IRONBOUND EXPRESS, INC.

973-491-2852 / 973-491-6540 (fax)

sm@ironboundexpress.com

CDL DRIVER APPLICATION

U.S. DOT 674147
MC‐434921

Date of Application: _____________________

PLEASE TYPE OR PRINT CLEARLY
APPLICANT NAME:
IT IS IRONBOUND EXPRESS, INC. POLICY TO PROVIDE EQUAL OPPORTUNITY WITH REGARD TO ALL TERMS AND CONDITIONS OF HIRING. IRONBOUND EXPRESS, INC.
COMPLIES WITH FEDERAL AND STATE LAWS PROHIBITING DISCRIMINATION ON THE BASIS OF RACE, COLOR, RELIGION, SEX, NATIONAL ORIGIN, DISABILITY, VETERAN STATUS, AGE
OR ANY OTHER PROTECTED CHARACTERISTIC. ANY DRIVER APPLICATION SUBMITTED TO IRONBOUND EXPRESS, INC. WHICH CONTAINS OMISSIONS, INCOMPLETE INFORMATION
(IF NO SPECIFIC ANSWER, WRITE “NONE”), OR IS MISSING OTHER REQUIRED FORMS OR PAPERWORK WILL NOT BE REVIEWED. INCOMPLETE APPLICATIONS AND FORMS WILL BE
RETURNED TO SENDER FOR COMPLETION.
THIS APPLICATION AND ALL INFORMATION SUBMITTED WITH THIS APPLICATION (INCLUDING COPIES OF DOCUMENTS) MUST BE CLEARLY
LEGIBLE OR WILL BE RETURNED TO SENDER.
GENERAL INFORMATION:
CURRENT STREET CITY: STATE: ZIP
ADDRESS: CODE:

HOW LONG AT DATE OF SOCIAL SEECUTIY

THIS ADDRESS? BIRTH: NUMBER:

CELL NUMBER HOME # DRIVER EMAIL

LIST ADDRESSES FOR PREVIOUS THREE YEARS (ATTACH ADDITIONAL PAGES IF NEEDED)
STREET ADDRESS: CITY: STATE: ZIP
CODE:

STREET ADDRESS: CITY: STATE: ZIP

CODE:

STREET ADDRESS: CITY: STATE: ZIP

CODE:

EMERGENCY ADDRESS: PHONE:

CONTACT NAME:
DO YOU HAVE THE LEGAL RIGHT TO □ YES □ NO HAVE YOU EVER BEEN CONVICTED OF A FELONY (IF YES, □ YES □ NO
WORK IN THE US? EXPLAIN BELOW)?

EXPLANATION OF FELONY
CONVICTIONS (IF APPLICABLE):
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
LICENSE INFORMATION:
STATE: LICENSE NO: TYPE: EXPIRATION
DATE:

HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT, □ YES □ NO IF YES, PLEASE
OR PRIVILEGE TO OPERATE A MOTOR VEHICLE? EXPLAIN:

HAS ANY LICENSE, PERMIT, OR PRIVILEGE EVER □ YES □ NO IF YES, PLEASE

BEEN SUSPENDED OR REVOKED? EXPLAIN:

PHYSICAL HISTORY (COPY OF YOUR CURRENT MEDICAL EXAMINATION AND MEDICAL CARD IS REQUIRED):
Have you been Granted a Waiver Under Section 391.49 of the FMCSA Regulations □ Yes □ No Date of your last D.O.T. Physical:
regarding Loss or Impairment of Limbs (a copy of the form is required)?

Page 1 of 10
DRIVER EXPERIENCE:
CLASS OF EQUIPMENT TYPE OF EQUIPMENT DATES FROM DATES TO APPROXIMATE NO. OF MILES

BOX TRUCK

STRAIGHT TRUCK

TRACTOR & SEMI‐TRAILER

OTHER

ACCIDENT RECORD FOR THE PAST THREE (5) YEARS OR MORE (ATTACH MORE SHEETS IF NEEDED):
DATES NATURE OF ACCIDENT NUMBER OF NUMBER OF PENALTY
FATALITIES INJURIES

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST THREE (5) YEARS (OTHER THAN PARKING VIOLATIONS, ATTACH ADDITIONAL SHEET IF NEEDED)

MONTH / YEAR VIOLATION STATE VIOLATION PENALTY

CONVICTED OCCURRED

EMPLOYMENT HISTORY:
CDL DRIVER APPLICANTS MUST PROVIDE TEN (10) YEARS OF EMPLOYMENT HISTORY. ADD ADDITIONAL EMPLOYMENT HISTORY PAGES, IF NEEDED. ANY GAPS IN EMPLOYMENT MUST BE EXPLAINED ON A SEPARATE PAGE AND INCLUDED
WITH THIS APPLICATION. ALL INFORMATION OBTAINED FROM PREVIOUS EMPLOYERS / CARRIERS WILL BE KEPT CONFIDENTIAL. PLEASE LIST MOST RECENT EMPLOYER / CARRIER FIRST. INCLUDE COMPLETE ADDRESS INFORMATION STREET
NUMBER AND NAME, CITY, STATE AND ZIP CODE.

