8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

Instructions for New Hire Packet – Applicant Directions
1. Page 2 – Checklist - Fill in or verify your name and social security number.
Supervisor to fill in the date of hire & Company assigned (EID) employee identification number.

2. Pages 3 – 7 – DOT Application - must all be completed including 10 years (if CDL holder); 3 years (if non-CDL holder) of previous work history, addresses, & phone numbers. ** If there is any time frame for unemployment or selfemployment please list. DOT is looking for a complete trail of information provided by the driver representing where they have been from date to date. Please complete this form and provide a signature/ date at bottom of page 7. Read “Driver Rights” provided by your company. 3. Page 8 - Previous Employer form – Only sign the top box on the first page where it states Applicant signature and date. Company / Supervisors will send out to the previous employers listed on driver’s application.

4. Page 9 – DISCLOSURE - sign and date bottom *Company is required to order and obtain a current MVR for driver prior to hiring or being moved into a driving position. Driver written authorization is required. 5. Page 10 top Record of Violations form – Fill in any moving traffic violations you have had within the past 12 months; provide a signature & date. If no violations check box. Page 10 bottom – Annual Review (SKIP) to be completed by supervisor with a current MVR. MVR=Motor Vehicle Report 6. Page 11 - Data Driver Sheet –fill in your name and SSN on top. On bottom half of form complete “Hours Of Service” section, provide the last 7 days, total hours worked both full time and part time jobs. It doesn’t matter if you were driving or not, while being employed. Must be completed with zeros and corresponding dates even if not working. Signature and date on bottom. Please follow other instructions on the form. 7. Page 12 - Pre-employment testing information (40.25(j)) by driver /applicant must be completed 8. Page 13 - Controlled Substance form – signature and date at bottom (if NONCDL holder, check the box in upper left corner). 9. Page 14 - Certificate of Compliance – Read and fill in information, signature, and date required. 10. Page 15 – GAP-IN-TIME Documentation – fill in name, social security number, and any information explaining gaps in time of employment. 11. Page 16 - Disability & Race Survey – check appropriate box, sign, and date. 12. Driver’s Road Test – Fill in name and SSN, Skip rest of page (Supervisor will complete either a road test will be preformed or waived, depending on CDL class.) 13. Provide/(attach) a clear & readable photocopy (both sides) of your current driver’s license (address needs to be current) and DOT medical carddepending on medical card issued -both sides may be required also. DOT medical card needs to show all required information. Thank you for your assistance in completing all this information.
Attention Supervisor: Prior to returning this packet to FLEET TEAM SERVICES please review the driver’s packet for accuracy of completion. Please refer to the color-coded packet or call FLEET TEAM SERVICES for clarification of any questions.

Page 1 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

CHECKLIST FOR NEW DRIVER
Legal Name of Driver:

DOT

over 10,001 lbs

NON-DOT
EID #

under 10,000 lbs

This employee is being classified as a (select type of driver -Put X)

*DATE

HIRED

Social Security Number:

Date started driving

Page #

Date Requested from driver

by driver and reviewed by management

Date Completed

Sent to Fleet Team Services

*Motor Vehicle Record

§391.23 Company MUST obtain the motor vehicle record(s) from the states in which the driver has held a license for the past 3 years. Driver authorization required. Send driver request to your MVR provider first to obtain results prior to employment.

Immediately
MVR results should be received prior to driver being hired.

*Application for Employment as a Driver
§391.21 **CDL= 10 years, Non CDL= 3 years previous employment history required

Pages 3-7 Prior to any driving allowed Page 8 Within 30 days of beginning employment

*Request for Information from Previous Employer (Send, or FAX copies to each previous employer)
§382.413 and §391.23 **CDL= 3 years (minimum), Non CDL= 3 years check. List previous employers below. Additional page may be added.

1. 2. 3.

*Copy of Driver’s current Medical Card—Medical
Examiners Certificate (From Doctor) §391.43(d). You must have copies of any letters granting waiver of physical disqualification.

Medical card/ physical Prior to

any driving allowed

*Photocopy of Driver License
(Both Sides) If you are waiving the road test you must have a legible copy of the driver’s license. §391.33

Copy of DL

Prior to any driving allowed
Prior to any driving allowed

*Record of Road Test
§391.31(g) See §391.33 for waiver.

*Annual Review / *Record of Violations
§391.25,391 27 Must complete a MVR and driver review prior to hiring the driver on this form. w/ sign off. Send in MVR results to Fleet Team Services with NH-5 form.

Page 10

Prior to any driving allowed include

MVR results

*Truck Driver Data Sheet and Employment Status Form-- §395.8(j)(2)
*CDL holder’s negative pre-employment drug screen (completed- paperwork in hand (382.301)) + Testing info from driver (40.25(j)). *Controlled Substance and Alcohol Policy and Training Verification §382.601Company DOT D&A Policy & training given to driver- need sign off.

