PREVIOUS PRE-EMPLOYMENT EMPLOYEE
ALCOHOL AND DRUG TEST STATEMENT



Sec. 40.25(j) As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years. If the employee admits that he or she had a positive test or a refusal to test, you must not use the employee to perform safety-sensitive functions for you, until and unless the employee documents successful completion of the return-to-duty process. (see Sec. 40.25(b)(5) and (e))

The prospective employee is required by Sec. 40.25(j) to respond to the following questions.



(1) Have you tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety­ sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?<

(2) If you answered yes, can you provide/obtain proof that you've successfully completed the DOT return-to-duty requirements?

I certify that the information provided on this document is true and correct.

Witnessed By:                            

Date:                            

DRIVER STATEMENT OF ON-DUTY HOUS
(For Newly Hired Drivers)

INSTRUCTIONS: Motor Carriers when using a driver for the first time shall obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and time at which such driver was last relieved from duty prior to beginning work for such carrier. Rule 395.8(j)(2) Federal Motor Carrier Safety Regulations. NOTE: Hours for any compensated work during the preceding 7 days, including work for a non-motor carrier entity, must be recorded on this form.

Driver's License:

DAY



DATE



HOURS WORKED

1 (yesterday)

2

3

4

5

6

7







I hereby certify that the information given above is correct to the best of my knowledge and belief, and that I was last relieved from work at

DRIVER CERTIFICATION FOR OTHER COMPENSATED WORK

INSTRUCTIONS: When employed by a motor carrier, a driver must report to the carrier all on-duty time including time working for other employers. The definition of on-duty time found in Section 395.2 paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations includes time performing any other work in the capacity of, or in the employ or service of, a common, contract or private motor carrier, also performing any compensated work for any nonmotor carrier entity.

I hereby certify that the information given above is true and I understand that once I become employed with this company, if I begin working for any additional employer(s) for compensation that I must inform this company immediately of such employment activity.

© Copyright 1998 J.J. KELLER & ASSOCIATES, INC., Neenah, WI - USA- (800)327-6868      644-F (Rev. 2/98)

CONTACT DRIVERS RECEIPT

This issue of the FMCSR Pocketbook includes all the most recent recent revisions issued on our before this date:

I acknowledge receipt of this FEDERAL MOTOR CARRIER SAFETY REGULATIONS POCKETBOOK (ORS-7A). In addition, I agree to familiarize myself with the Federal Motor Carrier Safety Regulations (FMCSR) of the United States Department of Truckingation, Parts 383, 387. 390-399, Sub Chapter B, Chapter 3, title 49 of the Code of Federal Regulations, as contained therein.

Note: this receipt shall be read and signed by the driver. A responsible company supervisor shall countersign the receipt and place it in the driver's qualification file.

Call Our Recruiting Dept @ 918-436-6058
to Begin Your Exciting New Career with JRT Trucking!



110 E Folsom Blvd
Pocola, OK 74902

(918) 436-6030

(918) 436-6067

safety@jrttruckinginc.com

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