CURRENT / LAST EMPLOYER:

EMPLOYER:

CITY STATE ZIP CODE

STREET ADD:

CONTACT: PHONE FAX

POSITION: FROM TO
MO/YR MO/YR
REASON FOR LEAVING:
WAS YOUR JOB DESIGNATED AS A SAFETY – SENSITIVE FUNCTION □ YES □ NO WHERE YOU SUBJECT TO THE FEDERAL MOTOR □ YES □ NO
IN ANY DOT‐ REGULATED MODE SUBJECT TO ALCOHOL & CARRIER SAFETY REGULATIONS (FMCSRs)?
CONTROLLED SUBSTANCES TESTING UNDER 49 CFR PART 40?

PREVIOUS EMPLOYER:
EMPLOYER:

CITY STATE ZIP CODE

STREET ADD:

CONTACT: PHONE FAX

POSITION: FROM TO
MO/YR MO/YR
REASON FOR LEAVING:
WAS YOUR JOB DESIGNATED AS A SAFETY – SENSITIVE FUNCTION □ YES □ NO WHERE YOU SUBJECT TO THE FEDERAL MOTOR □ YES □ NO
IN ANY DOT‐ REGULATED MODE SUBJECT TO ALCOHOL & CARRIER SAFETY REGULATIONS (FMCSRs)?
CONTROLLED SUBSTANCES TESTING UNDER 49 CFR PART 40?

Page 2 of 10
PREVIOUS EMPLOYER:
EMPLOYER:

CITY STATE ZIP CODE

STREET ADD:

CONTACT: PHONE FAX

POSITION: FROM TO
MO/YR MO/YR
REASON FOR LEAVING:
WAS YOUR JOB DESIGNATED AS A SAFETY – SENSITIVE FUNCTION □ YES □ NO WHERE YOU SUBJECT TO THE FEDERAL MOTOR □ YES □ NO
IN ANY DOT‐ REGULATED MODE SUBJECT TO ALCOHOL & CARRIER SAFETY REGULATIONS (FMCSRs)?
CONTROLLED SUBSTANCES TESTING UNDER 49 CFR PART 40?

PREVIOUS EMPLOYER:
EMPLOYER:

CITY STATE ZIP CODE

STREET ADD:

CONTACT: PHONE FAX

POSITION: FROM TO
MO/YR MO/YR
REASON FOR LEAVING:
WAS YOUR JOB DESIGNATED AS A SAFETY – SENSITIVE FUNCTION □ YES □ NO WHERE YOU SUBJECT TO THE FEDERAL MOTOR □ YES □ NO
IN ANY DOT‐ REGULATED MODE SUBJECT TO ALCOHOL & CARRIER SAFETY REGULATIONS (FMCSRs)?
CONTROLLED SUBSTANCES TESTING UNDER 49 CFR PART 40?

APPLICANT: PLEASE READ AND SIGN BELOW:

I authorize you to make sure investigations and inquiries to 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, health care providers, and other persons from all liability in responding
to inquiries and releasing information in connection with my application.
In the event of employment / work relationship, I understand that false or misleading information given in my applications or interview(s) may result in
termination. I understand also, that I am required to abide by all rules and regulations of Ironbound Express, Inc.
“I understand that information I provide regarding current / previous employers may be used, and those employer(s) will be contacted, for the purpose of
investigating my safety performance history as required by 49 CFR 391.23(d) and €. I understand that I have the right to:
●Review informa on provided by current / previous employers (see note* below);
●Have errors in the informa on corrected by previous and for those employers to re‐send the corrected information to the prospective employer / carrier; and
●Have a rebu al statement a ached to the alleged erroneous informa on, if the previous employer(s) and I cannot agree on the accuracy of the information.

