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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Old Mill RoadCarrollton, TX Street Address
PHONE NUMBER AVAILABLEStreet Address -06-2023 1:45:01PM CDTIntelliAppWelcome to the online application for Candidate's Name MOVING and STORAGE, BUSINESS DEVELOPMENT At (469) 461-5000.Personal InformationName Robert Terrell Walker, Sr.Residence 3 years or longer (If No,previous addresses shown below)YesCurrent Address 5360 Lakerock DrCity, State/Province Zip/Postal Atlanta, GA 30331 Country United StatesResidence 3 years or longer (If No,previous addresses shown below)YesSSN/SIN 5083Date of BirthPrimary Phone PHONE NUMBER AVAILABLEEmail EMAIL AVAILABLEYes, I agree to receive informationconcerning future opportunities orpromotions from Candidate's Name by email orother commercial electroniccommunications.Yes1Would you like to receive communicationfrom Candidate's Name via text message?By participating, you consent to receivetext messages sent by an automatictelephone dialing system, which maycontain recruiting/advertising messages.Consent to these terms is not a conditionof being hired, contracted, or leased. Youmay opt out at any time by texting STOP tounsubscribe. You also agree that All MySons's service provider receives in realtime and logs your text messages with AllMy Sons.YesCompany QuestionsGENERAL INFORMATIONWhat location are you applying for? Atlanta 3Are you legally eligible for employment inthe United States?YesDo you read, write, and speak English? YesDRIVING EXPERIENCEPlease select the amount of drivingexperience you haveNoneDo you have any driver training? NoIf yes, please provide descriptionLicensesPlease provide all licenses held in the last 5 years. License Number 145Licensing Authority GACountry USLicense ClassLicense Expiration Date 02-26-2028Current License YesCommercial Driver License No2Employment / UnemploymentUnemploymentStart Date 07-2023End Date 09-2023CommentDiaz FoodsCompany Diaz FoodsStart Date 05-2022End Date 07-2023AddressCity, State/Province Zip/Postal Atlanta, GA 30331Country United StatesPhone PHONE NUMBER AVAILABLEFax PHONE NUMBER AVAILABLEPosition Held PickerReason for leaving? TemporaryWere you terminated/discharged/laid off? NoIs this your current employer? NoMay we contact this employer at this time? YesDid you operate a commercial motorvehicle?NoWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?Did you perform any safety sensitivefunctions in this job subject to drug andalcohol testing?Areas DrivenMiles driven weeklyPay Range (cents/mile)Most common truck drivenMost common trailerTrailer lengthUnemploymentStart Date 09-20203End Date 04-2022CommentFMCSRUnder FMCSR 391.15, are you currentlydisqualified from driving a commercialmotor vehicle? [49 CFR 391.15]NoHas your license, permit or privilege todrive ever been suspended or revoked forany reason? [49 CFR 391.21(b)(9)]YesPlease provide additional detail, including the dates of the suspension(s)/revocation(s): Driving ticketsHave 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 concentration("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,No4formulations 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 5 years (even if not at fault)?No AccidentsTraffic Convictions \ ViolationsHave you had any moving violations or traffic convictions in the past 3 years? Violation Date 08-2023Charge / Description Driving Without A LicenseViolation State/Province GAIn Commercial Vehicle NoFined? YesLicense Suspended? YesLicense Revoked?Perform Community Service?Other Penalty?Fine Amount (if any):Comments:SignatureFull Name Robert Terrell Walker, Sr.IP Address 2601:c2:3:55b3:aSignature Date/Time 09-06-2023 1:45 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 5my knowledge.Signed Date: 09-06-2023 1:45 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 PSPDisclosure 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.YesFCRA 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 myYes6consent. An electronic signature is aslegally binding as an ink signature.Employment 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.YesClearinghouse ReleaseBy 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.YesINVESTIGATIVE 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 roc_ysn@icloud.com.Yes7DISCLOSURE FOR CONSUMER REPORTSIn connection with your employment or owner-operator (independent contractor) application, Candidate's Name Moving & Storage of Dallas LLC 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 information, 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, former employers, public court records, and federal, state, and other government agencies that maintain such records. Printed Name:Robert Terrell Walker, Sr.Social Security #:5083Signed Date: 09-06-2023Robert Terrell Walker, Sr.5360 Lakerock DrAtlanta, GA 30331PHONE NUMBER AVAILABLEGender:8AUTHORIZATION FOR CONSUMER REPORTSPlease note that this employer will not order a credit report with this authorization I authorize Candidate's Name Moving & Storage of Dallas LLC to obtain one or more consumer report(s) or investigative consumer report(s) about me. If hired or engaged as an owner-operator (independent contractor), I understand this authorization shall remain on file and shall serve as ongoing authorization for additional consumer reports or investigative consumer reports to be obtained from any consumer reporting agency at any time during my employment or contract period without asking me for authorization again. Printed Name:Robert Terrell Walker, Sr.Social Security #:5083Signed Date: 09-06-2023Robert Terrell Walker, Sr.5360 Lakerock DrAtlanta, GA 30331PHONE NUMBER AVAILABLEGender:9IMPORTANT DISCLOSUREREGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Candidate's Name ("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 Candidate's Name ("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:Robert Terrell Walker, Sr.Signed Date: 09-06-202310Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol ClearinghouseI hereby provide consent to Candidate's Name 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. 09-06-2023Robert Terrell Walker, Sr. Date11Summary 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 Candidate's Name
('Company'):AsurintCompliance DeptPO Box 14730Cleveland, Ohio 44114Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: https://www.asurint.com/candidatesTenstreet120 W. 3rd StreetTulsa, OK 74103Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: http://www.tenstreet.com/drivers/For Pre-Employment Screening Program (PSP) and 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.12INVESTIGATIVE CONSUMER REPORT DISCLOSURECandidate's Name ("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: AsurintCompliance DeptPO Box 14730Cleveland, Ohio 44114Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: https://www.asurint.com/candidatesTenstreet120 W. 3rd StreetTulsa, OK 74103Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEWeb: http://www.tenstreet.com/drivers/For Pre-Employment Screening Program (PSP) and 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. 13NEW 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. WASHINGTON 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. 14DISCLOSURE FOR CONSUMER REPORTSIn connection with your employment or owner-operator (independent contractor) application, Candidate's Name Moving & Storage of Dallas LLC 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 information, 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, former employers, public court records, and federal, state, and other government agencies that maintain such records. Employer / Contractor / Educational Institution:Diaz FoodsPrinted Name:Robert Terrell Walker, Sr.Social Security #:5083Signed Date: 09-06-2023Robert Terrell Walker, Sr.5360 Lakerock DrAtlanta, GA 30331PHONE NUMBER AVAILABLEGender:15AUTHORIZATION FOR CONSUMER REPORTSPlease note that this employer will not order a credit report with this authorization I authorize Candidate's Name Moving & Storage of Dallas LLC to obtain one or more consumer report(s) or investigative consumer report(s) about me. If hired or engaged as an owner-operator (independent contractor), I understand this authorization shall remain on file and shall serve as ongoing authorization for additional consumer reports or investigative consumer reports to be obtained from any consumer reporting agency at any time during my employment or contract period without asking me for authorization again. Employer / Contractor / Educational Institution:Diaz FoodsPrinted Name:Robert Terrell Walker, Sr.Social Security #:5083Signed Date: 09-06-2023Robert Terrell Walker, Sr.5360 Lakerock DrAtlanta, GA 30331PHONE NUMBER AVAILABLEGender:16A 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 the 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 |
