Netcor Transports Employment Application

Documentation Needed for Employment Immigration Law compliance Valid Driver’s license Valid Social security card. Federal form I-9 W- 4 Employee Background Check Criminal Background Driving Record Prior employment Verification Reference checks Education (Updated Certifications, @ least CPR first responder level)

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

EMPLOYMENT APPLICATION APPLICANT INFORMATION Last Name

First

M.I.

Street Address

Date

Apartment/Unit #

City

State

Phone

E-mail Address

Date Available

ZIP

Social Security No.

Position Applied for

Desired Salary Full Time (40hrs)

Part Time (20hrs +)

Are you a citizen of the United States?

YES

NO

If no, are you authorized to work in the U.S.?

Have you ever worked for this company?

YES

NO

If so, when?

Have you ever been convicted of a felony?

YES

NO

If yes, explain

YES

NO

Availability From:

To:

Comments:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday -

EDUCATION High School From

Address To

Did you graduate?

College From

NO

Degree

NO

Degree

NO

Degree/Certification

Address To

Did you graduate?

Other From

YES

YES Address

To

Did you graduate?

YES

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

REFERENCES (PLEASE LIST 3 PROFESSIONAL REFERENCES) Full Name

Relationship

Company

Phone

(

)

(

)

(

)

Address Full Name

Relationship

Company

Phone

Address Full Name

Relationship

Company

Phone

Address

PREVIOUS EMPLOYMENT Company

Phone

Address

Supervisor

Job Title

Starting Salary

(

)

$

Ending Salary

$

Ending Salary

$

Ending Salary

$

Responsibilities From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary

(

)

$

Responsibilities From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

Company

Phone

Address

Supervisor

Job Title

Starting Salary

$

(

)

Responsibilities From

To

Reason for Leaving

May we contact your previous supervisor for a reference?

YES

NO

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

MILITARY SERVICE Branch

From

To

Rank at Discharge

Type of Discharge

If other than honorable, explain

DISCLAIMER AND SIGNATURE I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. Signature

Date

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

EMPLOYEE EMERGENCY INFORMATION FORM Date last updated: PERSONAL INFORMATION

Employee ID First name Middle name Last name Gender Citizenship Place of birth (country/region) Home address Home phone Cellular phone Home e-mail address Birthday (MM/DD/YYYY) Government ID or SSN Driver’s license/state ID number MEDICAL INFORMATION

Doctor’s name Address Phone number Blood type Medical conditions Allergies Current medications EMERGENCY INFORMATION

Emergency contact’s name Relationship Address Phone number(s)

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK IN COMPLIANCE WITH THE FCRA and the DPPA

(Fair Credit Reporting Act and the Federal Driver’s Privacy Protection Act) Date:_____________

Driver’s Lic #____________________________

State Issued______

________________________

____________________________

________

Last Name

First Name

Middle Initial

_________________________________________________________________________

Maiden and/or Other Last Names Used ________________________

_________________________

________________

Current Address

City and County

State and Zip Code

______________________

______________________

Date of Birth

Social Security Number

Circle One: Male / Female

This authorization and consent for release of personal information acknowledges that

Netcor Transports LLC. (Hereafter referred to as "Company") and/or its agent, may now, or at any time I am assigned to, volunteer with or am employed by this Company, conduct investigations whether the records are of a public, private or confidential nature. These investigations might include, but are not limited to, searches of educational institutions attended; financial or credit institutions, including records of loans; records of commercial or retail credit agencies; other financial statements; records of previous employment, including work history, efficiency ratings, complaints and grievances filed by or against me; records and recollections of attorney-at-law or of other counsel, whether representing me or any other person (in either a civil or criminal case in which I have been involved); records from the U.S. Veterans' Administration; criminal history information of file in local, state or federal agencies; and motor vehicle records, and following an employment offer, workers' compensation reports from either the Department of Labor, National Personnel Records or the Industrial Commission or similar agencies under the provisions of the Fair Credit Reporting Act 15, USC section 1681 et seq. I also authorize the National Personnel Records Center, or other custodian of my military service record, to release to Secure search, the following information and/or copies of documents from my military service record: DD214, service record, and any disciplinary records. I understand that these searches will be used to determine work assignment or employment eligibility under the company's employment or volunteer policies. Therefore, I authorize and consent for full release of records (either orally or in writing) to the authorized representatives of the company. In addition, I release and discharge the company and its agent and associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs expenses or any other charge or complaint filed with any agency arising from retrieving and reporting this information. I understand that according to the Federal Fair Credit Reporting Act, I am entitled to know whether employment was denied based upon the information obtained and to receive, upon written request, a disclosure of the background report. I also understand that I may request a copy of the report from my employer. After reading this document, I fully understand its contents and authorize the background verification.