Signature: Date:

*NOTE: Drivers who have had a previous DOT regulated employment history in the ten (10) years and wish to review previous employer‐provided investigative information
must submit a written request to the prospective employers / carrier. This 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 / work. Prospective employers / carriers must provide this information within five (5) days of receiving the written
request. If Prospective employers / carriers have not yet received the requested information from the previous employer, then the five (5) day deadline will begin when the
requested safety performance history information is received. If you have not arranged to pick up or receive the requested records within thirty (30) days of the Prospective
employer / carrier making them available, the Prospective employer / carrier may consider you to have waived your request to review the record(s).

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

Signature: Date:

Page 3 of 10
 DRUG AND ALCOHOL TESTING RECORD REQUIRED QUESTIONS

In accordance with 49 CFR Part 40 Section 40.25 (i) of FMCSA regulations, please answer the following questions:

1. Have you ever tested positive on any pre‐employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety‐sensitive
transportation work covered by DOT agency drug and alcohol testing rules during the past 2 years?
□ YES □ NO

2. Have you ever refused to test on any pre‐employment drug or alcohol test administered by an employer which you applied for, but did not obtain, safety‐sensitive
transportation work covered by D.O.T agency drug and alcohol testing rules during the past 2 years?
□ YES □ NO

3. If you answered YES to either of the above questions, you must be able to show documentation that you completed the Return‐To‐Duty process before you are allowed
to perform any safety sensitive functions.

DATE: Signature:
Please Print or Type Name:

ACKNOWLEDGEMENT OF RECIEPT OF CONTROLLED SUBSTANCES AND ALCOHOL POLICY

I acknowledge that I have read, understand, and have accepted a copy of Ironbound Express, Inc. Controlled Substances and Alcohol Policy. I consent to
submit to drug and alcohol screening and agree to comply with all of the requirements of the Federal Motor Carrier Safety Regulations, as well as all Federal,
State, and Local Law, rules, or regulations. I understand failure to adhere to the terms of this acknowledgment will result in my application being denied or my
suspension as a qualified drive, and is grounds for my discharge or permanent cancellation of my lease.

DATE: Signature:
Please Print or Type Name:

DRUG WAIVER AND CONSENT FORM

This form must be completed and signed BEFORE the test and mailed with the physical form directly to the Ironbound Express, Inc.

Please Print or Type Name: Date of Birth:

I hereby voluntarily authorize a physician or clinic authorized by Ironbound Express, Inc. Agent (please enter full Agent Name): i3Screen,
Concentra, or Ironbound Express, Inc. to take specimens of my urine to be tested for marijuana and / or controlled substances herein and further determine
the content thereof. I understand and agree that the physician or clinic will disclose the results of the test to Ironbound Express, Inc. and release any
employees and / or agents thereof from any and all claims or causes resulting from the disclosure of the test results to the parties designated herein. I hereby
further agree to waive any physician‐patient privilege that may otherwise exist with the respect to the confidentiality of the test results.

I understand that this consent and release is subject to revocation at any time, except to the extent that action has taken in reliance hereon. In any event, this
consent will remain in effect until revoked upon termination of employment / work relationship with Ironbound Express, Inc..

Please Print or Type Name: Date:

Signature:

Page 4 of 10
 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 Ironbound Express, 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 Ironbound Express, 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.

Page 5 of 10
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.

Date: __________________________ _______________________________________

Signature _____________________________________________________________

Name (Please Print) ______________________________________________________

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.

Page 6 of 10
 Additional State Law Notices

Please also note the fol lowing:

CALIFORNIA: Pursuant to section 1786.22 of the California Civil Code, you may view the file maintained on
you by the consumer reporting agency during normal business hours. You may also obtain a copy of this file,
upon submitting proper identification and paying the actual copying costs, by appearing at the consumer
reporting agency's offices in person, during normal business hours and on reasonable notice, or by certified
mail. You may also receive a summary of the file by telephone, upon submitting proper identification and
written request. The consumer reporting agency has trained personnel available to explain your file to you,
including any coded information, and will provide a written explanation of any coded information contained in
your file. If you appear in person, you may be accompanied by one other person, provided that person furnishes
proper identification. "Proper identification" includes documents such as a valid driver"s license, social security
account number, military identification card, and credit cards. If you cannot identify yourself with such
information, the consumer reporting agency may require additional information concerning your employment
and personal or family history to verify your identity.

HireRight, Inc. ("HireRight'') will prepare the background report for the Company. HireRight is located and can
be contacted at 3349 Michelson Drive, Suite 150, Irvine, CA 92612, (800) 400-2761. Information about
HireRight's privacy practices is available at www.hireright.com/Privacy-Policv.aspx.

Additional California-specific information is set out below.

