Apollo Energy Resources — Driver Application

17311 Market Street, Channelview, Texas 77530

Class A CDL Driver · Hazardous Materials · Minimum 10 years of CDL driving experience

Welcome

Thank you for your interest in driving for Apollo Energy Resources. Please complete every section. Incomplete applications cannot be processed. Plan on about 30–40 minutes, and have your CDL, DOT medical card, and 10 years of employment history ready.

Position requirements: Class A CDL with Hazardous Materials (H or X) endorsement, at least 21 years of age, a current DOT medical examiner's certificate, and a minimum of 10 years of verifiable CDL driving experience.
After you submit this application, you will complete five separate forms, each signed on its own page:
  1. Disclosure for Consumer Reports
  2. Authorization for Consumer Reports
  3. Motor Vehicle Record (MVR) Release & Consent
  4. PSP Disclosure & Authorization
  5. FMCSA Clearinghouse Limited Query Consent

Equal Employment Opportunity

In compliance with federal and state equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job-related disability, or any other legally protected status.

Consent to Use Electronic Records and Signatures

This application and the separate disclosure and authorization forms that follow it are provided electronically. By checking the box below, you agree that (a) you can access, read, and print or save these documents; (b) you agree to sign them electronically; and (c) your electronic signature has the same legal effect as a handwritten (ink) signature. You may request paper copies of any document at no charge by contacting Apollo Energy Resources.

Personal Information

Current Address

Previous Addresses (past 3 years)

Eligibility

Are you legally eligible for employment in the United States? *
Are you at least 21 years of age? *
Can you read, write, and speak English well enough to communicate with the public, understand highway signs, respond to official inquiries, and make entries on reports and records? (49 CFR 391.11(b)(2)) *
Are you currently employed? *
Have you ever worked for Apollo Energy Resources before? *

Licenses, Endorsements & Credentials

List every motor vehicle license or permit held in the past 3 years.

Current Commercial Driver's License

Other licenses held in the past 3 years

Have you held any other license or permit (any state or country) in the past 3 years? *

Driving Experience & Safety Record

Equipment experience

FMCSR Questions

Under 49 CFR 391.15, are you currently disqualified from driving a commercial motor vehicle? *
Has your license, permit, or privilege to drive ever been suspended or revoked for any reason? *
Have you ever been denied a license, permit, or privilege to operate a motor vehicle? *
Within the past two years, have you 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 the past three (3) years, have you been convicted of any of the following offenses? *
  • Driving a CMV with a blood alcohol concentration of .04 percent or more
  • Driving under the influence of alcohol, as prescribed by state law
  • Refusal to undergo drug and alcohol testing required for enforcement of FMCSA regulations
  • Driving a CMV under the influence of a Schedule I controlled substance, an amphetamine, a narcotic drug, or a derivative
  • Transportation, possession, or unlawful use of any of those substances while on duty
  • Leaving the scene of an accident while operating a CMV
  • Any other felony involving the use of a CMV

Accident Record — past 3 years

Were you involved in any accidents or incidents with any vehicle in the past 3 years (even if not at fault)? *

Traffic Convictions & Forfeitures — past 3 years

Other than parking violations

Have you had any moving violations or traffic convictions in the past 3 years? *

Employment History

List all employers for the past 3 years, and every employer for whom you operated a commercial motor vehicle in the past 10 years, most recent first. Include owner-operator and lease periods.

Account for every gap of more than 30 days in the Unemployment section below.

The employer information you provide will be used, and your previous employers will be contacted, to investigate your safety performance history as required by 49 CFR 391.23(d) and (e). Your rights regarding that information are explained in the next step.
Documented CDL driving experience: 0 years, 0 months (10 years required)

Unemployment and Gaps in Employment

Did you have any periods of unemployment (more than 30 days) in the past 10 years? *

Applicant Certification & Safety Performance History Release

DISCLOSURE AND AUTHORIZATION UNDER 49 CFR 391.23
INCLUDING DOT DRUG AND ALCOHOL INFORMATION

For purposes of an investigation in accordance with 49 CFR 391.23, I authorize my previous employers, contractors (if owner-operator), and trucking schools, as applicable, to release and forward to Apollo Energy Resources ("Company") the following information for the past three (3) years:

1. DOT alcohol and controlled substance information in accordance with 49 CFR Part 382 and 49 CFR Part 40, Section 40.25, limited to the following DOT-regulated testing items, including pre-employment testing results: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested; (iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation.

