Safety Performance History Information

I hereby authorize release of information to this prospective employer from my employment file and my Department of Transportation regulated drug and alcohol testing records. This release is in accordance with DOT Regulation 49 CFR Parts 40.25/382.413/391.23. I understand that information to be released, by my previous employer, is limited to the previous three years. You are released from any and all liability which may result from releasing such information. Pursuant to the federal Fair Credit Reporting Act, I hereby authorize this company and its designated agents and representatives to conduct a comprehensive review of my background through any consumer report for employment. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

I understand that it is my right to review information provided by previous employers; to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information; as well as the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer and I cannot agree on the accuracy of the information. I understand that if I wish to review previous employer-provided investigative information, I must submit a written request, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. This information must be provided to me within five (5) business days of Phillips Premier Transportation LLC receiving my written request. If Phillips Premier Transportation LLC has not yet received the requested information from the previous employer(s), then the five-business days deadline will begin when the Phillips Premier Transportation LLC receives the requested safety performance history information. I understand that if I have not arranged to pick up or receive the requested records within thirty (30) days of them becoming available, it may be considered that I have waived my request to review the record(s).

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Drug & Alcohol Clearinghouse Consent

I hereby provide consent to Phillips Premier Transportation LLC and its authorized agents to conduct limited queries of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.

I am consenting to an unlimited number of queries and for the duration of employment with Phillips Premier Transportation LLC

I understand that if a limited query conducted by Phillips Premier Transportation LLC indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Phillips Premier Transportation LLC without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for Phillips Premier Transportation LLC to conduct a limited query of the Clearinghouse, or if I refuse to provide FMCSA with specific consent to disclose drug or Alcohol violation information about me to Phillips Premier Transportation LLC after a limited query indicates such information exists in the Clearinghouse, Phillips Premier Transportation LLC must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

PSP Driver Disclosure & Authorization

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with Phillips Premier Transportation LLC (“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.

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AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:

I authorize Phillips Premier Transportation LLC(“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.

Alcohol & Drug Testing Policy

Please review the company alcohol and drug testing policy below. Once finished, electronically sign to confirm receipt, understanding and agree. Upon completion of the online application, you will be emailed a copy of this policy.

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Employer Policy on the Misuse of Alcohol and Use of Controlled Substances

Company Name: Phillips Premier Transportation LLC

Address: 2620 Gaines Mill Drive

City: Virginia Beach State: VA Zip: 23456

Phone Number: (800)966-8316

This policy follows Department of Transportation and Federal Motor Carrier Safety Administration regulations found in 49 CFR Parts 40 and 382.601

If you have questions about this controlled substances and alcohol testing, please contact the designated company official to answer questions.

All drivers who drive Commercial Motor Vehicles (CMV) which require a Commercial Drivers License (CDL) are subject to controlled substances and alcohol testing.

Definition of driver Safety Sensitive Function is found in 49 CFR Section 382.107.

Safety sensitive function means all time from the time a driver begins to work or is required to be in readiness to work until the time he/she is relieved from work and all responsibility for performing work. Safety sensitive function shall include:

(1) All time at an employer or shipper plant, terminal, facility, or other property, or on any public property, waiting to be dispatched, unless the driver has been relieved from duty by the employer.

(2) All time inspecting equipment, as required by 49 CFR Sections 392.7 and 392.8, or otherwise inspecting, servicing, or conditioning any commercial motor vehicle at any time.

(3) All time spent at the driving controls of a commercial motor vehicle in operation.

(4) All time, other than driving time, in or upon any commercial motor vehicle except time spent resting in a sleeper berth (a berth conforming to the requirements of 49 CFR Section 393.76).

Driver conduct that is prohibited is found in 49 CFR Part 382 Subpart B.

(1) No driver shall report for duty requiring the performance of a safety sensitive function with an alcohol concentration of 0.04 or greater.

(2) No driver shall use alcohol while performing a safety sensitive function.

(3) No driver shall perform a safety sensitive function within 4 hours after using alcohol.

(4) No driver required to take a post accident alcohol test under 49 CFR Section 382.209 shall use alcohol for 8 hours following the accident.

(5) No driver shall refuse to submit to any required alcohol or controlled substances test.

(6) No driver shall report for duty requiring the performance of a safety sensitive function when the driver uses controlled substances, except when the use is pursuant to the instructions of a licensed medical practitioner, as defined in 49 CFR Section 382.107. This must not interfere with the driver’s ability to perform a safety sensitive function.

(7) No driver shall report for duty or remain on duty requiring the performance of a safety sensitive function, if the driver tests positive for controlled substances.