MASSACHUSETTS: Upon request to the Company, you have the right to know whether the Company
requested an investigative consumer report about you and, upon written request to the Company, you have the
right to receive a copy of any such report. You also have the right to ask the consumer reporting agency (e.g.,
HireRight) for a copy of any such report.

MINNESOTA: You have the right in most circumstances to submit a written request to the consumer reporting
agency (e.g., HireRight) for a complete and accurate disclosure of the nature and scope of any consumer report
the Company ordered about you. The consumer reporting agency must provide you with this disclosure within 5
days after (i) its receipt of your request or (ii) the date the repo1t was requested by the Company, whichever date
is later.

NEW JERSEY: You have the right to submit a request to the consumer reporting agency (e.g., HireRight) for
a copy of any investigative consumer report the Company requested about you.

NEW YORK: You have the right, upon written request to the Company, to be in formed of whether or not the
Company requested a consumer report or an investigative consumer repo,t about you. Shown above is the
address and telephone number for HireRight, the consumer reporting agency used by the Company. You may
inspect and receive a copy of any such report by contacting that consumer reporting agency. A copy of Article
23-A of the New York Correction Law is also provided below.

WASHINGTON ST ATE: If the Company requests an investigative consumer repo,t, you have the right, upon
written request made to the Company within a reasonable period of time after your receipt of this disclosure, to
receive from the Company a complete and accurate disclosure of the nature and scope of the investigation
requested by the Company. You are entitled to this disclosure within 5 days after the date your request is
received or the Company ordered the report, whichever is later. You also have the right to request a written
summary of your rights and remedies under the Washington Fair Credit Reporting Act.

Applicant Last Name ___________ First ________ Middle ______

Applicant Signature _______________ Date___________

Page 7 of 10
 PART II – CONSUMER DISCLOSURE AND AUTHORIZATION FORM

Disclosure Regarding Background Investigation

Ironbound Express, Inc. may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection
with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be
obtained in the form of consumer reports and / or investigative consumer reports (commonly known as “background reports”). An “investigative consumer
report” is a background report that includes information from personal interviews (except in California, where that term includes background reports with or
without information obtained from personal interviews), the most common form of which is checking person or professional references. These background
reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by Ironbound Express, Inc., throughout your
employment or your contract period, as allowed by law.

Hireright Inc. ("HireRight") will prepare or assemble the background reports for the Company. HireRight is located and can be contacted at 3349 Michelson
Drive, Suite 150, Irvine, CA 92612, (800) 400-2761, www.hireright.com.

The background report may contain information concerning your character, general reputation, personal characteristics, mode of living, and credit standing.
The types of information that may be obtained include, but are not limited to: social security number verifications, address history; credit reports and history;
criminal records and history; public court records; driving records; accident history; worker’s compensation claims; bankruptcy filings; educational history
verifications; (e.g., dates of attendance, degrees obtained); professional licensing and certification checks, drug / alcohol testing results, and drug / alcohol
history in violation of the law and / or Ironbound Express, Inc. policy; and other information bearing on your character, general reputation, personal
characteristics, mode of living and credit standing.

This information may be abstained from private and public record sources, including, as appropriate: government agencies and courthouses; educational
institutes; and former employers; and, for investigative consumer reports, personal interviews with sources such as neighbors, friends, former employers and
associates; and other information sources. If Ironbound Express, Inc. should obtain information bearing on your credit worthiness, credit standing or credit
capacity for reasons other as required by law, then Ironbound Express, Inc. will use such credit information to evaluate whether you would present an
unacceptable risk of theft or other dishonest behavior in the job for which you are being evaluated.

You may request more information about the nature and scope of an investigative consumer report, if any, by contacting Ironbound Express, Inc..

A summary of your rights under the Fair Credit Reporting Act, as well as the FMCSA Notification of Driver Rights and certain state‐specific notices, are provided.

Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summery of rights under the Fair Credit Reporting Act. By my
signature below, I consent to preparation of background reports to Ironbound Express, Inc. and its designated representatives and agents, for the purpose of
assisting Ironbound Express, Inc. in making a determination as to my eligibility for employment (including independent contractor assignments, as applicable),
promotion, and retention or for other lawful purposes. IO understand that if Ironbound Express, Inc. hires me, without asking for my authorization again,
throughout my employment or contract period from Hireright, I3Escreen, and other consumer reporting agencies.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my employment or
contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also understand that nothing contained
herein shall be construed as an offer of employment or contract for services.

