CHAUFFEUR APPLICATION

Personal Information

General Information

Are you 25 years of age or older?
Are you physically able to lift 50 pounds?
Have you been previously employed by the Company?
Are you employed now?
Have you previously applied for work here?
Do you have a Commercial Driver’s license (CDL)?
Do you have a valid medical card?
Enter Exp. Date
How did you hear about this position?
Do you have any moving violations/points in the past three years?

Education

High School/Preparatory
College/Tech or Trade School

Employment History

To drive in interstate commerce all driver applicants must provide the following information on all employers during the last three years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle* in intrastate commerce must also provide an additional seven years information on those employers for whom the applicant operated such vehicle. *Include vehicles having a GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding. List employers in reverse order - starting with the most recent.

Data Employed

Driving Policy Agreement
and MVR Release Form

Purpose:

No applicant will be hired into a position that requires driving as a key aspect of the position, nor will any existing employee be allowed to drive a personal car on Company business or a Company owned leased or rented vehicle, unless the requirements set forth in this procedure have been met.

Scope:

This procedure pertains to any applicant for positions requiring driving, as well as all existing employees who drive a Company owned, leased or rented vehicle or a personal vehicle on Company business. Satisfactory driving performance and behavior is essential for the safety of our employees and the public.

Basic Requirements to Drive:

Applicants and employees must have a valid driver’s license. A hardship or restricted license, or learner’s permit are not a valid license per this policy.

Employment with Extensis is contingent upon having an acceptable Motor Vehicle Record (MVR). Applicants must authorize Extensis to run an MVR

Applicants may be disqualified for employment or driving positions if:

1. The MVR indicates that the applicant’s driver’s license is currently suspended, revoked, or cancelled, including for administrative reasons (non-safety related).

2. Drivers indicate at risk driving behaviors by evidence of MVR records, call in complaints, direct observation by company employees, preventable collisions or any other valid source.

MVR Release and Policy Agreement:

In connection with any application made by me, I understand that investigative background inquiries may be made on me regarding motor vehicle information. I understand that you may be requesting information from various government agencies which maintain records concerning past driving records.

I authorize without reservation, any party or agency

contacted to furnish the above mentioned information and release all parties involved from any liability for doing so. I hereby consent to my employer, Extensis, obtaining such information. I recognize that these inquiries may be made randomly in the future and no further authorization is required by me.

I understand the importance of driving defensively safely and that if the company determines my driving record indicates evidence of at risk driving, as described above, my employment can be terminated.

Please Read

This Employment Application will remain active for 30 days. If you are hired by the company, you will be required to attest to your identity and employment eligibility, and to present documents confirming your identity and employment eligibility. You cannot be hired if you cannot comply with these requirements.

I certify that the information provided on or in connection with this form is true, accurate and complete. I also understand that any false statements or deliberate omissions on this form or any other document that I submit to Flyte Tyme Worldwide may be grounds for disqualification from employment or, if discovered after employment begins, could result in discipline up to and including termination of employment. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background reports that may be requested by or on behalf of the company.

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