Netcor Transports Employment Application

Documentation Needed for Employment
Immigration Law compliance

Valid Driver’s license
Valid Social security card.
Federal form I-9
W- 4
Employee Background Check

Criminal Background
Driving Record
Prior employment Verification
Reference checks
Education (Updated Certifications, @ least CPR first responder level)
1010 E. Indian School Rd. Phx, AZ 85014 – Office: 623-243-7245 Fax: 480-522-3608
ride@netcortransports.com - www.netcortransports.com
EMPLOYMENT APPLICATION
APPLICANT INFORMATION
Last Name First M.I. Date
Street Address Apartment/Unit #
City State ZIP
Phone E-mail Address
Date Available Social Security No. Desired Salary
Position Applied for Full Time (40hrs) Part Time (20hrs +)
If no, are you authorized to work in the

Are you a citizen of the United States? YES NO YES NO
U.S.?
Have you ever worked for this company? YES NO If so, when?
Have you ever been convicted of a felony? YES NO If yes, explain
Availability
From: To: Comments:
Monday -
Tuesday -
Wednesday -
Thursday -
Friday -
Saturday -
Sunday -
EDUCATION
High School Address
From To Did you graduate? YES NO Degree
College Address
From To Did you graduate? YES NO Degree
Other Address
From To Did you graduate? YES NO Degree/Certification
REFERENCES (PLEASE LIST 3 PROFESSIONAL REFERENCES)
Full Name Relationship
Company Phone ( )
Address
Company Phone ( )
Address
Company Phone ( )
Address
PREVIOUS EMPLOYMENT
Company Phone ( )
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone ( )
Address Supervisor
Responsibilities
Company Phone ( )
Address Supervisor
Responsibilities
MILITARY SERVICE
Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain
DISCLAIMER AND SIGNATURE

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature Date
EMPLOYEE EMERGENCY INFORMATION FORM
Date last updated:
PERSONAL INFORMATION
Employee ID
First name
Middle name
Last name
Gender
Citizenship
Place of birth (country/region)
Home address
Home phone
Cellular phone
Home e-mail address
Birthday (MM/DD/YYYY)
Government ID or SSN
Driver’s license/state ID number
MEDICAL INFORMATION
Doctor’s name
Address
Phone number
Blood type
Medical conditions
Allergies
Current medications
EMERGENCY INFORMATION
Emergency contact’s name
Relationship
Address
Phone number(s)
CONSENT TO PERFORM CRIMINAL HISTORY BACKGROUND CHECK
IN COMPLIANCE WITH THE FCRA and the DPPA
(Fair Credit Reporting Act and the Federal Driver’s Privacy Protection Act)
Date:_____________ Driver’s Lic #____________________________ State Issued______

