AOG - Moving America On Ground

APPLICANT INFORMATION

PERSONAL INFORMATION

First Name *

Middle Initial *

None

Last Name *

Date Of Birth *

Social Security No. *

Mobile Phone No. *

Other Phone No

Email *

confirm *

Position Applied For: *

Do you have legal right to work in the United States? *

yes

no

Date Available To Start *

Applicant Resident

RESIDENCY

Present Address *

Country *

State *

City *

Zip *

Years At This Address *

DRIVERS LICENSE INFORMATION

LICENSE DETAILS

Driver’s License Number *

Issuing State *

Issuing Date *

None

Expiration Date *

CDL Type *

A

B

C

None

DRIVING/HAULING EXPERIENCE

Equipment

Dry Van: *

Years Of Experience

Dump: *

Years Of Experience

Reefer: *

Years Of Experience

Double: *

Years Of Experienc

Flatbed: *

Years Of Experienc

Tanker: *

Years Of Experienc

DRIVING RECORD

VIOLATION

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

yes

no

ACCIDENT DETAILS

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)? *

yes

no

FEDERAL MOTOR CARRIER SAFETY REGULATIONS

FMCSR12

1. Under FMCSR 391.15, are you currently disqualified from driving a commercial motor vehicle? [49 CFR 391.15] *

yes

no

2. Has your license, permit, or privilege to drive ever been suspended or revoked for any reason? [49 CFR 391.21(b)(9)] *

yes

no

3. 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? [49 CFR 40.25(j)] *

yes

no

4. In the past three (3) years, have you ever been convicted of any of the following offenses committed during on-duty time [49 C.F.R. 391.15 and 49 C.F.R. 395.2]: *

Driving a commercial motor vehicle with a blood alcohol concentration ("BAC") of .04 percent or more
Driving under the influence of alcohol, as prescribed by state law
Refusal to undergo drug and alcohol testing as required by any jurisdiction for the enforcement of Federal Motor Carrier Safety Act regulations
Driving a commercial motor vehicle under the influence of any 21 C.F.R. 1308.11 Schedule I identified controlled substance, an amphetamine, a narcotic drug, a formulation of an amphetamine, or a derivative of a narcotic drug
Transportation, possession, or unlawful use of a 21 C.F.R. 1308.11 Schedule I identified controlled substance, amphetamines, narcotic drugs, formulations of an amphetamine, or derivatives of narcotic drugs while you were on duty driving for a motor carrier
Leaving the scene of an accident while operating a commercial motor vehicle Or any other felony involving the use of a commercial motor vehicle

yes

no

In the three years before the conviction you identified above, had you been convicted on a separate occasion of either the same offense or one of the other offenses listed below? [49 C.F.R. 391.15(c)(3)] *

yes

no

EMPLOYMENT HISTORY

The Federal Motor Carrier Safety Regulations (49 CFR 391.21) require that all applicants wishing to drive a commercial vehicle list all employment for the last three (3) years. In addition, if you have driven a commercial vehicle previously, you must provide employment history for an additional seven (7) years (for a total of ten (10) years). Any gaps in employment in excess of one (1) month must be explained. Start with the last or current position, including any military experience, and work backwards (attach separate sheets if necessary). You are required to list the complete mailing address, including street number, city, state, zip; and complete all other information.

Are you currently working? *

yes

no

Current (Most Recent) Employer

Company Name *

Address *

Country *

State *

City *

Zip *

Contact / Supervisor Name *

Phone No *

Company Email *

None

From

To

Salary

Position

Reason For Leaving *

Driving/Hauling Experience With This Employer *
Equipment Type:

May we contact current employer? *

yes

no

While employed here, were you subject to the Federal Motor Carrier Safety Regulations? *

yes

no

Was the job designated as a safety-sensitive function in any Department of Transportation-regulated mode subject to alcohol and controlled substances testing as required by 49 CFR, part 40? *

yes

no

Explain Any Gaps In Employment (Include Month/Year & Reason)

Add Employment

EMPLOYMENT GAP *

yes

no

Description of gap

From

To

Add Employment Gap

EDUCATION

Highest Level Of Education

Did you graduate from college? *

yes

no

OTHER QUALIFICATIONS

Please list any other qualifications that you have and which you believe should be considered

EEO/Criminal Record

Criminal Record

All Applicants: Do not disclose information regarding arrests, charges, and/or convictions that have been sealed, expunged, annulled, erased, statutorily eradicated, or judicially dismissed. Answering yes to any of the questions below will not automatically disqualify you from employment and instead will be considered, on an individualized basis, only as it relates to the job in question.

California Applicants: In California, "crime" shall exclude convictions for marijuana-related offenses that are more than two years old, as defined in California Health and Safety Code sections 11357 (b) and (c) and 11360 (c), or in California Health and Safety Code sections 11364, 11365, or 11550 of the Health and Safety Code as they related to marijuana prior to January 1, 1976, or their statuary predecessors.

Washington Applicants: Do not disclose information regarding convictions that occurred more than ten years ago or for which you were released from prison more than ten years ago.