I hereby authorize the following, without limitation, to disclose information about me to the consumer reporting agency and its agents: law enforcement and all
other federal, state and local agencies, learning institutions (including public and private schools, colleges and universities), testing agencies, information
service bureaus, credit bureaus, recording / date repositories, courts ( federal, state and local), motor vehicle record agencies, my past or present employers,
the military, and all other individuals and sources with any information about or concerning me. The information disclosed to the consumer reporting agency
and its agents includes, but is not limited to, information concerning my employment and earning history, education, credit history, motor vehicle history,
criminal history, military service, professional credentials and licenses.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I agree that this form is
original, faxed, photocopies or electronic (including electronically signed) form will be valid for any background reports that may be requested by or on behalf
of Ironbound Express, Inc..

□ California, Minnesota or Oklahoma applicants only: Please check this box if you would like to receive (whenever you have such right under the applicable
state law) a copy of your background report if one is obtained on you by Ironbound Express, Inc..

Print Applicant Last Name: First: Middle:

Applicant Signature: Date:

Page 8 of 10
 PART I – DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES
79 CFR PART 391.23, DOT DRUG AND ALCOHOL TESTING

In accordance with DOT Regulation 79 CFR Part 391.23 and 49 CFR part 40, each as applicable, I hereby authorize release of my DOT‐ regulated drug and
alcohol testing records by the DOT – regulated employer(s) listed below. I understand that information / documents released pursuant to this Part I is limited
to the following DOT – regulated testing items, including FMCSA Clearinghouse full and limited query results, pre‐employment testing results, occurring during
the previous three (3) years: (i) alcohol tests with a result of 0.04 or higher alcohol concentration: (ii) verified positive drug tests; (iii) refusals to be tested
(including adulterated and / or substituted test); (iv) other violations of DOT drug and alcohol testing regulations (i.e., violations of 49 CFR 382 Subpart B); (v)
information obtained from previous employers of a drug and alcohol rule violation; and (vi) any documentation of completion of a return‐to‐duty process
following a rule violation.

If any company listed below furnishes information concerning items (i) through (vi) above, I authorize such company to furnish the following information to
Ironbound Express, Inc. and if applicable: (i) dates of my negative drug and / or alcohol test and / or tests with results below 0.04 during the previous three (3)
years; and (ii) the name and phone number of any substance abuse professional who evaluated me during the previous three (3) years.

List all Dot – regulated employers you have applied with and / or worked for in a safety‐sensitive function during the previous three (3) years. If necessary,
attach additional pages, including the date, your name, social security number and signature.

List all Dot – regulated employers you have applied with and / or worked for in a safety‐sensitive function during the previous three (3) years. If necessary,
attach additional pages, including the date, your name, social security number and signature.

Previous DOT‐Regulated Employer City State Phone Number

By my signing below, I also certify the information I provide on and in connection with this form is true, accurate and complete. I agree that this
form in original, faxed, photocopied or electronic (including electronically signed) form will be valid for any background checks that may be
requested by or on behalf of the Customer.

Print Applicant Name: Social Security Number:

Applicant Signature: Date:

Page 9 of 10
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105 Form - DQF-107

ANNUAL VIOLATION AND REVIEW RECORD

DRIVER NAME:

_____________________________________ _________________________ ____________________

LAST FIRST MIDDLE

CERTIFICATION OF VIOLATIONS

I certify that the following information is a true and complete list of traffic violations (other than parking
violations) for which I have been convicted or forfeited bond or collateral during the past twelve months.

Date Offense Location Vehicle Operated

CHECK IF NONE

Date Drivers Signature

In accordance with Section 391.25, Motor Carrier Safety Regulations, all information pertinent to the
above driver's safety of operations, including the list of violations furnished by him/her in accordance
with Section 391.27, has been reviewed for the past twelve months.

Reviewed By: ___________________________________________

Signature Date

Title
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105 Form - DQF-108
Drug / Alcohol & Prior Work History Request
To _________________________________________ Date _____________________________
COMPANY NAME

_________________________________________ PHONE _________________________

ADDRESS

_________________________________________
CITY STATE ZIP CODE FAX _________________________

ATTENTION: _____________________________ __________________________________

TITLE

REFERENCE: _____________________________ __________________________________

NAME OF APPLICANT SIGNATURE OF APPLICANT

FROM: ____________TO:_________________ __________________________________

DATES APPLICANT LISTED AS WORKING WITH YOUR CO. APPLICANT'S SOCIAL SECURITY NUMBER

The above person has applied with us listing you as a past employer/contractor and under CFR 49 we are required
to request the following information from you and in turn you are required to provide us with this information. By
signing this form he/she has authorized you to release the following information to us:
Drug & Alcohol History
In the past two (2) years, has this person ever tested positive for a controlled substance, had an
alcohol test with a "BAC" of 0.04 or greater or refused to take a required test for drugs.

