Application form – Luxor Drive

Thank you for your interest in LUXOR DRIVE INC. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

To fill out this form, you will need to know the following:

✓ Social Security Number
✓Home address history for the past 3 years
✓ Current driver license number and driver license history for the past 3 years
✓ Employment history up to 10 years
✓ History of traffic accidents, violations and/or convictions from the last 3 years (including DUI or reckless driving conviction and license suspension)
✓ Military history (if applicable)

Required entry fields are followed by *, meaning you must provide the requested information to continue. If you encounter any errors during this process and cannot continue, please contact us at +1 630-915-3026

To qualify with LUXOR DRIVE INC, you must meet the following criteria:
✓ Must be at least 21 years of age
✓ Able to pass medical and functional capacity testing
✓ No reckless driving, DUI, hit and run, manslaughter or use of a motor vehicle for felonious purposes
✓ No abandonment of equipment

Personal Information

Name *

First

Last

Suffix

SSN / SIN *

Date of Birth *

Address

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Residence address for 3 or more years? *

Contact

Primary Phone *

Cell Phone

Email *

Confirm Email

Preferred method of contact

Yes, I agree to receive information concerning future opportunities or promotions from LUXOR DRIVE INC by email or other commercial electronic communications. *

Would you like to receive communication from LUXOR DRIVE INC via text message?

First Choice

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 LUXOR DRIVE INC’s service provider receives in real time and logs your text messages with LUXOR DRIVE INC. Yes

GENERAL INFORMATION

What position are you applying for? *

Are you legally eligible for employment in the United States? *

Are you currently employed? *

Do you read, write, and speak English? *

Have you ever worked for this company before? *

Do you have a current TWIC card? *

Please enter the names of any relatives employed here:

Have you ever been known by any other name? *

How did you hear bout us? Your answer is really important to us. *

DRIVING EXPERIENCE

Please select the amount of experience you have.

Flatbed and/or Step Deck *

Tractor and Semi-Trailer *

Which safe driving awards do you hold and from whom?

EDUCATION

List highest grade completed:

List last school attended (name, city, and state):

PERSONAL REFERENCES

List name, address, city, state, phone number, and relationship:

First Reference: *

Second Reference: *

License Number *

Country *

License State/Province *

License Expiration *

Physical Expiration

Is this your current driver license? *

Is this a commercial driver license? *

Were you ever in the U.S. military?

Have you been employed, contracted, or attended a company orientation in the last 10 years? *

Have you attended a driver training school? *

Have you attended a school (not related to truck driving) in the last 10 years? *

Have you been unemployed at any time within the last 10 years? *

Motor Vehicle Record

Has any license, permit or privilege ever been denied, suspended or revoked for any reason? *

Have you ever been convicted of driving during license suspension or revocation, or driving without a valid license or an expired license, or are any charges pending? *

Have you ever been convicted for any alcohol or controlled substance related offense while operating a motor vehicle, or are any charges pending? *

Have you ever been convicted for possession, sale or transfer of an illegal substance (including but not limited to, marijuana, amphetamines, or derivatives thereof) while on duty, or are any charges pending? *

Have you ever been convicted of reckless driving, careless driving or careless operation of a motor vehicle, or are any charges pending? *

Have you ever 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 in past three years, or have you ever tested positive or refused to test on any DOT-mandated drug or alcohol test? *

Have you had any moving violations or traffic convictions in the past 3 Years? *

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)? *

Criminal Record

Have you ever been convicted of a crime? *

Do you have any deferred prosecutions? *

Do you have criminal charges pending? *

Felonies

Have you ever pled "guilty" to, been convicted of, or pled "no contest" to a felony? *

If you have any felony convictions, do you currently hold a minister's permit to enter or exit Canada? *

Misdemeanors

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? *

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with LUXOR DRIVE 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

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize LUXOR DRIVE 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. By checking the box, I (a) acknowledge that I have read and understand the PSP Disclosure and 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.

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