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Resume:
TransForce, Inc.
Suite ***
Alexandria, VA 22310
**-**-**** *:32:25AM CDT
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Join more than 10,000 satisfied drivers across the US and Canada, and an employer invested in your success.
"TransForce is great about setting you up to succeed. They match your skill level with customer needs and never put you in a situation you can't handle." -Aaron, Alexandria, VA
Start your application today!
Personal Information
Referral Code: indeed
Name Samuel Lee Jackson
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 11040 Fall Driver
City, State/Province Zip/Postal Indianapolis, IN 46229 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 4847
Date of Birth
Primary Phone 317-***-****
Cell Phone 317-***-****
Preferred method of contact Primary Phone
Best time to contact you Any
Email ad9q4u@r.postjobfree.com
Yes, I agree to receive information
concerning future opportunities or
promotions from TransForce, Inc. by email
or other commercial electronic
communications.
Yes
Would you like to receive communication
from TransForce, Inc. via text message?
By participating, you consent to receive
text messages sent by an automatic
Yes
1
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
TransForce, Inc.'s service provider
receives in real time and logs your text
messages with TransForce, Inc..
Company Questions
GENERAL INFORMATION
Which Commercial Class License do you
have?
A
How much CDL driving experience do you
have?
3 years +
How many violations have you been cited
for in the last 12 months?
0
How many accidents have you been
involved in during the last 12 months?
0
Job ID passed on the url 5180
What location are you applying to? IN, Indianapolis Where did you see our job advertised? Indeed
If you selected "Other" above, please
specify the source:
Type of Route you want: Local Delivery
Have you have ever served in any branch
of the United States military?
Yes
If you are applying as an Owner Operator
in California, who are you contracted with?
Your experience: 5+ years
Preferred Job Shift: Any
Types of Job: Full Time
Do you have experience driving a vehicle
equipped with a Manual Transmission?
Yes
Do you have experience using an
Electronic Logging Device for Hours of
Service Compliance?
No
Please list the devices you are familiar
with:
Do you have a "Fast" pass? No
2
Do you have a TWIC card? No
Do you currently have a valid passport? No
Are you registered for the FMCSA
Clearinghouse?
No
Where do you want to work? Midwest
Have you tested positive, or refused to
test, on any pre-employment drug screen
within the previous 2 years?
No
In case of Emergency, notify (list name,
address, phone and relationship):
Daisy Jackson 11040 Fall Drive
Indianapolis Indiana 46229
Licenses
License Number 625
State/Province IN
Country United States
License Class Class A
Original Issue Date 10-26-2019
License Expiration Date 10-26-2021
Physical Expiration Date 10-26-2019
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement Yes
Employment / Unemployment
Unemployment
Start Date 05-2021
End Date 06-2021
Comment
SecurAmerica LLC
Company SecurAmerica LLC
3
Start Date 03-2019
End Date 04-2021
Address 3399 Peachtree Road Ne suite 1
City, State/Province Zip/Postal Atlanta, GA 30326
Country United States
Phone 404-***-****
Position Held Security guard
Reason for leaving? Company was brought out
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
No
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job subject to drug and
alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Xexpress Truck driver training
Company Xexpress Truck driver training
Start Date 09-2019
End Date 04-2020
Address 2330 Enterprise Park Pl
City, State/Province Zip/Postal Indianapolis, IN 46218 Country United States
Phone 855-***-****
Position Held Professional truck driver trained
Reason for leaving? Covid19
4
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Across the city of Indianapolis
Miles driven weekly 500-1000
Pay Range (cents/mile) $20.00 an hour
Most common truck driven Tractor-Trailer
Most common trailer Container
Trailer length 53 feet or more
Unemployment
Start Date 10-2011
End Date 02-2018
Comment I am a retired veteran and I retired from
interstates brands
Interstate Brands Corp.
Company Interstate Brands Corp.