________________________ ____________________________ ________
Last Name First Name Middle Initial
_________________________________________________________________________
Maiden and/or Other Last Names Used
________________________ _________________________ ________________
Current Address City and County State and Zip Code
______________________ ______________________ Circle One:
Date of Birth Social Security Number Male / Female
This authorization and consent for release of personal information acknowledges that
Netcor Transports LLC. (Hereafter referred to as "Company") and/or its agent, may now, or at any time I am assigned to, volunteer with or am
employed by this Company, conduct investigations whether the records are of a public, private or confidential nature. These investigations might include, but
are not limited to, searches of educational institutions attended; financial or credit institutions, including records of loans; records of commercial or retail credit
agencies; other financial statements; records of previous employment, including work history, efficiency ratings, complaints and grievances filed by or against
me; records and recollections of attorney-at-law or of other counsel, whether representing me or any other person (in either a civil or criminal case in which I
have been involved); records from the U.S. Veterans' Administration; criminal history information of file in local, state or federal agencies; and motor vehicle
records, and following an employment offer, workers' compensation reports from either the Department of Labor, National Personnel Records or the Industrial
Commission or similar agencies under the provisions of the Fair Credit Reporting Act 15, USC section 1681 et seq. I also authorize the National Personnel
Records Center, or other custodian of my military service record, to release to Secure search, the following information and/or copies of documents from my
military service record: DD214, service record, and any disciplinary records.
I understand that these searches will be used to determine work assignment or employment eligibility under the company's employment or volunteer policies.
Therefore, I authorize and consent for full release of records (either orally or in writing) to the authorized representatives of the company. In addition, I release
and discharge the company and its agent and associates to the full extent permitted by law from any claims, damages, losses, liabilities, costs expenses or
any other charge or complaint filed with any agency arising from retrieving and reporting this information. I understand that according to the Federal Fair
Credit Reporting Act, I am entitled to know whether employment was denied based upon the information obtained and to receive, upon written request, a
disclosure of the background report. I also understand that I may request a copy of the report from my employer. After reading this document, I fully
understand its contents and authorize the background verification.
Signed this _________________ day of _________________________________, 20_____
Applicant (Print Name) _________________________________________________________________________
Applicant Signature __________________________________________________________________________
Netcor Transports LLC.
FLEET CARD AGREEMENT
Netcor Transports LLC. will utilize Fleet Cards to simplify the fueling process, low-dollar purchases for goods and services and to reduce the
generation of petty cash.
This policy establishes the guidelines for the Fleet Card program to ensure the use of these cards is in accordance with Netcor Transports policies and
procedures.
Fleet Card compliance is the responsibility of all Netcor Transports Employees.
a. The Fleet Card shall only be used for authorized Fuel purchases in accordance with Netcor
Transports.
b. The Fleet Card is not to be used for personal purchases under any circumstances.
c. Fleet Cards are to remain under the designated vehicle at all times.
d. Employees will sign out the assigned Fleet Card along with the equipment box on a daily basis.
It is the employee’s responsibility to verify the Fleet Card’s accuracy to the assigned vehicle.
e. The card holder is responsible to obtain, retain and submit the original receipt for any purchase
made with a Fleet Card in a timely manner. Any transaction applied without the proper receipt of
purchase will be the assigned card holder’s financial responsibility. NO EXEPTIONS.
f. Card holders are required to report lost or stolen cards immediately.
g. All Fleet Cards are the property of Netcor Transports and must be surrendered immediately
upon supervisor request.
h. Upon discovery of fraud or misuse of the Fleet Card by a Netcor Transports employee, the card
will be forfeited. The employee will be subject to disciplinary action, up to and including
dismissal and financial restitution.
Employee Name: ______________________ Date: ______________

Employee Signature: ___________________
Netcor Transports LLC.
General Radio/ Phone Guidelines
All cell phone units are to be used strictly for company purposes!
Field units shall first give the assigned radio identifier (e.g. Net - 10) when calling Dispatch. Communications both to and from units and the dispatcher
shall be conducted in a businesslike manner, using proper language and correct procedures. Use specific, clear, concise language in all transmissions.
Be brief and to the point. Avoid slang.
All personnel should be aware that all voice communications are subject to FCC rules and regulations.
Nonprofessional conduct loses its humor when later used as a reference, or when the data is subpoenaed into court for trial action.
Radio transmissions will be brief and to the point.

- All messages shall be impersonal. The use of nicknames, first names,
superfluous and unnecessary radio transmissions are forbidden.
 Pronounce words distinctly and not too rapidly. Choose words that are clear
and forceful in sound, and convey a definite meaning.
Radio Transmission Sequence: The calling sequence to establish communications is

as follows:
 State the radio identifier you are calling. (e.g. Net 10)
 State your radio identifier and wait for acknowledgment (except when
responding, arriving or going in-service)
 State your Message.
 Message is repeated by the receiving unit and confirmed.
e.g.
Unit: “ Net - 10 Dispatch”
Dispatch: “ Net - 10 Go ahead”
Unit: “ Net – 10 returning to quarters”
Dispatch: “ Copy, Net 10 Returning to quarters”
Violation of radio procedures or other causes for complaint, from either the dispatcher or
field unit, will be processed through established Land Lines.
Twenty-four Hour Time.