2. Safety performance history information in accordance with 49 CFR 391.23, which includes employment dates, work history (which may include position held, reason for leaving, any termination information, whether subject to the Federal Motor Carrier Safety Regulations, equipment experience, area driven, and other information as applicable) and accident information (including accident date, nature of accident, whether it was preventable, whether there were injuries, fatalities, or hazardous materials involved, and copies of any accident report).

Your rights under 49 CFR 391.23(i):

1. You have the right to make a written request at any time to review the information provided by previous employers, contractors (if owner-operator), or trucking schools, as applicable.
2. You have the right to have errors in the information corrected by the previous employer, contractor, or trucking school, and for that party to re-send the corrected information.
3. You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer, contractor, or trucking school and you cannot agree on the accuracy of the information.

This release will be sent to each of these previous employers

Add employers in the Employment step to see them here.

Applicant Certification

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 understand that any misrepresentation or omission of fact may be grounds for refusal of employment or, if employed, for discharge. I authorize Apollo Energy Resources to make investigations and inquiries of my employment, driving, safety, and drug and alcohol testing history as described above.

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Documents & Submit

Upload clear photos or PDFs. These are optional now but required before hire.

Final review

Use the step buttons at the top of the page to review any section. When you submit, your application, signature, and the date and time of signing are recorded. You will then complete the five consent and disclosure forms.

Disclosure for Consumer Reports

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

In connection with your application for employment, Apollo Energy Resources ("Company") may obtain one or more consumer reports (commonly known as "background reports") about you from one or more consumer reporting agencies for employment purposes. If you are hired, additional consumer reports may be obtained during your employment for employment purposes, including the annual review of your driving record required by 49 CFR 391.25.

These consumer reports may include your motor vehicle records and driving records (including records from the Texas Department of Public Safety and any other state in which you have held a license, and Commercial Driver's License Information System (CDLIS) data, obtained in accordance with the Driver's Privacy Protection Act, 18 U.S.C. § 2721 et seq., and the Texas Motor Vehicle Records Disclosure Act, Texas Transportation Code Chapter 730), employment history and verification, drug and alcohol testing history, Social Security number verification, licensure and certification verification, and verification of other information you have provided. Such reports may be obtained from private and public record sources, former employers, and federal, state, and other government agencies that maintain such records.

Authorization for Consumer Reports

AUTHORIZATION

I have read the Disclosure Regarding Background Investigation provided to me by Apollo Energy Resources ("Company"). I authorize the Company, and any consumer reporting agency acting on its behalf, to obtain consumer reports about me for employment purposes, including my motor vehicle record (MVR) from the Texas Department of Public Safety and from every other state in which I have held a driver's license or permit in the past three (3) years, as required by 49 CFR 391.23(a)(1), and CDLIS driver record information.

I understand that my driving record is a personal record protected by the Driver's Privacy Protection Act (18 U.S.C. § 2721) and Texas Transportation Code Chapter 730, and I consent to its release to the Company for verifying information relating to my commercial driver's license and for employment purposes.

If I am hired, I understand that this authorization remains on file and authorizes the Company to obtain my motor vehicle record at least once every twelve (12) months, as required by 49 CFR 391.25, and to obtain additional consumer reports for employment purposes during my employment, without asking me for authorization again, unless I revoke it in writing.

A copy or electronic version of this authorization is as valid as the original.

Please review A Summary of Your Rights Under the Fair Credit Reporting Act (Consumer Financial Protection Bureau). You may print or save it for your records.
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Motor Vehicle Record (MVR) Release & Consent

CONSENT TO OBTAIN MOTOR VEHICLE RECORDS
49 CFR 391.23 and 391.25 · Texas Transportation Code Chapter 730 · 18 U.S.C. § 2721

I, the undersigned applicant, authorize Apollo Energy Resources ("Company"), and any consumer reporting agency or record-retrieval service acting on its behalf, to request and obtain my motor vehicle record (MVR) and driver history from:

(1) the Texas Department of Public Safety, Driver License Division;
(2) the licensing agency of every other state or jurisdiction in which I have held a driver's license or permit during the preceding three (3) years; and
(3) the Commercial Driver's License Information System (CDLIS).