Start Date 06-1991
End Date 10-2011
Address 12 East Armour Boulevard
City, State/Province Zip/Postal Kansas City, MO 64111 Country United States
Phone 816-***-****
Fax 888-***-****
Position Held Professional truck driver
Reason for leaving? Retired
Were you terminated/discharged/laid off? No
Is this your current employer? No
5
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Across the Midwest
Miles driven weekly 1000-1500
Pay Range (cents/mile) $15.00 an hour
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 45 to 52 feet
U.S. Military
Branch of Service Army
Start Date 06-1974
End Date 06-2006
Can you obtain your DD214? Yes
Rank at discharge E7
Trucking School
Start Date 06-1990
End Date 10-1990
School Ctt truck driving school
City, State/Province Indianapolis, IN
Country US
Phone
Did you graduate? Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while attending this truck
school?
Yes
6
Did you perform any safety sensitive
functions at this truck school, regulated by
DOT, and subject to drug and alcohol
testing?
Yes
GPA 3
Hours of Instruction 40
Border Crossing No
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
Motor Vehicle Record
1. Has any license, permit or privilege ever
been denied, suspended or revoked for
any reason?
Yes
Date 02-1992
Comment Miss the date paying my ticket
2. 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?
No
3. Have you ever been convicted for any
alcohol or controlled substance related
offense while operating a motor vehicle, or
are any charges pending?
No
4. 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?
No
5. Have you ever been convicted of
reckless driving, careless driving or
careless operation of a motor vehicle, or
are any charges pending?
No
6. 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
No
7
test?
7. Have you ever been convicted of
excessive speeding (15 mph or greater) in
a motor vehicle or are any charges
pending?
No
Please explain and include the date of
conviction:
Vehicle Accident Record
Please list ALL accidents and incidents regardless of severity or type of vehicle operated at the time of the crash.
Were you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?
Type of Accident / Incident Non-Injury
Date of Accident / Incident 03-2019
Hazmat Accident / Incident No
Was the vehicle towed away? Yes
City Indianapolis
State/Province IN
Were you in a commercial vehicle? No
If yes, was this a Department of
Transportation recordable accident?
Were you at fault? Yes
Were you ticketed? No
Description It was raining hard and I ran the red light on my car
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 3 years? No Violations
Criminal Record
Have you ever been convicted of a crime? No
Do you have any deferred prosecutions? No
Do you have criminal charges pending? No
No
8
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?
No
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?
No
Signature
Full Name Samuel Lee Jackson
IP Address 2607:fb90:f0e8:4
Signature Date/Time 06-12-2021 9:32 AM
By 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: 06-12-2021 9:32 AM
Signed:
Federal FCRA Summary of Rights Acknowledgment
By checking this box, I (a) acknowledge
that I have read and understand the
federal FCRA Summary of Rights and
have been given the opportunity to
copy/print the Summary of Rights and (b)
agree to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Yes
PSP Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the PSP
Yes
9
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.
Additional Consent or Certification
By checking the box, I (a) acknowledge
that I have read and understand the above
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.
Yes
FCRA Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the above
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.
Yes
Employment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledge
that I have read and understand the above
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.
Yes
Clearinghouse Release
By checking the box, I (a) acknowledge
that I have read and understand the above
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.
Yes
10
Conditional Offer Letter
By checking the box, you attest that you
have read and understand the conditions
of employment set forth in this document.
Yes
User Requested Copy
User requested a copy to be sent to this
email address ad9q4u@r.postjobfree.com.
