Have you been trained for the following?

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.
I authorize to make such investigations and inquiries of my personal, employment, financial or medical
history and other related matters as may be necessary in arriving at an employment decision. I hereby
release employers, schools or persons from all liability in responding to inquiries in connection with my
application, In the event of my employment, I understand that false or misleading information given in my
application or interview(s) may result in discharge. I understand, also, that I am required to abide by all
rules and regulations of, as permitted by Law.
I understand that information I provide regarding current and previous employers may be used and
those employers will be contacted, for the purpose of investigating my safety performance history as
required by FMCSA 391.23 and I understand that I have the right to:
Review information provided by previous employers:
Have Errors in the information corrected by previous employers and for those previous employers to
resend the corrected information.
Have a rebuttal statement attached to the alleged erroneous information, if the previous employer and I
can’t agree on the accuracy of the statement. 

Emergency Contact Information

PERSONS TO BE NOTIFIED IN THE EVENT OF AN EMERGENCY:

Employment History

All driver applicants to drive a commercial motor vehicle in interstate or intrastate commerce shall provide
information on all employers during the preceding 10 years. Gaps in Employment Must be accounted for
with explanation. Please list all employers in reverse order, starting with the most recent.

RELEASE & AUTHORIZATION TO CONTACT PREVIOUS EMPLOYER

I hereby authorize you to release the following information for the purpose of investigation as required by 49 cfr 391.23 of the federal motor carrier’s safety regulations. Information may include all employment information concerning my employment, including
written and oral assessments of my work performance, fitness and ability. You are released from any and all liability which may result from furnishing such information. I hereby authorize you to release the following information for the purpose of investigation.

Medical Declaration

I certify that I am qualified to operate a commercial motor vehicle in the United States. I further certify that:
 I have no clinical diagnosis of diabetes currently requiring insulin for control.
 I have no established medical history or clinical diagnosis of epilepsy.
 I do not have impaired hearing. (A driver must be able to perceive a forced whispered voice in the better ear at not less than 5 feet with or without the use of a hearing aid, or does not have an average hearing loss in the better ear greater than 40 decibels at 500Hz, 1000Hz, or 2000Hz with or without a hearing aid when tested by an audiometric device calibrated to American
National Standard Z24.5 – 1951).
 I have not been issued a waiver by the Province of Ontario allowing me to operate a commercial motor vehicle pursuant to Section 20 or 21 of Ontario Regulation 340/94.

As per Federal Motor Carrier Safety Regulations (Section 391.21), the company must review your driving record for the past three years, including all commercial and personal vehicle violations. In Ontario, this is known as a Commercial Vehicle Operator Record Driver Abstract. The company regularly checks both commercial and personal violations. By signing, you authorize the company to obtain this information. This is a requirement for your employment/contract. You confirm that you understand these conditions.

Motor Carrier Instructions:
The requirements in Part 383 apply to drivers operating vehicles in Intrastate, Interstate, or foreign commerce, weighing 26,001 pounds or more, transporting over 15 people, or carrying hazardous materials. Part 391 applies to drivers in Interstate commerce with vehicles over 10,001 pounds or carrying over 15 people or hazardous materials.

Driver Requirements:

1. You may only have one driver's license. If you have more, return the extra licenses to the issuing states.
2. Notify your employer within one business day if your license is revoked or suspended. Report any traffic violations (except parking) to your employer and the issuing state within 30 days.

Driver Certification:
By signing, you certify that you have read and understand the above requirements and confirm the license you hold is the only one you possess.

1. Policy Statement:

I acknowledge that I have been trained on the proper procedures for Pre-Trip and Post-Trip Inspections, coupling/uncoupling, and performing a 5th wheel tug test for a Commercial Motor Vehicle. I agree to conduct a full inspection each day, following Regulation 199/07 of the Highway Traffic Act and FMCSA reg. 392.7, and record the inspections in the vehicle inspection booklet. I will ensure the 5th wheel is properly connected during coupling by performing a visual and tug test. I will immediately report any defects to dispatch. I understand failure to follow these procedures may result in disciplinary action, including termination.

I acknowledge that I have been trained on the Hours-of-Service Regulations for Commercial Motor Vehicle drivers in Canada and the United States (Regulations 555/06 of the Highway Traffic Act and Regulation 395 of FMCSR). I agree to strictly follow these regulations based on the jurisdiction I am operating in. I understand the company will monitor my compliance, and any non-compliance will result in disciplinary action, remedial training, and potential dismissal if violations are repeated.

Purpose:

Shah Transport Ltd. enforces a No Passenger Policy due to high liability risks and insurance requirements. Only company employees or authorized team members may ride in company or Owner Operator vehicles. Violating this policy may result in termination of employment or contract.