Circumstances in which a driver will be tested are incorporated and found in 49 CFR Part 382 Subpart C.

(1) Pre-employment testing;

(2) Random testing, Per the prevailing rate as required by U.S. DOT

(3) Reasonable Suspicion testing

(4) Post Accident testing

(5) Return to duty testing

(6) Follow up testing

All definitions, regulations, and procedures used to test for controlled substances and alcohol in order to protect the integrity of the testing process, safeguard test validity, and insure results are attributed to the correct driver are found in 49 CFR Parts 40 and 382.

Refusal to submit to an alcohol or controlled substances test is defined in 49 CFR 382.107.

Refusal to submit to an alcohol or controlled substances test means that a driver:

(1) Failedto appear for any test (except a Pre-employment test) within a reasonable time, as determined by the employer, consistent with applicable DOT agency regulations, afterbeing directed to do so by the employer. This includes the failure of an employee (including an owner operator) to appear for a test when called by a C/TPA.

(2) Failed to remain at the testing site until the testing proceeds is complete. Provided, that an employee who leaves the testing site before the testing process commences on a pre-employment test is not deemed to have refused to test.

(3) Failedto provide a urine specimen for any drug test required by this part or DOT agency regulations. Provided, that an employee who does not provide a urine specimen, because he or she has left the testing site before the testing process commences on a pre-employment test is not deemed to have refused to test.

(4) In the case of a directly observed or monitored collection in a drug test, fails to permit the observation or monitoring of the drivers provision of a specimen.

(5) Failed to provide a sufficient amount of urine specimen when directed and it has been determined that there was no adequate medical explanation for the failure.

(6) Failed or declined to take a second test the employer or the collector has directed the driver to take.

(7) Failed to undergo a medical examination or evaluation, as directed by the MRO as part of the verification process, or as directed by the DER under 49 CFR 40.193(d). In the case of a pre-employment drug test, the employee is deemed to have refused to test on this basis only if the pre-employment test is conducted following a contingent offer of employment.

(8) Failed to cooperate with any part of the testing process (e.g., refuse to empty pockets when so directed by the collector, behave in a confrontational way that disrupts the collection process).

(9) Is reported by the MRO as having a verified adulterated or substituted test result.

Note: In reference to item 1 for the FMCSA; reasonable timemeans the employer shall ensure the driver ceases to perform the safety sensitive function and proceeds to the testing site as soon as possible.

Consequences for violators of Subpart B are incorporated and found in 49 CFR Part 382 Subpart E.

(1) All CDL drivers will be removed from any safety sensitive position.

(2) The driver must see a Substance Abuse Professional to ever drive again, anywhere.

(3) The driver must take a Return To Duty test with a Negative result and/or an Alcohol test with results below .02.

Note: The consequences for CDL drivers tested for Alcohol with results at .02 but below .04 are the driver will be removed from any safety sensitive position for 24 hours (49 CFR Part 382.505(a))

COMPANY POLICY

This company has a ZERO TOLERENCE for the use of Alcohol or misuse of Controlled Substances. Any driver found to be in violation of 49 CFR Parts 40/382 will be terminated.

Any driver found to be in violation of 49 CFR Parts 40/382 may possibly be terminated. A driver could be retained if he/she successfully meets the requirements of 49 CFR Part 40 Subpart O and 382.503.

Fair Credit Reporting Authorization

Pursuant to the federal Fair Credit Reporting Act, I hereby authorize Phillips Premier Transportation LLC and its designated agents and representatives to conduct a comprehensive review of my background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: verification of Social Security number; current and previous residences; employment history, including all personnel files; education; references; credit history and reports; criminal history, including records from any criminal justice agency in any or all federal, state or county jurisdictions; birth records; motor vehicle records, including traffic citations and registration; and any other public records.

I authorize the complete release of these records or data pertaining to me that an individual, company, firm, corporation or public agency may have. I hereby authorize and request any present or former employer, school, police department, financial institution or other persons having personal knowledge of me to furnish Phillips Premier Transportation LLC or its designated agents with any and all information in their possession regarding me in connection with an application of employment. I am authorizing that a photocopy of this authorization be accepted with the same authority as the original.

I understand that, pursuant to the federal Fair Credit Reporting Act, if any adverse action is to be taken based upon the consumer report, a copy of the report and a summary of the consumer's rights will be provided to me.

I acknowledge that I have received and read the Fiar Credit Reporting Act Background Check Disclosure, A Summary of Your Rights Under the Fair Credit Reporting Act, and this authorization. I certify that I understand the documents I have received.

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Summary of Your Rights Under the Fair Credit Reporting Act