All personnel use Twenty-four hour time.
All personnel must be aware of the responsibility attached to radio usage, and
unjustified attempts to breach operational procedures may be subject to disciplinary
action.
Employee Signature: ________________________ Date: ___________
DRUG AND/OR ALCOHOL TESTING CONSENT FORM
EMPLOYEE AGREEMENT AND CONSENT TO

DRUG AND/OR ALCOHOL TESTING
I hereby agree, upon a request made under the drug/alcohol testing policy of Netcor Transports LLC. (the Company),
to submit to random drug or alcohol tests and to furnish a sample of my urine, breath, and/or blood for analysis. I
understand and agree that if I at any time refuse to submit to a drug or alcohol test under company policy, or if I
otherwise fail to cooperate with the testing procedures, I will be subject to immediate termination. I further authorize
and give full permission to have the Company and/or its company physician send the specimen or specimens so
collected to a laboratory for a screening test for the presence of any prohibited substances under the policy, and for the
laboratory or other testing facility to release any and all documentation relating to such test to the Company and/or to
any governmental entity involved in a legal proceeding or investigation connected with the test. Finally, I authorize the
Company to disclose any documentation relating to such test to any governmental entity involved in a legal proceeding
or investigation connected with the test.
I will hold harmless the Company, its company physician, and any testing laboratory the Company might use, meaning
that I will not sue or hold responsible such parties for any alleged harm to me that might result from such testing,
including loss of employment or any other kind of adverse job action that might arise as a result of the drug or alcohol
test, even if a Company or laboratory representative makes an error in the administration or analysis of the test or the
reporting of the results. I will further hold harmless the Company, its company physician, and any testing laboratory the
Company might use for any alleged harm to me that might result from the release or use of information or
documentation relating to the drug or alcohol test, as long as the release or use of the information is within the scope of
this policy and the procedures as explained in the paragraph above.
This policy and authorization have been explained to me in a language I understand, and I have been told that if I have
any questions about the test or the policy, they will be answered.
I UNDERSTAND THAT THE COMPANY WILL REQUIRE A DRUG SCREEN TEST UNDER THIS POLICY
WHENEVER I AM INVOLVED IN AN ON-THE-JOB ACCIDENT OR INJURY UNDER CIRCUMSTANCES THAT
SUGGEST POSSIBLE INVOLVEMENT OR INFLUENCE OF DRUGS OR ALCOHOL IN THE ACCIDENT OR INJURY
EVENT. I ALSO AGREE TO SUBMITT MYSELF TO ANY RANDOM DRUG AND/OR ALCHOHOL TEST REQUIRED
BY THE COMPANY.
__________________________________ __________________
Signature of Employee Date
__________________________________
Employee's Name - Printed

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Netcor Transports Employment Application

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Copyright:

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Documentation Needed for Employment

Immigration Law compliance

Employee Background Check

Street Address Apartment/Unit #

City State ZIP

Phone E-mail Address

Date Available Social Security No. Desired Salary

Position Applied for Full Time (40hrs) Part Time (20hrs +)

If no, are you authorized to work in the

Have you ever been convicted of a felony? YES NO If yes, explain

From: To: Comments:

From To Did you graduate? YES NO Degree

From To Did you graduate? YES NO Degree

From To Did you graduate? YES NO Degree/Certification

Full Name Relationship

Full Name Relationship

Job Title Starting Salary $ Ending Salary $

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Job Title Starting Salary $ Ending Salary $

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Job Title Starting Salary $ Ending Salary $

From To Reason for Leaving

May we contact your previous supervisor for a reference? YES NO

Rank at Discharge Type of Discharge

If other than honorable, explain

DISCLAIMER AND SIGNATURE

Date:_____________ Driver’s Lic #____________________________ State Issued______

Signed this _________________ day of _________________________________, 20_____

Applicant (Print Name) _________________________________________________________________________

Applicant Signature __________________________________________________________________________

Fleet Card compliance is the responsibility of all Netcor Transports Employees.

Employee Name: ______________________ Date: ______________

Radio transmissions will be brief and to the point.

Radio Transmission Sequence: The calling sequence to establish communications is

Twenty-four Hour Time.

Employee Signature: ________________________ Date: ___________

EMPLOYEE AGREEMENT AND CONSENT TO

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Date:_ Driver’s Lic #__________ State Issued

Signed this _ day of _____________, 20_

Employee Name: ________ Date:

Employee Signature: ______________ Date: _