics Inc unless I give additional specific consent within the Clearinghouse. However, I understand that Amg Logistics Inc will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle.
Printed name
(Required)
Signature
(Required)
Signed date
(Required)
MM slash DD slash YYYY
Federal FCRA Summary of Rights Acknowledgment
(Required)
I acknowledge that I have read and understand the federal FCRA Summary of Rights and have been given the opportunity to copy/print the Summary of Rights.
1681m
(Required)
I represent that I understand and agree to the document attached below the form.
Investigative Consumer Report Disclosure
(Required)
I represent that I understand and agree to the document attached below the form.
Upload front and back side of your CDL
(Required)
Drop files here or
Select files
Max. file size: 3 GB, Max. files: 2.
Upload MEDICAL CARD / DOT physical certificate
(Required)
Drop files here or
Select files
Max. file size: 3 GB, Max. files: 2.
Upload Social Security card
(Required)
Drop files here or
Select files
Max. file size: 3 GB, Max. files: 2.