Yes
11
NOTIFICATION AND RELEASE TO CONDUCT BACKGROUND CHECKS In connection with your employment or application for employment and in accordance with pertinent laws, TransForce, Inc. may obtain or assemble consumer reports and/or investigative consumer reports (collectively, "Reports" related to information concerning your: previous employment (including employers, dates of employment, reasons for termination, etc.), academic history, verification of references and verification of other information supplied by you, professional credentials, drug/alcohol use in violation of law and/or company policy, driving record, accident history, workers compensation claims, criminal history records and information about your character, general reputation, and personal characteristics (collectively, "Information"). Information may be obtained from government agencies, educational institutions, TransForce clients, personal references, personal interviews and other Information sources
(collectively, "Suppliers"). These reports will be obtained from HireRight, Asurint and other credit/consumer reporting agencies. Upon providing proper identification and subject to applicable legal requirements and restrictions, you have the right to request the nature and substance of all Information in TransForce, HireRight and Asurint files pertaining to you, as well as information including, but not limited to: (i) whether any Reports have been provided by TransForce, HireRight or Asurint to other parties; (ii)identification of any Suppliers utilized by TransForce, HireRight or Asurint in compiling such Reports; and (iii) identification of any recipients of Reports furnished by TransForce, HireRight or Asurint within certain statutorily-prescribed time periods preceding your request. TransForce may be contacted by mail at 5520 Cherokee Ave Ste. 200, Alexandria, VA 22312, or by phone at 800-***-****. AUTHORIZATION FOR RELEASE OF INFORMATION
I hereby authorize TransForce to obtain information and disclose Information to its customers ("Customers"), if applicable, for the purpose of making a determination as to my eligibility for employment, promotion, retention or other lawful purpose. If hired, I authorize TransForce and TransForce Customers, if applicable, to retain this document on file to act as ongoing authorization for the procurement and assembly of Reports at any time during my employment or contract period. As permitted by law, I fully release TransForce, TransForce Customers and Suppliers from all claims of damages related to the investigation of my background and provision of Information as set forth in this document. I agree that if hired by TransForce, information in TransForce's possession may be supplied by TransForce to TransForce Customers for legally permissible purposes which maybe required by the Federal Motor Carrier Safety Regulations.
By signing below, I certify that: (i) all information provided herein is complete and accurate; (ii) I have read and fully understand this disclosure and authorization for release; (iii) prior to signing I was given an opportunity to ask questions and to have those questions answered to my satisfaction; (iv) I execute this authorization voluntarily and with the knowledge that the Information obtained pursuant to this authorization could affect my eligibility for employment, independent contractor status, promotion, retention or other lawful purpose: (v) I understand I may review this document with legal counsel prior to signing; (vi) I authorize TransForce and any person or entity contracted by TransForce to furnish the above-mentioned Information; and
(vii ) facsimile or e-mail copies of this authorization are as valid as an original. AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION
I hereby authorize Concentra Medical Networks, Clinical Reference Laboratory and any other laboratory or medical facilities used by TransForce to release to TransForce, Inc. ("the Company" and its designated agents, including Medical Review Officers, Substance Abuse Professionals, and rehabilitation personnel, the results of laboratory tests and the fitness determination findings from the medical examination report, to which I have consented for the purpose of determining the presence of drugs and/or alcohol in my body or my medical fitness to operate a commercial vehicle. I expressly understand and agree that the Company will review the results of these tests in connection with making a decision concerning my employment.
I understand that consistent with guidance issued by the Federal Motor Carrier Safety Administration, TransForce shares ownership and responsibility for ensuring that the Part 382 & 391.41-53 testing regulations are followed with its clients and customers who perform regulated functions. Therefore, I hereby authorize TransForce to release the results of any of any drug, alcohol or medical test that I submit which are required by Part 382 & 391.41-53 of the Federal Motor Carrier Safety Regulations, to any of its motor carrier customers to whom I am assigned or for whom I may perform work, meet the for the purpose of permitting those customers to ensure that they can meet the obligations imposed upon them by Part 382 & 391.41-53. This authorization shall become effective immediately. I understand that I have the right to receive a copy of this authorization upon request. Printed Name:
Samuel Lee Jackson
Social Security #:
4847
Signed Date: 06-12-2021
Samuel Lee Jackson
11040 Fall Driver
Indianapolis, IN 46229
Gender:
12
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with TransForce, 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 TransForce, 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. 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:
Samuel Lee Jackson
Signed Date: 06-12-2021
13
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to TransForce, Inc. to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for TransForce, Inc. to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent. I understand that if I refuse to provide consent for TransForce, Inc. to conduct a limited query of the Clearinghouse, TransForce, Inc. is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle. I understand that if the limited query conducted by TransForce, Inc. indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to TransForce, Inc. unless I give additional specific consent within the Clearinghouse. However, I understand that TransForce, Inc. 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. 06-12-2021
Samuel Lee Jackson Date
14
ACKNOWLEDGEMENT OF COMPLIANCE RESPONSIBILITIES
Section 1
TransForce acts as the agent for its customers in helping them meet the Federal Motor Carrier Safety Regulations (FMCSRs) for each driver that they use. Hence, we may be required to share employment records with them. I hereby release and permit TransForce to provide copies of any records regarding my employment to the motor carriers to whom I am assigned or to any other client or party deemed relevant by TransForce.
