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Click here or scroll down to respond to this candidateRyder Integrated Logistics, Inc.DOT#Street Address 0Street Address NW 105th StreetMiami, FL Street Address
Street Address -27-2024 2:14:05PM CDTIntelliAppPersonal InformationName Roger Wayne ScottCurrent Address 4938 DriskillAddress 2 4938driskillCity, State/Province Zip/Postal San Antonio, TX 78228 Country United StatesResidence 3 years or longer (If No,previous addresses shown below)YesSSN/SIN 5822Date of BirthPrimary Phone PHONE NUMBER AVAILABLECell Phone PHONE NUMBER AVAILABLEPreferred method of contact Primary PhoneBest time to contact you AnyEmail EMAIL AVAILABLECompany QuestionsGENERAL INFORMATIONApplicant Type: Truck DriverIf you answered YES to the questionabove, will you require now or in the nearfuture employment visa sponsorship (i.e.,H-1B visa)?Are you currently employed? NoWhat date did your last employment end? 04/27/2024 Do you read, write, and speak English? YesEnter start and end dates, location,position, and reason for leaving:Do you have a current TWIC card? NoExpiration date:No1Have you ever been known by any othername?Enter name:Please enter the names of any relativesemployed here:N/aDRIVING EXPERIENCEFor each class of equipment, enter type of equipment (van, reefer, tank, etc.), start and end dates, and approximate number of total miles. If no experience in a class, enter"NONE".Straight Truck 40yrsTractor and Semi-Trailer 40yrsTractor - Two Trailers 40yrsOther 40yrsWhich safe driving awards do you hold andfrom whom?40yrsEQUIPMENT (OWNER/OPERATORS ONLY)Equipment Description (Tractor):Type: N/aYear:Make:Model:Color: WhiteVIN:WeightMileageFifth Wheel HeightFirst Reference:Have you completed your registration forthe FMCSA Drug & AlcoholClearinghouse?YesApplicant Workflow ID 3450961Person ID 2135699System ID 34509612LicensesLicense Number 584Licensing Authority TXCountry USLicense Class Class AOriginal Issue Date 03-07-2024License Expiration Date 05-03-2032DOT Medical Card Expiration Date 11-07-2025Current License YesCommercial Driver License YesEndorsementsTanker Endorsement YesHAZMAT Endorsement NoX Endorsement NoDoubles Triples Endorsement YesOther Endorsement NoRestrictions NoneEmployment / UnemploymentSouthern Mail Service, Inc.PLEASE DO NOT CONTACTCompany Southern Mail Service, Inc.Contact / Supervisor Name JamieStart Date 06-1988End Date 04-2024Address P. O. Box 2145Address 2 3938 naco perrinCity, State/Province Zip/Postal Houston, TX 77252Country United StatesPhone PHONE NUMBER AVAILABLEPosition Held DriverReason for leaving? NaWere you terminated/discharged/laid off? NoIs this your current employer? Yes3May we contact this employer at this time? NoDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas Driven Tx ark la ok NMMiles driven weekly 3500+Pay Range (cents/mile) 2750hrsMost common truck driven Tractor-TrailerMost common trailer VanTrailer length 53 feet or moreFMCSRUnder FMCSR 391.15, are you currentlydisqualified from driving a commercialmotor vehicle? [49 CFR 391.15]YesPlease provide additional detail:N/aHas your license, permit or privilege todrive ever been suspended or revoked forany reason? [49 CFR 391.21(b)(9)]NoHave you ever been denied a license,permit, or privilege to operate a motorvehicle?[49 CFR 391.21(b)(9)]NoWithin the past two years, have you testedpositive, or refused to test, on apre-employment drug or alcohol test by anemployer to whom you applied, but did notobtain, safety-sensitive transportation workcovered by DOT agency drug and alcoholtesting rules? [49 CFR 40.25(j)]NoIn the past three(3) years, have you everbeen convicted of any of the followingoffenses: [49 CFR 391.15]:Driving a commercial motor vehiclewith a blood alcohol concentrationNo4("BAC") of .04 percent or moreDriving under the influence ofalcohol, as prescribed by state lawRefusal to undergo drug andalcohol testing as required by anyjurisdiction for the enforcement ofFederal Motor Carrier Safety ActregulationsDriving a commercial motor vehicleunder the influence of any 21C.F.R. 1308.11 Schedule Iidentified controlled substance, anamphetamine, a narcotic drug, aformulation of an amphetamine, ora derivative of a narcotic drugTransportation, possession, orunlawful use of a 21 C.F.R.1308.11 Schedule I identifiedcontrolled substance,amphetamines, narcotic drugs,formulations of an amphetamine, orderivatives of narcotic drugs whileyou were on duty driving for amotor carrierLeaving the scene of an accidentwhile operating a commercial motorvehicleOr any other felony involving theuse of a commercial motor vehicleVehicle Accident RecordWere you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?No AccidentsTraffic Convictions \ ViolationsHave you had any moving violations or traffic convictions in the