YES NO

Work History
Are the above dates correct? If not, advise correct dates:
YES NO From ____________To_________________
Did the person have any accidents? If yes, advise dates:

YES NO From ____________To_________________

Equipment
Type of equipment driven: Please advise number of months each driven.
Tractor/Trailer ________ Container _______ Reefer ________
Straight Truck ________ Flatbed _______ Tank ________

____________________________________ ____________________________________
Print Name & Title of Previous Company Representative Signature of Previous Company Representative

Phone Interview? YES NO Date: ___________________

Name & Title of Person Talked To: Name ____________________Title ________________________
I.E.I. Employee Conducting Interview ______________________________________________
Please Fax/Mail Your Reply To: (973) 741-0948
Attention: Chris Krawiec-Safety Manager 921 Delancy Street, Newark, NJ 07105
Telephone Number (973) 741-0946

Page 10 of 10
 Ironbound Express, Inc.
DRIVER QUALIFICATION - PRIOR DRUG and ALCOHOL
WORK HISTORY - CONFIRMATION SHEET
Form - DQF-1XX

Driver submitted: ____________________________________ Date: ___________________

Social Security Number: ____________________________________________

It is mandatory that the previous two (2) years of alcohol/drug testing information; previous three
(3) years work history; and a minimum of two (2) years Tractor Trailer driving experience be verified
before receiving "FINAL" qualification. Confirmations of verification are as follows:

Previous two (2) years of alcohol/drug testing information.

Company Name: Dates: To From

1. __________________________________________ ________/ ________

2. __________________________________________ ________/ ________
3. __________________________________________ ________/ ________
4. __________________________________________ ________/ ________

Previous three (3) years of work history.

Company Name: Dates: To From

1. __________________________________________ ________/ ________

2. __________________________________________ ________/ ________
3. __________________________________________ ________/ ________
4. __________________________________________ ________/ ________
5. __________________________________________ ________/ ________

Previous two (2) years of tractor-trailer driving experience.

Company Name: Dates: To From

1. __________________________________________ ________/ ________

2. __________________________________________ ________/ ________
3. __________________________________________ ________/ ________
4. __________________________________________ ________/ ________
5. __________________________________________ ________/ ________
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105
Form - DTF-410

DRIVER EDUCATIONAL MATERIALS

I hereby certify that Ironbound Express, Inc. has given me educational materials that explain
the drug and alcohol testing requirements contained in Part 382 of the federal Motor Carrier
Safety Regulations.

I hereby further certify that I have received information explaining Ironbound Express, Inc.
policies and procedures with respect to these testing requirements.

Name (Please Print) __________________________________________________________

Signature __________________________________________________________

Month/Date/Year __________________________________________________________
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105 Form - DQF-112

PREVIOUS EMPLOYER DRUG/ALCOHOL TESTS & PRIOR WORK HISTORY

D.O.T. 382-413

CONTACT LIST
Driver Name ___________________________________________________________________________________
Social Security Number __________________________________________________________________________
Company (Previous Employer) ____________________________________________________________________
First Attempt (Made By) ______________________ Second Attempt (Made By) __________________________
Spoke With: Spoke With:

Name: _____________________________________ Name: ___________________________________________

Title: ______________________________________
Date: ______________________________________
Phone Number: _____________________________
Fax Number: _______________________________
Time Faxed Copy of DQF-108: _________________
Title: ____________________________________________
Date: ___________________________________________
Phone Number: ___________________________________
Fax Number: _____________________________________
Time Faxed Copy of DQF-108: _______________________

You must fax a copy of a blank, signed DQF-108

Comments:

Third Attempt (Made By) ______________________ Fourth Attempt (Made By) __________________________
Spoke With: Spoke With:

Name: _____________________________________ Name: ___________________________________________

Title: ______________________________________
Date: ______________________________________
Phone Number: _____________________________
Fax Number: _______________________________
Time Faxed Copy of DQF-108: _________________
Comments:
Title: ____________________________________________
Date: ___________________________________________
Phone Number: ___________________________________
Fax Number: _____________________________________
Time Faxed Copy of DQF-108: _______________________

If the information required on the Drug/Alcohol & Prior Work History Form (DQF-108) is not provided on the initial
contact with a previous employer, the terminal personnel must document the initial contact on the Contact List and
attempt to obtain the information a second and third time.
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105 Form - Cell Policy

Cell Phone use Policy

It is well supported by accident statistics that using a cellular phone, either a hand-held
or a hands-free model, while operating a motor vehicle distracts a driver's attention
from traffic conditions. To help reduce the possibility of vehicle accidents in connection
with the use of cellular phones, our company has adopted a cellular phone use policy
that is applicable to all drivers operating a vehicle that is leased to our company at any time.