Section 2
Section 383.21 of the FMCSRs states that no person who operates a commercial motor vehicle requiring a Commercial Driver's License
(CDL) may have more than one license at any time. I certify that I have only one license. Section 3
Section 383.31 of the FMCSRs requires that any time you are convicted of violating a state or local traffic law (other than parking) you must report the conviction to your employing motor carrier and the state that issued your license within 30 days. The report to the state need not be made if the violation occurred in your state of licensure. A form has been provided to you to facilitate your compliance with this requirement. Also, Sections 383.33 and 391.15 of the FMCSRs require that you notify your employer of any revocation or suspension of your driver's license by the end of the next business day. I promise to comply with these requirements. Section 4
Section 395.8(j)(2) of the FMCSRs requires that each time you begin work for a new motor carrier, or resume work for a motor carrier for whom you drive intermittently, you must provide a signed statement giving your total time on-duty for the immediately preceding seven days. Alternatively, you may furnish a copy of your daily record of duty status (log) for each of the seven preceding days. Because any work done at the direction of a motor carrier or any compensated time for a non-motor carrier is considered on-duty time, we require that you notify us if you work for any other person or company while in the employment of TransForce. I promise to comply with these requirements.
Section 5
Section 395.3 of the FMCSRs prohibits you from driving more than 11 hours (following 10 consecutive hours off-duty), from driving for any period after having been on-duty following the 14th consecutive hour after first coming on duty (following 10 consecutive hours off-duty), from driving after having been on-duty for 60 hours in any 7 consecutive days (if the motor carrier does not operate every day of the week) or 70 hours in any period of 8 consecutive days (if the motor carrier operates every day of the week). You may not accept an assignment from TransForce or any of its customers without having the available hours to complete the assignment within the legal time limits. No motor carrier may require or permit you to violate these rules. I certify that I understand and will comply with these requirements. Section 6
Section 390.3(e)(2) requires that every driver and employee be instructed in and shall comply with all applicable regulations. The driver orientation process discusses relevant rules and regulations applicable to you. Training and informational materials will be provided to you throughout your employment with TransForce. In addition, the Federal Motor Carrier Safety Regulations (FMCSRs) are available to you upon request. By initialing here, you are indicating that you will comply with all applicable Federal and State regulations, and will seek guidance from TransForce operations staff for any regulations you are unfamiliar with. Section 7
TransForce provides each driver with a copy of our Work Rules that set forth our performance and attendance requirements. I acknowledge that I have received a copy of TransForce's Work Rules. Section 8
Any applicant who does not have a current, valid medical examiners certificate, or who is required by TransForce to obtain a new medical examiners certificate because there is doubt as to his physical qualification, must successfully complete and pay for a physical exam before beginning work with TransForce and furnish a copy of such certificate accompanied with the medical examination report for filing under FMCSR 391.43(f), 391.45, 391.51 & 391.53. I will comply with this requirement if applicable. Section 9
Section 382.601 of the Federal Motor Carrier Safety Regulations requires motor carriers to
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