past 3 years? No ViolationsCriminal RecordHave you ever been convicted of a crime? NoDo you have any deferred prosecutions? NoDo you have criminal charges pending? NoNo5Have you ever pled "guilty" to, beenconvicted of, or pled "no contest" to afelony?If you have any felony convictions, do youcurrently hold a minister's permit to enteror exit Canada?NoHave you, within the last five years, pled"guilty" to, been convicted of, hadprosecution deferred in connection with, orpled "no contest" to a misdemeanor?NoSignatureFull Name Roger Wayne ScottIP Address 2603:8081:3f05:bSignature Date/Time 04-27-2024 2:14 PMBy signing my application below, I agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.Signed Date: 04-27-2024 2:14 PMSigned:Federal FCRA Summary of Rights AcknowledgmentBy checking this box, I (a) acknowledgethat I have read and understand thefederal FCRA Summary of Rights andhave been given the opportunity tocopy/print the Summary of Rights and (b)agree to use an electronic signature todemonstrate my consent. An electronicsignature is as legally binding as an inksignature.YesPSP Disclosure and AuthorizationBy checking the box, I (a) acknowledgethat I have read and understand the PSPYes6Disclosure and Authorization and alsohave been given the opportunity tocopy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.FCRA DisclosureBy checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesFCRA AuthorizationBy checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesEmployment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesSummary of Rights Under 15 U.S.C. Section 1681m(a) By checking the box, I (a) acknowledgethat I have read and understand theSummary of Rights Under 15 U.S.C.Section 1681m(a) and have been giventhe opportunity to copy/print the 1681mSummary of Rights and (b) agree to usean electronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.Yes7INVESTIGATIVE CONSUMER REPORT DISCLOSUREBy checking this box, I represent that Iunderstand and agree to the aboveInvestigative Consumer ReportDisclosure.YesUser Requested CopyUser requested a copy to be sent to thisemail address scottroger254@gmail.com.Yes8DISCLOSURE AND AUTHORIZATION TO REQUEST INVESTIGATIVE CONSUMER REPORT & STATE SPECIFIC CONSUMER REPORTSDISCLOSUREThe Company may obtain an investigative consumer report and/or state specific consumer report ("Report") that contains background information about you from First Advantage Enterprise Screening Corporation ("First Advantage"), 1 Concourse Parkway NE Suite 200 Atlanta, GA 30328 (www.FADV.com), PHONE NUMBER AVAILABLE, for purposes of evaluating your application, appointment and/or contract terms at the time of application and throughout your affiliation with the Company.The Reports may include, but are not limited to, information regarding your character, general reputation, personal characteristics and standard of living, educational and employment history, drug/alcohol test results, OFAC/terrorist watch list, sex offender search, Social Security verification and address history, driving record and criminal record and accident history as required by the Federal Motor Carrier Safety Act, subject to any limitations imposed by applicable federal and state law. This information may be obtained through direct or indirect contact with public and private sources, including former employers, schools and public agencies or other sources. If an investigative consumer report is requested, in addition to the description above, the nature and scope of any such report will be employment verifications and references, or personal references.The specific type of report most often requested is criminal record, driving record, accident history, and employment history. You have the right to request a complete disclosure of the nature and scope of the consumer report requested and/or prepared.You also have a right to request a written summary of your rights under the FCRA from the Company. It is also available online through the Consumer Financial Protection Bureau's website: https://www.consumerfinance.gov/compliance/compliance-resources/other-applicable-requirements/fair- credit-reporting-act/model-forms-and-disclosures/AUTHORIZATIONI have carefully read the foregoing Disclosure and this Authorization. By signing below, I consent to and authorize the COMPANY to obtain from First Advantage the Reports described above. I acknowledge receipt of a copy of the "A Summary of Your Rights Under the Fair Credit Reporting Act." Printed Name:Roger Wayne ScottSocial Security #:5822Signed Date: 04-27-2024Roger Wayne Scott4938 Driskill4938driskillSan Antonio, TX 78228PHONE NUMBER AVAILABLEGender:9DISCLOSURE & AUTHORIZATION FOR BACKGROUND INVESTIGATION The Company will utilize the services of a third-party agency or consumer reporting agency to obtain a consumer report for purposes of evaluating your application, appointment and/or contract terms at the time of application and throughout your affiliation with the Company. The term "consumer report" includes communications by a third-party agency or consumer reporting agency bearing on your criminal background, driving record, education, prior employment, credit history, character or mode of living. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying or are employed in. Pursuant to the Fair Credit Reporting Act, the Company is required to obtain your permission prior to procuring the consumer report. By signing below, you hereby authorize the Company to procure report(s) on your background as described above from any third-party or consumer reporting agency contacted by the Company. You further authorize ongoing procurement of the above-mentioned report(s) at any time that you are considered for another position with the Company or at any time during your association with the Company. Printed Name:Roger Wayne ScottSocial Security #:5822Signed Date: 04-27-2024Roger Wayne Scott4938 Driskill4938driskillSan Antonio, TX 78228PHONE NUMBER AVAILABLEGender:10IMPORTANT DISCLOSUREREGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Ryder Integrated Logistics, Inc. DOT#165420 ("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. AUTHORIZATIONIf you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Ryder Integrated Logistics, Inc. DOT#165420 ("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:Roger Wayne ScottSigned Date: 04-27-202411Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing RecordsAnd changes in Parts 390 and 391 of the FMCSAX 04-27-2024DateX 5822Social Security NumberRoger Wayne Scott4938 Driskill4938driskillSan Antonio, TX 78228PHONE NUMBER AVAILABLEGender:X Roger Wayne ScottPrint Name (First, MI, Last)XSignatureI, the above mentioned signer, hereby authorize Southern Mail Service, Inc. To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Ryder Integrated Logistics, Inc. DOT#165420 DISCLOSURE AND RELEASEIn accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed above to Ryder Integrated Logistics, Inc., or to HireRight for the sole purpose of transmitting such records to Ryder Integrated Logistics, Inc.. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers(company/school) listed above to release information about names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and other information. The information that I have authorized Ryder Integrated Logistics, Inc. or HireRight to review involves tests required by DOT. If any carrier (company/school) listed above furnishes Ryder Integrated Logistics, Inc. or HireRight with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years. 12Summary of Rights Under 15 U.S.C. Section 1681m(a) You are hereby provided a summary of the following provisions of the Fair Credit Reporting Act, 15 U.S.C. 1681m(a): The following consumer reporting agencies will prepare the background report / consumer report for Ryder Integrated Logistics, Inc. DOT#165420 ('Company'):Tenstreet120 W. 3rd StreetTulsa, OK 74103Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: http://www.tenstreet.com/drivers/For Clearinghouse:U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SEWashington, DC 20590Phone: PHONE NUMBER AVAILABLE, TTY PHONE NUMBER AVAILABLEhttps://dataqs.fmcsa.dot.gov/Default.aspxNo consumer reporting agency utilized by the Company makes adverse decisions relating to your employment or contract relationship and no consumer reporting agency utilized by the Company is able to provide any specific reasons to you why an adverse decision relating to your employment or contract relationship may be taken or was taken based on a consumer report.15 U.S.C. 1681j provides for the right to obtain a free copy of a consumer report on you from the consumer reporting agency which prepared your background report, under various circumstances, including but not limited to where you receive notice that an adverse action has been taken toward you based on the consumer report. In that instance, Section 1681j provides a right to a free copy of the report provided that you make the request within 60 days of the date that you received notice of the adverse action.15 U.S.C. 1681i provides for the right to dispute, with a consumer reporting agency the accuracy or completeness of any information in a consumer report furnished by the agency.13INVESTIGATIVE CONSUMER REPORT DISCLOSURERyder Integrated Logistics, Inc. DOT#165420 ("Company") will order an 'investigative consumer report' concerning you for employment purposes or, if you are an owner-operator (independent contractor), for the legitimate business purpose of evaluating your suitability for an independent