Armstead Logistics LLC — Complete Digital Driver Application

Applicant instructions: Complete all applicable sections. Required fields are marked *. The application includes employment and driving history, authorizations, and electronic signatures. Do not enter a Social Security number in this demonstration form; the company must collect sensitive identifiers through an approved secure process.

1. Applicant Information

Current address

Previous addresses (past three years)

Worked for this company before?YesNo

Reason for leaving (if applicable)

Highest education completed

Details of any Yes answers

2. Employment History

List all employment, self-employment and unemployment for the past three years, and commercial driving experience for the past ten years.

3. Driving Experience and Records

States operated in during past five years

Driving awards or recognition

Accidents in past three years

Traffic convictions / forfeitures in past three years (excluding parking)

Driver licenses held in past three years

4. Applicant Certification — Original Page 5

Drivers Application for Employment This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Applicant Signature Date To Be Read and Signed by Applicant: It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to obtain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and person named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file. It is agreed and understood that this Application in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse. Applicant Signature Date ©2018 Truck Safety Consulting Inc

Certification of application accuracy

Electronic signature — type full legal name *

Date *

To Be Read and Signed by Applicant

Electronic signature — type full legal name *

Date *

5. Standalone FMCSA PSP Disclosure & Authorization — Original Pages 6–7

Separate authorization: The following PSP disclosure and authorization is displayed on its own, without other consents. Review the full text before signing.

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 _ARMSTEAD LOGISTICS 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. AUTHORIZATION If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize _____ARMSTEAD LOGISTICS 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. 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. Last Updated 12/22/15

PSP authorization

Electronic signature — type full legal name *

Date *

Printed name *

6. FCRA Disclosure — Original Page 8

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT In accordance with the provisions of Section 604(b) (2) (A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment p u r p o s e s . These reports are required by sections 382.413, 391.23, and 391.125 of the Federal Motor Carrier Safety Regulations. ___________________________________ _______________________ Applicant Signature Date

FCRA disclosure

Electronic signature — type full legal name *

Date *

7. Drug and Alcohol History Release — Original Page 8

DRUG AND ALCOHOL HISTORY RELEASE I, (Print Name) _, IN COMPLIANCE WITH 49 CFR§§ 40.25 (g) AND 391.23 (N) Hereby authorize the release and forward of the information requested concerning my Alcohol and Controlled Substance Testing records to: Truck Safety Consulting Inc Safety and Compliance Agent for: ARMSTEAD LOGISTICS LLC 5650 W. Central Ave., Ste D6 Toledo, OH 43615 419-812-2300 419-219-9558 Confidential Fax safety@trucksafe.org Confidential Email Applicant Signature Date Print Name Social Security Number

Applicant printed name *

Drug and alcohol history release

Electronic signature — type full legal name *

Date *

Social Security number is not collected here until a secure employer-approved method is configured.

8. Driver License Certification — Original Page 9

Certification of Compliance with Driver License Requirements For Commercial Drivers Section A Driver/Applicants please read By State and Federal Motor Carrier Safety Regulations 49 CFR §383 and §391, all commercial drivers operating motor vehicles with a Gross Vehicle Weight Rating (GVWR) of 10,001 lbs. or greater, operating vehicles designed to transport 15 or more passengers, or transporting hazardous materials in a great enough quantity to require placarding (1) must possess the correct license type for the vehicles they operate including the proper endorsements (2) may possess only one driver’s license and (3) this license must be valid and not under suspension, revocation or cancellation. Section B Completed by Driver/Applicants By your signature, you are indicating that you are in compliance with the Federal Motor Carrier driver’s license requirements and understand the conviction reporting regulations stated in this Section. 1. Single license requirement: By State and Federal Motor Carrier Safety Regulations, 49 CFR §383.21(a), a commercial driver may possess no more than one valid driver’s license. A commercial driver may have no other driver’s licenses in any other state under his/her name and SSN that are still officially active other than the one in current possession. 2. Legal action/suspension/revocation of license It is the legal responsibility of commercial drivers to divulge information to their employer(s) or potential employer concerning any legal action against their Commercial Driver’s License, suspension, revocation or cancellation. The following license is in force and the only one I possess Driver’s license number State Expiration date 3. Conviction reporting requirements: I understand that, by State and Federal Motor Carrier Safety Regulations 49 CFR§ 383.31 & §391.15, I am required to: (a) Report to my employer by the next business day the suspension, revocation or cancellation of my driver’s license. (b) Report to my employer within 30 days, the conviction of any traffic offenses (other than parking tickets) in any state and in any type of vehicle, commercial or private. (c) Report traffic convictions I receive in any other state to the state which issued my license within 30 days of conviction. Drivers name (please print) Signature Date