Page 11

Prior to any driving allowed

Immediately
Results from MRO
&

Page 12

Page 13

Prior to any driving allowed

*Driver Notice/Certificate of Compliance Commercial Motor Vehicle Act of 1986 this is an optional form but recommended-DRIVER FORM Federal Motor Carrier Safety Regulation Pocketbook Receipt this is an optional form ( found in front page of FMCSR- pocketbook)
Other Documents:

Page 14

Prior to any driving allowed

Inside cover of FMCSR handbook

*DATE HIRED- The date the employee is hired "as a driver" or an employee returns or transfers to a driving position after a period of being inactive as a driver is considered the date of hire .

Page 2 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

APPLICATION FOR EMPLOYMENT AS A TRUCK DRIVER (§391.21)
Full Legal Name: ________________________________________SSN___________________ Address:_____________________________________________________________________
(Present address, include street, city, state & zip code) PLEASE PRINT CLEARLY

*How long at this address:_______

Phone #:

________________ Date of Birth :_______________
____________________Date Available: ______________
City
ST.

Who referred you? sw paper online employee other:______________ Cell Phone #:

*Previous address(es) for 3 years preceding the date of this application
Dates (list) Street Address Zip

List DRIVER’S LICENSE NUMBER & following information: Please include your years including permits.

REQUIRED INFORMATION

CURRENT,

valid license plus past 3

State

Driver’s License Number

Class and Endorsements

CDL Class Y/ N
(Put X)
YES YES
NO NO

Expiration Date

DRIVING EXPERIENCE & CDL DATE REQUIRED
Need date the CDL license was first obtained. The nature and extent of your experience in the operation of motor vehicles, including the type of equipment (such as buses, trucks, truck tractors, semitrailers, full trailers, and pole trailers) which you have operated. Due to SUBPART E- ENTRY-LEVEL DRIVER TRAINING REQUIREMENTS- Part 380 this information is required.

*MY CDL LICENSE was FIRST OBTAINED ON:
Type of Equipment Period of Time

MONTH

DAY/

YEAR

Nature and Extent

MOTOR VEHICLE ACCIDENTS
List all motor vehicle accidents in which you were involved during the 3 years preceding the date that the application is submitted. Please include the date, location, nature of accident, fatalities or personal injuries. (Use additional paper if necessary.) If NONE, please write NONE
1.
Date incident occurred: Location: Details:

2.

Date incident occurred:

Location:

Details:

Page 3 of 20

SAFETY-SENSITIVE FUNCTION §382.107 ***safety sensitive subject to 49 CFR Part 40 is required information on the application under past employment history - must be completed for each previous employer
The FMCSA originally determined that “safety-sensitive” functions (382.107) were functions performed as part of on-duty time. However, the FMCSA amended the rule to remove this complex link with on-duty time. Safety-sensitive function – means all time from the time a driver begins to work or is required to be in readiness to work until the time he/she is relieved from work and all responsibility for performing work.  All time at an employer or shipper plant, terminal, facility, or other property, or on any public property, waiting to be dispatched, unless the driver has been relieved from duty by the employer; this includes employees who are “eligible” at work to drive a CMV at anytime, e.g., salesperson, clerks, secretaries, supervisors.  All time inspecting equipment as required by 392.7 and 392.8 of this subchapter or otherwise inspecting, servicing, or conditioning any commercial motor vehicle at any time;  All time spent at the driving controls of a commercial motor vehicle in operation;  All time, other than driving time, in or upon any commercial motor vehicle except time spent resting in a sleeper berth (a berth conforming to the requirements of 393.76 of 393.76 this subchapter);  All time loading or unloading a vehicle, supervising, or assisting in the loading or unloading, attending a vehicle being loaded or unloaded, remaining in readiness to operate the vehicle, or in giving or receiving receipts for shipments loaded or unloaded; and  All time repairing, obtaining assistance, or remaining in attendance upon a disabled vehicle. NOT-Safety-Sensitive  All time spent providing a breath sample or urine specimen, including travel time to and from the collection site, in order to comply with the random, reasonable suspicion, post accident or follow-up testing required by part 382 when directed by an employer.  Performing any other work in the capacity of or in the employ or service of a common, contract or private employer.

Page 4 of 20

EDUCATION
Type of School Attended High School: School name and location Did you graduate
YES/ NO

Diploma/ Degree

Major Course of Study

circle highest grade completed

9 10 11 12 Technical or Vocational College or University Graduate School Professional Seminars, or Additional Training

 Have you worked for this company before?