contractor engagement pursuant to your written instructions. An 'investigative consumer report' is defined as a consumer report or portion thereof in which information on a consumer's character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with neighbors, friends, or associates of the consumer reported on or with others with whom he is acquainted or who may have knowledge concerning any such items of information.The investigative consumer report the Company will order concerning you will contain information concerning your character, general reputation, personal characteristics, and mode of living, obtained through personal interviews. You have the right to request the additional disclosures provided for under the Fair Credit Reporting Act, 15 U.S.C. 1681d(b), which reads as follows:Any person who procures or causes to be prepared an investigative consumer report on any consumer shall, upon written request made by the consumer within a reasonable period of time after the receipt by him of the disclosure required by subsection (a)(1) of this section, make a complete and accurate disclosure of the nature and scope of the investigation requested. This disclosure shall be made in a writing mailed, or otherwise delivered, to the consumer not later than five days after the date on which the request for such disclosure was received from the consumer or such report was first requested, whichever is the later. At present, the specific 'nature and scope' of the investigative consumer report the Company may request is as follows: Employment Verifications, Motor Vehicle Reports, CDLIS, Criminal Records, and PSP. The report(s) will be requested from the following: Tenstreet120 W. 3rd StreetTulsa, OK 74103Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: http://www.tenstreet.com/drivers/For Clearinghouse:U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SEWashington, DC 20590Phone: PHONE NUMBER AVAILABLE, TTY PHONE NUMBER AVAILABLEhttps://dataqs.fmcsa.dot.gov/Default.aspxYou have the right to request whether an investigative consumer report was ordered. You can also make a written request for a complete and accurate disclosure of the nature and scope of the investigation that was requested, request a copy of the report, a copy of any federal or state local notices of rights that may apply to you, or request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries of each consumer reporting agency issuing an investigative consumer report about you, by sending a letter or email to the Company. You may also request and promptly receive from all such consumer reporting agencies free copies of any such investigative consumer reports. MARYLAND: You have the right to request additional disclosures from the Company regarding the nature and scope of the requested investigation.MASSACHUSETTS: If you contact the Company, you have the right to know whether the Company ordered an investigative consumer report about you. You also have the right to ask the CRA for a copy of any such report. MINNESOTA: You have the right in most circumstances to submit a written request to the CRA for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The CRA must provide you with this disclosure within five business days after its receipt of your request or the report was requested by the Company, whichever date is later. NEW JERSEY: You have the right to submit a request to the CRA for a copy of any investigative consumer report the Company ordered about you.NEW YORK: If you contact the Company, you have the right to know whether the Company ordered a consumer report or investigative consumer report about you. Shown above is the CRA's address and telephone number. You have the right to contact the CRA to inspect or receive a copy of any such report. A copy of Article 23-A of the Correction Law is provided in connection herewith. 14WASHINGTON STATE: If you submit a written request to the Company, you have the right to a complete and accurate disclosure of the nature and scope of any investigative consumer report the Company ordered about you. You are entitled to this disclosure within five business days after the date your request is received or we ordered the report, whichever is later. You also have the right to request a written summary of your rights under the Washington Fair Credit Reporting Act. 15A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information.You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:a person has taken adverse action against you because of information in your credit report;you are the victim of identity theft and place a fraud alert in your file;your file contains inaccurate information as a result of fraud;you are on public assistance;you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.You have the right |