Our company's policy is as follows:

1) Cellular phone calls, incoming or outgoing, are not allowed while driving.
2) The cellular phone's voicemail feature should be on to store incoming calls while driving.
3) All calls and message retrievals should be made after the vehicle is safely parked.
4) Accidents incurred while the driver is using a cellular phone may be considered to be
preventable, and the driver subject to disciplinary action.
5) Hands-free cellular phones are subject to the same policy as the hand-held cellular phones.

I have read the above policy and will abide by it.

Driver Signature: _____________________________________

Print name: _____________________________________

Date: _____________________________________
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105 Form - DQF 109

UNAUTHORIZED PASSENGERS

AS STATED IN PARAGRAPH 392.60 OF THE FEDERAL MOTOR CARRIER'S SAFETY REGULATIONS.

Unless specifically authorized to do so by the Motor Carrier under whose authority

the motor vehicle is being operated, no driver shall transport or permit any person
to be transported on any motor vehicle other than a bus. When such authorization
is issued, it shall state the name of the person to be transported, the points where the
transportation is to begin and end, and the date upon which the authority expires.
No written authorization, shall be necessary for the transportation of :

A) Employees of other persons assigned to a vehicle by a motor carrier.

B) Any person transported when aid is being rendered in case of accident or other emergency.
C) An attendant delegated to care for livestock.

Failure to comply with the Regulation stated above may result in driver disqualification.

Driver Signature: ______________________________________________________

Date: ______________________________________________________
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105
Form - DP-11-01

Hazardous Material Guidelines for Drivers

1) Driver must have a copy of the Hazardous Materials Certificate of Registration in his/her
possession.
2) Driver must perform and record a pre-trip inspection and post trip inspection.
3) Driver must check the Hazardous Materials shipping documents against Hazardous
Materials Table to ensure the shipper has completed the shipping documents correctly.
4) Driver must place Emergency Response Guidebook with the Shipping Documents.
5) Driver must ensure placards match the shipping documents.
6) The shipper must supply the placards.
7) It is the driver's responsibility to placard the container.
8) It is the driver's responsibility to ensure shipment is properly blocked and braced before
transporting the load.
9) Driver must keep the shipping documents within his/her immediate reach while
restrained by seatbelt or in the driver's door pocket.
10) Driver must ensure the Hazardous Materials Shipping Document appears first or it must
be clearly distinguished by having it tabbed when grouped with other paperwork.
11) When driver exits the cab, the Hazardous Material Shipping document and the
Emergency Response Guide must be on the drivers seat or in the driver's door pocket.
12) Driver must check all tires every two (2) hours or one hundred (100) miles, whichever
comes first and must record the tire check in the logbook (if applicable).
13) Smoking is not allowed with in twenty-five (25) feet when transporting, loading or
unloading any class 1,3.4.5. and 2.1.
14) A Hazardous material load may not be dropped or left unattended unless it is at one
of the following locations: Ironbound Express facility, port, railroad, shipper or consignee.
15) Drivers must stop at all railroad crossings when transporting a placarded load. Stop must
be made within 50 feet of the crossing and no closer than 15 feet. Exception: Driver's
are not required to stop at railroad crossing when transporting divisions 1.5, 1.6, 6.2,
and class 9.
16) Drivers must follow Hazardous Materials Routes when marked and may not transport
certain hazardous material through a tunnel.
17) Empty Containers: It is the driver's responsibility to remove the placards before moving
an empty container.

If you are involved in as accident or incident resulting is a release, spill, or leakage

of hazardous materials or diesel fuel, IMMEDIATELY notify:
1. Chemtrek: 1-800-424-9300
2. Local Police and Fire departments
3. Ironbound Express, Inc.: 973-491-2852 or 862-215-0210
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105 Form - DQF 111

Driver Receipt Statement

DRIVER RECEIPT HAZARDOUS MATERIALS COMPLIANCE POCKETBOOK

I acknowledge receipt of the Hazardous Materials Compliance Pocketbook (117-ORS) which details driver
responsibilities and duties in the transportation of hazardous materials, as prescribed by the U.S.
Department of Transportation in Title 49 CFR PARTS 107, 171-180 and 390-397.

____________________________________________ ___________________
Driver's Signature Date

Ironbound Express, Inc.