1. Have you ever been convicted of a criminal offense? *

yes

no

2. Do you currently have any criminal actions pending in which you are a defendant? *

yes

no

Equal Employment Opportunity Information

Optional EEO Information

Providing this information is voluntary. We ask for this information to maintain records. Any information you voluntarily provide is confidential and will not be considered in making any employment decision. If you choose not to complete this form, it will not affect your being considered for employment.

Gender: *

Please select a race/ethnic category: *

Veteran Status: *

AUTHORIZATION CONSENTS

OTHER QUALIFICATIONS

By selecting each of the boxes below and using your finger or other method to sign below; you hereby agree and consent to autofill and sign the required documents electronically as part of the Application process. Your selection and electronic signature will serve the same as your handwritten signature

Release Of Information Form - (49CFR PART 40 & FMCSR PART 391.23)

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RELEASE OF INFORMATION FORM – 49CFR PART 40 & FMCSR PART 391.23

The Federal Motor Carrier Safety Regulations require all previous employers of this applicant to respond to this request for information within 30 days. Failure to comply with this request is in violation of 49CFR 391.23 and 40.25, for which you may be prosecuted.

Ihereby authorize to release all records of employment, including assessments of my job performance, ability, and fitness, including the dates of any and all drug and alcohol testing records to each and every company (or their authorized agents) making such request in connection with my Application for employment with said company by my previous employer. This release is in accordance with DOT Regulation 49 CFR Part 40, Section 40.25 and FMCSR Part 391.23 investigation and inquires. I understand that information to be released by my previous employer, is limited to the following DOT-regulated testing items for the past (3) years

1. Alcohol tests with a result of 0.04 or higher
2. Verified positive drug tests
3. Refusals to be tested
4. Other violations of DOT agency drug and alcohol rule violation
5. Information obtained from previous employers of a drug and alcohol rule violation
6. Documentation, if any, of completion of the return-to-duty process following a rule violation
7. Documentation, if any, of any driving record investigations and/or safety performance history

I have NOT worked in a Safety Sensitive position in the previous 3 years. (Sign & Return)

I, hereby, release the above-named company, and its employees, officers, directors, and agents from any and all liability of any type as a result of providing the following information to the below mentioned person and/or company.

Date Signed :

07-10-2025

SSN :

Signature:

INQUIRY EMPLOYMENT HISTORY, PRECEDING 3 YEARS

Was the applicant employed by you?

yes

No

Did the applicant work for you as a from to ?

yes

No

If NO, please explain

Type of Equipment Driven

Passenger Car

Tractor Semi Trailer

Straight Truck

Bus

Other (specify):

Type of Trailers:

Van

Doubles

Flatbed Refrigerated

Cargo Tank

Other (specify):

Triples

Accident History:

Complete the following for any accidents included on your accident register (390.15(b)) that involved the employee:

Date Of Accident	Location City/State	No. Of Injuries	No. Of Fatalities	Hazmat Spill?

Was the applicant a safe and efficient driver?

yes

No

Reason for leaving your employer

Discharged

Laid Of

Resigned

Other

Remarks

Was the applicant’s general conduct satisfactory?

yes

No

Is the applicant competent for the position sought?

yes

No

Did the applicant drink any alcoholic beverages while on duty?

yes

No

Overall quality of work performance:

Excellent

Good

Fair

Poor

Very Poor

Name of Company Representative Providing Information Above:

Title:

Phone Number:

Date Completed:

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PSP Consent Form

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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 AOG TEAM SERVICES LLC DBA AOG (“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 (FMCSR).

When the Application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSR 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 FMCSR 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 FMCSR; the name, address, and the toll free telephone number of FMCSR; that the FMCSR 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 FMCSR 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 FMCSR 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.FMCSR.dot.gov. If you challenge crash or inspection information reported by a State, FMCSR 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 FMCSR, 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 FMCSR 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 AOG TEAM SERVICES LLC DBA AOG (“Prospective Employer”) to access the FMCSR 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 FMCSR contractor supplying the crash and safety

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE

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.FMCSR.dot.gov. If I challenge crash or inspection information reported by a State, FMCSR 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 FMCSR, 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.

First Name:

Last Name:

Date:

July 10, 2025, 12:38 pm

Signature:

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 (FMCSR). 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 FMCSR 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

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Disclosure / Acknowledgment And Authorization For Background Investigation

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DISCLOSURE REGARDING BACKGROUND INVESTIGATION

AOG TEAM SERVICES LLC dba AOG may obtain information about you from a third party consumer reporting agency (CRA) for employment purposes. This information may be obtained in the form of a “consumer report” and/or an “investigative consumer report” (commonly known as a “background report”). These reports may contain information regarding your criminal history, social security verification, motor vehicle records (“driving records”), credit history*, verification of your education or employment history, drug screening or other background checks.
This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses and educational institutions. The reports may also include information about your character, general reputation, personal characteristics, mode of living, etc., which can involve personal interviews with individuals or companies that you have listed as a reference, former employer, etc. A more comprehensive background investigation may be required pursuant to state or federal law, contract agreement or for certain sensitive positions (such as those with significant financial responsibilities). (*Please note that credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying.)
You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of any investigative consumer report obtained with regard to applicants for employment is an investigation conducted by FSSolutions.
FSSolutions can be contacted via mail, phone or email at:

FSSolutions
1192 Hansen Road Ste 100
Green Bay, WI 54304
Phone: 855.610.9373
backgrounds@fssolutions.com

Date:

July 10, 2025, 12:38 pm

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

I acknowledge receipt of the separate document entitled “Disclosure Regarding Background Investigation” and “A Summary of Your Rights under the Fair Credit Reporting Act” and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by the Company at any time after receipt of this authorization and throughout my employment, or status as an Advisor, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all drug screening and background information requested by FSSolutions 1192 Hansen Road Ste 100 Green Bay, WI 54305 855.610.9373, www.firstsourcesolutions.com and/or the Company itself. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

New York applicants only: Upon request, you will be informed whether or not a consumer report was requested by the Company, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. You have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting the consumer reporting agency identified above directly. By signing below, you acknowledge receipt of Article 23-A of the New York Correction Law.

Washington State applicants only: You also have the right to request from the consumer reporting agency a written summary of your rights and remedies under the Washington Fair Credit Reporting Act.

Minnesota and Oklahoma applicants only:

Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company.

California applicants only: YUnder California Civil Code section 1786.22, you are entitled to find out what is in the CRA’s file on you with proper identification, as follows:

In person, by visual inspection of your file during normal business hours and on reasonable notice. You also may request a copy of the information in person. The CRA may not charge you more than the actual copying costs for providing you with a copy of your file.
A summary of all information contained in the CRA file on you that is required to be provided by the California Civil Code will be provided to you via telephone, if you have made a written request, with proper identification, for telephone disclosure, and the toll charge, if any, for the telephone call is prepaid by or charged directly to you
By requesting a copy be sent to a specified addressee by certified mail. CRAs complying with requests for certified mailings shall not be liable for disclosures to third parties caused by mishandling of mail after such mailings leave the CRAs.

Proper Identification” includes documents such as a valid driver’s license, social security account number, military identification card, and credit cards. Only if you cannot identify yourself with such information may the CRA require additional information concerning your employment and personal or family history in order to verify your identity. The CRA will provide trained personnel to explain any information furnished to you and will provide a written explanation of any coded information contained in files maintained on you. This written explanation will be provided whenever a file is provided to you for visual inspection. You may be accompanied by one other person of your choosing, who must furnish reasonable identification. A CRA may require you to furnish a written statement granting permission to the CRA to discuss your file in such person’s presence.

Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law

ACKNOWLEDGMENT AND AUTHORIZATION FOR BACKGROUND CHECK

BACKGROUND INFORMATION

Last Name:

First:

Middle:

Other Names/ Aliases Used:

Social Security number:

Date of Birth:

Driver’s License Number:

State of Driver’s License:

Current Address:

Phone Number:

Email Address:

Zip / State / City:

Permission to contact current employer for employment and reference verifications:

yes

No

Date:

July 10, 2025, 12:38 pm

Signature:

*This information will be used as identification for background screening purposes only and will not be used as hiring criteria.

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Controlled substance and Alchohol consent form (49cfrpart49-(j))

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Please click the “View Form to Enable Checkbox” link to view the disclosure prior to checking the box on the left of each form. Checking the box next to each disclosure, will serve as your intention to autofill and sign the form

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DRIVER DRUG & ALCOHOL CERTIFICATE

FOR DRIVER APPLICANTS OF COMMERCIAL MOTOR VEHICLES THAT REQUIRE A COMMERCIAL DRIVER LICENSE (CDL) THE APPLICANT MUST DISCLOSE THEIR CONTROLLED SUBSTANCE AND ALCOHOL STATUS PER THE REQUIREMENTS OF 49 CFR PART 40.25(J).

As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s) and for that previous employer(s) to re-send the corrected information to the prospective employer; the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

Driver employees who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer provided investigative information, must submit a written request to the prospective employer, which may be done at any time, including when applying or as late as thirty (30) days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five (5) business day deadlines will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records.

“I CERTIFY 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.”

SSN:

Date:

July 10, 2025, 12:38 pm

Signature:

TO BE COMPLETED BY EMPLOYER

Application RECEIVED BY

Name:

Title:

Date:

Application REVIEWED FOR COMPLETENESS BY:

Name:

Title:

Date:

SIGNIFICANT DATES:

Date Of Hire :

Time & Date Of Pre-Employment Est

Time & Date Of Pre-Employment Est Results Received :

Date First Used In Safety Sensitive Position :

Date Of Termination :

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Upload Required Documents

Drivers License

Medical Card

Insurance

Ownership / Title

Equipment Registration

Truck DOT Annual Inspection

Additional documents

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I consent that this Application and selections’ were completed by me and are true to the best of my knowledge.

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Date: July 10, 2025, 12:38 pm

Signature:

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Information provided may not be editted after submission, please make sure all of your data is correct.

I Confirm all the information above is correct, and I am ready to submit my application