Pre-Employment Notification and Acknowledgement Form

I understand and acknowledge that I will be required to undergo a urine drug test under the authority of the U.S. Department of Transportation (DOT), Federal Motor Carrier Safety Administration (FMCSA) prior to being hired or transferred into a safety-sensitive position as defined in 49 CFR Part 40 and Part 382. I understand and acknowledge that I will not be assigned to perform a safety-sensitive function unless my urine drug test has a verified negative result. I also understand and acknowledge that my result, regardless of the outcome, will be entered into the EZDOT Repository. After successfully being entered into a safety sensitive position, I will be subject to randomized testing as required by the DOT.

Name *

First

Middle

Last

Signature *

Date *

Email *

CDL/CLP Number *

1) Have you ever occupied a safety sensitive position for any DOT regulated industry in the previous two years? *

Yes
No

(if you answer yes to this question, please download the provided form, fully complete it and then upload the mandatory paperwork to the area below.)

Mandatory Paper Download

Mandatory Paperwork File Upload *

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2a) Have you ever Tested Positive, or Refused to test, on any DOT drug or alcohol test? *

Yes
No

2b) If you answered YES, can you provide documentation that you successfully completed the DOT return-to-duty requirements described in 49 CFR Part 40? *

Yes
No
N/A

Documentation Alert!!

Upload Mandatory Paperwork *

Click or drag files to this area to upload. You can upload up to 10 files.