Company Company Supervisor's Signature

DRIVER RECEIPT EMERGENCY RESPONSE GUIDEBOOK

I acknowledge receipt of the 2000 Emergency Response Guidebook (14-ORS-0), detailing emergency
response procedure as developed under the supervision of the Offices of Hazardous Materials Initiatives
and Training, Research and Special Programs Administration, U.S. Department of Transportation.

____________________________________________ ___________________
Driver's Signature Date

Ironbound Express, Inc.

Company Company Supervisor's Signature

DRIVER RECEIPT FEDERAL MOTOR CARRIER SAFETY REGULATIONS POCKETBOOK

I acknowledge receipt of this FEDERAL MOTOR CARRIER SAFETY REGULATIONS POCKETBOOK

(ORS-7a). In addition, I agree to familiarize myself with the Federal Motor Carrier Safety Regulations
(FMCSR) of the U.S. Department of Transportation, Parts 40, 382, 383, 390-397, 399 Subchapter B,
Chapter 3, Title 49 of the Code of Federal Regulations, as contained therein.

____________________________________________ ___________________
Driver's Signature Date

Ironbound Express, Inc.

Company Company Supervisor's Signature

DRIVER RECEIPT HAZARDOUS MATERIAL GUIDELINES FOR DRIVERS

I acknowledge receipt of the Hazardous Material Guidelines for Drivers (DP-11-01), which details
responsibilities and duties in the transportation of hazardous materials.

____________________________________________ ___________________
Driver's Signature Date

Ironbound Express, Inc.

Company Company Supervisor's Signature
Note: This receipt shall be read and signed by the driver. A responsible company supervisor shall counter
sign the receipt and place it in the driver's qualification file.
 Ironbound Express, Inc.
65 Jabez Street
Newark, NJ 07105 Form - CS -1

CARGO SECURITY: THEFT PROTECTION

Ironbound Express, Inc. is committed to the safe and efficient

handling of our customer's products. Our goal is to incur zero cargo
loss or damage as a result of company or driver carelessness, or
negligence.

It is the policy of Ironbound Express, Inc., that all information

about cargo contents and pickup and delivery schedules is strictly
confidential. Drivers are prohibited from discussing information related
to customer's cargo or schedules with any person's) other than
Ironbound Express, Inc. officials. Drivers shall not park an unattended,
loaded container in any area aside from a secured port, rail and Ironbound
Express, Inc. terminal or customer's facility.

Drivers failing to abide by this policy will be subject to disqualification.

Ron Faiella
President, Ironbound Express, Inc.

I fully understand the policy as stated above:

Print Name ___________________________________ Unit # __________________________

Signature: ____________________________________ Date: __________________________

 DRIVER STATEMENT OF ON-DUTY HOURS
(For Newly Hired Drivers)
INSTRUCTIONS: Motor carriers when using a driver for the first time shall obtain from the driver a signed
statement giving the total time on-duty during the immediately preceding 7 days and time at which such
driver was last relieved from duty prior to beginning work for such carrier. Rule 395.8(j)(2) Federal Motor
Carrier Safety Regulations. NOTE: Hours for any compensated work during the preceding 7 days, including
work for a non-motor carrier entity, must be recorded on this form.
Driver Name (Print)
Social Security Number
Driver’s License State: Number: Class:
Endorsement(s): Restriction(s):
Type of License Issuing State:

DAY 1 2 3 4 5 6 7
(Yesterday)

DATE

HOURS TOTAL HOURS

WORKED 0

I hereby certify that the information given above is correct to the best of my knowledge and belief,
and that I was last relieved from work at
A.M.
P.M. On
Time Day Month Year

Driver’s Signature Date

DRIVER CERTIFICATION FOR OTHER COMPENSATED WORK

INSTRUCTIONS: when employed by a motor carrier, a driver must report to the carrier all on-duty time
including time working for other employers. The definition of on-duty time found in Section 395.2
paragraphs (8) and (9) of the Federal Motor Carrier Safety Regulations, includes time performing any other
work in the capacity of, or in the employ or service of, a common, contract or private motor carrier, also
performing any compensated work for any non-motor carrier entity.
(Check One)
Are you currently working for another employer? Yes No
At this time, do you intend to work for another employer while still employed by this
Company? Yes No
I hereby certify that the information given above is true and I understand that once I become employed with
this company, if I begin working for any additional employer(s) for compensation that I must inform this
company immediately of such employment activity.

Driver’s Signature Date

WITNESS
Company Representative Date

Υ Retain in Employee’s DOT File Υ