I understand that this record may include my license status and history, endorsements and restrictions, medical certification status, convictions, accidents, suspensions, revocations, cancellations, and disqualifications.

I understand that my driving record contains personal information protected by the federal Driver's Privacy Protection Act (18 U.S.C. § 2721 et seq.) and the Texas Motor Vehicle Records Disclosure Act (Texas Transportation Code Chapter 730). I give my written consent for the release of this personal information to the Company for the purposes of verifying information relating to my commercial driver's license and evaluating my qualification for employment as a commercial motor vehicle driver.

Pre-employment: The Company must obtain my MVR from each state in which I held a license or permit in the past three years within 30 days of my hire date (49 CFR 391.23(a)(1)).

Continuing consent: If I am hired, this consent remains in effect for the duration of my employment and authorizes the Company to obtain my MVR from each state licensing agency at least once every twelve (12) months, as required by 49 CFR 391.25, and at any other time for safety or insurance purposes, without asking me for further consent. I may revoke this consent in writing, but I understand that the Company cannot permit me to operate a commercial motor vehicle without the annual record review the regulations require.

I understand that I may request a copy of any MVR the Company obtains about me, and that I may dispute inaccurate information directly with the issuing state agency. A copy or electronic version of this consent is as valid as the original.

States where you held a license or permit in the past 3 years

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IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Apollo Energy Resources ("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 Apollo Energy Resources ("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.

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NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.
NOTICE: The prospective employment concept referenced in this form contemplates the definition of "employee" contained at 49 C.F.R. 383.5.
LAST UPDATED 2/11/2016

Apollo Energy Resources
FMCSA Drug & Alcohol Clearinghouse — Limited Query Consent Form

I, the undersigned, hereby provide my express written consent to Apollo Energy Resources (hereinafter "Employer") to conduct a limited query of the Federal Motor Carrier Safety Administration (FMCSA) Commercial Driver's License Drug and Alcohol Clearinghouse ("Clearinghouse") to determine whether drug or alcohol violation information exists about me in the Clearinghouse.

I understand that a limited query will only reveal whether a Clearinghouse record exists for me, but will not disclose the specific content of that record. I further understand that if the limited query returns a result indicating that information exists in the Clearinghouse, my Employer must conduct a full query within 24 hours, for which I must provide separate consent electronically through my account in the Clearinghouse (https://clearinghouse.fmcsa.dot.gov). I understand that if I do not provide that electronic consent within the Clearinghouse, I will not be permitted to perform safety-sensitive functions, including operating a commercial motor vehicle, until the full query is conducted and shows no prohibition.

I understand that I am not required to provide this consent; however, if I refuse, the Employer must prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle (CMV), as required by 49 CFR 382.703(c).

This consent is valid for a period of twelve (12) months from the date of my signature below, unless revoked in writing prior to that date. This consent authorizes the Employer to conduct limited queries during pre-employment screening, during the term of employment, and/or as otherwise required by FMCSA regulations.

I acknowledge that I have been informed of my rights under 49 CFR Part 382.701 and understand that I may request a copy of any information obtained from the Clearinghouse as a result of a query conducted pursuant to this consent.

Pre-employment full query: Before you can be hired, the Employer must run a full query of the Clearinghouse (49 CFR 382.701(a)). You give that consent electronically inside the Clearinghouse, not on this form. If you are not already registered, create your account at clearinghouse.fmcsa.dot.gov so you can approve the request when it arrives.
Are you registered in the FMCSA Clearinghouse? *

Driver Information

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Apollo Energy Resources | FMCSA Clearinghouse Limited Query Consent | Retain for three (3) years from the date of the last query (49 CFR 382.703(a)). Employer representative countersignature is completed internally.

Thank you — your application is complete

We have received your driver application and all five signed consent and disclosure forms.

Apollo Energy Resources will review your application and contact you about next steps, including the Clearinghouse full-query request (approve it in your Clearinghouse account), your DOT drug test, and your road test.