Driver license number *

Issuing state *

Expiration *

Driver printed name *

Driver license compliance certification

Electronic signature — type full legal name *

Date *

9. Statement of On-Duty Hours — Original Page 10

DRIVER STATEMENT OF ON-DUTY HOURS (For Newly Hired Drivers) INSTRUCTIONS: Motor carriers, when using a driver for the first time, must obtain from the driver a signed statement giving the total time on-duty during the immediately preceding 7 days and the time at which the driver was last relieved from duty prior to beginning work for the carrier, as required by section 395.8(j) (2} of the Federal Motor Carrier Safety Regulations. NOTE: Hours for any work during the preceding 7 days, including any compensated work for a non-motor carrier, must be recorded on this form. This form should be completed on the day the driver is scheduled to begin driving a commercial motor vehicle, and must be kept on file for at least 6 months. Driver Name (Print) Employee ID No 1 2 3 4 5 6 7 DAY (yesterday) DATE TOTAL HOURS HOURS WORKED 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, and 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 r while still employed Yes No this company? 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

Driver printed name *

Employee ID (if assigned)

Seven individual days — immediately preceding first driving day

Day 1 date *

Day 1 on-duty hours *

Day 2 date *

Day 2 on-duty hours *

Day 3 date *

Day 3 on-duty hours *

Day 4 date *

Day 4 on-duty hours *

Day 5 date *

Day 5 on-duty hours *

Day 6 date *

Day 6 on-duty hours *

Day 7 date *

Day 7 on-duty hours *

Total on-duty hours

Last relieved from duty — date *

Last relieved from duty — time *

Driver statement of on-duty hours

Electronic signature — type full legal name *

Date *

Other compensated work

Are you currently working for another employer? *

Do you intend to work for another employer while employed here? *

Driver other compensated work certification

Electronic signature — type full legal name *

Date *

Company representative witness — complete by company

Electronic signature — type full legal name *

Date *

10. Drug and Alcohol Policy Receipt — Original Page 11

ARMSTEAD LOGISTICS LLC Drug and alcohol policy Termination Upon First Violation of policy RECEIPT OF ARMSTEAD LOGISTICS LLC DRUG AND ALCOHOL POLICY I have received a copy of the ARMSTEAD LOGISTICS LLC Drug and Alcohol policy and have read and understand the policy as written. I agree to the provisions of the testing requirements set forth in the ARMSTEAD LOGISTICS LLC Drug and Alcohol Policy. Employee Sign Date Witness Date

Employee drug and alcohol policy receipt

Electronic signature — type full legal name *

Date *

Company witness — complete by company

Electronic signature — type full legal name *

Date *

11. Safety Manual Receipt — Original Page 12

ARMSTEAD LOGISTICS LLC RECEIPT FOR SAFETY MANUAL I hereby certify that I have received the ARMSTEAD LOGISTICS LLC safety manual and that I have read and understand all the information contained therein. I further agree to abide by the provisions that are set forth in the manual. Driver Name: (Print) Driver Signature: Date:

Driver printed name *

Safety manual receipt

Electronic signature — type full legal name *

Date *

12. Review and Export Application

By signing electronically, I intend my signature to authenticate this application and the acknowledgments I have selected. The company may request additional separate authorizations.

I consent to electronic records and signatures for this application. *

This is a complete fillable offline application, not a connected Jotform submission. Save as PDF and transmit only through an employer-approved secure channel. Electronic typed signatures should be reviewed for suitability before use.