Signed this _________________ day of _________________________________, 20_____ Applicant (Print Name) _________________________________________________________________________ Applicant Signature __________________________________________________________________________

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

Netcor Transports LLC. FLEET CARD AGREEMENT

Netcor Transports LLC. will utilize Fleet Cards to simplify the fueling process, low-dollar purchases for goods and services and to reduce the generation of petty cash. This policy establishes the guidelines for the Fleet Card program to ensure the use of these cards is in accordance with Netcor Transports policies and procedures. Fleet Card compliance is the responsibility of all Netcor Transports Employees.

a. The Fleet Card shall only be used for authorized Fuel purchases in accordance with Netcor Transports. b. The Fleet Card is not to be used for personal purchases under any circumstances. c. Fleet Cards are to remain under the designated vehicle at all times. d. Employees will sign out the assigned Fleet Card along with the equipment box on a daily basis. It is the employee’s responsibility to verify the Fleet Card’s accuracy to the assigned vehicle. e. The card holder is responsible to obtain, retain and submit the original receipt for any purchase made with a Fleet Card in a timely manner. Any transaction applied without the proper receipt of purchase will be the assigned card holder’s financial responsibility. NO EXEPTIONS. f. Card holders are required to report lost or stolen cards immediately. g. All Fleet Cards are the property of Netcor Transports and must be surrendered immediately upon supervisor request. h. Upon discovery of fraud or misuse of the Fleet Card by a Netcor Transports employee, the card will be forfeited. The employee will be subject to disciplinary action, up to and including dismissal and financial restitution. Employee Name: ______________________ Employee Signature: ___________________

Date: ______________

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

Netcor Transports LLC. General Radio/ Phone Guidelines All cell phone units are to be used strictly for company purposes! Field units shall first give the assigned radio identifier (e.g. Net - 10) when calling Dispatch. Communications both to and from units and the dispatcher shall be conducted in a businesslike manner, using proper language and correct procedures. Use specific, clear, concise language in all transmissions. Be brief and to the point. Avoid slang. All personnel should be aware that all voice communications are subject to FCC rules and regulations. Nonprofessional conduct loses its humor when later used as a reference, or when the data is subpoenaed into court for trial action. Radio transmissions will be brief and to the point.

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All messages shall be impersonal. The use of nicknames, first names, superfluous and unnecessary radio transmissions are forbidden.



Pronounce words distinctly and not too rapidly. Choose words that are clear and forceful in sound, and convey a definite meaning.

Radio Transmission Sequence: The calling sequence to establish communications is as follows:

 

State the radio identifier you are calling. (e.g. Net 10) State your radio identifier and wait for acknowledgment (except when responding, arriving or going in-service)

 

State your Message. Message is repeated by the receiving unit and confirmed.

e.g. Unit: “ Net - 10 Dispatch” Dispatch: “ Net - 10 Go ahead” Unit: “ Net – 10 returning to quarters” Dispatch: “ Copy, Net 10 Returning to quarters” Violation of radio procedures or other causes for complaint, from either the dispatcher or field unit, will be processed through established Land Lines. Twenty-four Hour Time. All personnel use Twenty-four hour time. All personnel must be aware of the responsibility attached to radio usage, and unjustified attempts to breach operational procedures may be subject to disciplinary action. Employee Signature: ________________________ Date: ___________

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com

DRUG AND/OR ALCOHOL TESTING CONSENT FORM EMPLOYEE AGREEMENT AND CONSENT TO DRUG AND/OR ALCOHOL TESTING I hereby agree, upon a request made under the drug/alcohol testing policy of Netcor Transports LLC. (the Company), to submit to random drug or alcohol tests and to furnish a sample of my urine, breath, and/or blood for analysis. I understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy, or if I otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize and give full permission to have the Company and/or its company physician send the specimen or specimens so collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or to any governmental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorize the Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding or investigation connected with the test. I will hold harmless the Company, its company physician, and any testing laboratory the Company might use, meaning that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing, including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol test, even if a Company or laboratory representative makes an error in the administration or analysis of the test or the reporting of the results. I will further hold harmless the Company, its company physician, and any testing laboratory the Company might use for any alleged harm to me that might result from the release or use of information or documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of this policy and the procedures as explained in the paragraph above. This policy and authorization have been explained to me in a language I understand, and I have been told that if I have any questions about the test or the policy, they will be answered. I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN TEST UNDER THIS POLICY WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY EVENT. I ALSO AGREE TO SUBMITT MYSELF TO ANY RANDOM DRUG AND/OR ALCHOHOL TEST REQUIRED BY THE COMPANY.

__________________________________ __________________ Signature of Employee

Date

__________________________________ Employee's Name - Printed

1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608 [email protected] - www.netcortransports.com