Dates: From_______ To_______ Rate of pay ______ Position ____________

EMPLOYMENT EXPERIENCE
List names and addresses where you were employed during the last 10 years “This is a DOT requirement. (391.21(10&11) **You must include the complete address including street, city, state, zip code and phone number**
PRINT CLEARLY. 1. Past Employer
Address

ANSWER

EACH

SAFETY SENSITIVE QUESTION (YES OR NO ) UNDER EACH EMPLOYER RECORDED Work Performed Dates Employed From / TO
(mm/dd/yyyy)

from

To

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

2. Past Employer
Address

Dates Employed From / TO
(mm/dd/yyyy)

Work Performed

from Fax #:

To Hourly Rate/ Salary Starting | Final

Address

Phone #:

Phone #:

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

3. Past Employer

Dates Employed From / TO
(mm/dd/yyyy) To from

Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

4. Past Employer

Dates Employed From / TO
(mm/dd/yyyy) To from

Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

Page 5 of 20

EMPLOYMENT EXPERIENCE CONTINUED
List names and addresses where you were employed during the last 10 years. **You must include the complete address including street, city, state, zip code and phone number**
5. Past Employer Dates Employed From / TO
(mm/dd/yyyy) To from Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

6. Past Employer

Dates Employed From / TO
(mm/dd/yyyy) To from

Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

7. Past Employer

Dates Employed From / TO
(mm/dd/yyyy) To from

Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

8. Past Employer

Dates Employed From / TO
(mm/dd/yyyy) To from

Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

9. Past Employer

Dates Employed From / TO
(mm/dd/yyyy) To from

Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

10. Past Employer

Dates Employed From / TO
(mm/dd/yyyy) To from

Work Performed

Address

Phone #:

Fax #:

Hourly Rate/ Salary Starting | Final

Job Title:

Supervisor Name:

Reason for Leaving

I was subject to FMCSR rules while employed at this company: My job was designated as a safety sensitive subject to 49 CFR Part 40

YES YES

NO NO

Page 6 of 20

TRAFFIC VIOLATIONS- LAST 3 YEARS
List all motor vehicle laws or ordinances (other than violations involving only parking) of which you were convicted or forfeited bond or collateral during the 3 years preceding the date of this application. If NONE, please write NONE.
Date Violation Location- City and State
In CMV( check box)

Yes Yes Yes Yes

No No No No

REVOCATIONS AND SUSPENSIONS
Have you had a license, permit or privilege to operate a motor vehicle denied, revoked or suspended?

Yes

No
Explanation

If yes, give facts and circumstances in detail.
Date Violation

Date

Violation

Explanation

SPECIAL SKILLS AND QUALIFICATIONS
Summarize special job-related skills and qualifications acquired from employment and other experience.

Note: Previous employer(s) may be contacted and information provided may be used to investigate the applicant’s background. Per 391.23(i), (due process rights) the employee can request information received as part of the background investigations completed.
(i)(1)(i) The right to review information provided by previous employers; (i)(1)(ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; (i)(1)(iii) 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. (For a more detailed explanation of the driver’s rights please see FMCSR 391.23)

“This certifies that the application was completed by me, and that all entries on it and information contained in it are true and complete to the best of my knowledge. I understand that if I am employed, false statements may result in dismissal. I authorize Biffs, Inc. to make an investigation of any of the facts set forth in this application.” All offers of employment are conditional upon satisfactory reference checks. Successful completion of a physical exam and drug test is required for certain classifications. By signing this form I authorize Biffs, Inc. to obtain a Motor Vehicle Report pursuant to §391.23 requirements.

__________________________________________
Applicant’s Signature

__________________
Date

Page 7 of 20

8610 Hansen Ave. Shakopee, MN 55379
EMPLOYEE AUTHORIZATION AND COMPANY REQUEST FOR INFORMATION FROM PREVIOUS EMPLOYER
(§382.413, §383.35, §390.15, §391.23)
** REQUESTS FOR INFORMATION ARE TO ALL PREVIOUS EMPLOYERS IS MANDATORY PER FMCSR FOR THIS APPLICANT, RESPOND TO THIS REQUEST FOR INFORMATION WITHIN 30 DAYS. FAILURE TO COMPLY WITH REQUEST IS IN VIOLATION OF 49CFR391.23 AND 40.25, FOR WHICH YOU MAY BE PROSECUTED.

BIFFS, INC.

I hereby authorize you to provide Biff’s, Inc. with the following information regarding my Alcohol and Controlled Substances Testing results, services, character, and conduct while in your employ. You are released from any and all liability, which may result from furnishing such information. A photocopy of this authorization is to be considered as valid as the original.

________________________________________________________________ Applicant signature
To: From:

____________________________ Date

FAX #_________________________________________

Return FAX#____________________________________

Applicant Name: _

_______________ Social Security #:

The above referenced individual has made application to Biffs, Inc., as a company driver. To comply with §382.413, §390.15; §391.23, and §383.35 of the Federal Motor Carrier Safety Regulations, we must investigate the employment record, accidents and Alcohol and Controlled Substance Testing record of the applicant. Your reply will be held in strict confidence

*Did the applicant work for you as __________________? **YES  NO  (check one)

From ___/____/___ to ____/_____/____

if NO, please explain____________________________________ Other: ____________

*Did applicant drive a motor vehicle(s) for you? YES  NO  (Check one)  Passenger Van  Bus  Straight Truck  Tractor-Trailer *Was applicant involved in any accidents?
(Check one)

YES 

NO 

IF yes, please provide a

Short description of accident(s) w/ dates_____________________________________________. *Reason for leaving your employ: Discharged Laid Off Resigned Other_____________
(Check one)

*Would you rehire this employee at a later date?

YES 

NO 

====================================================================================
INQUIRY FOR ALCOHOL AND CONTROLLED SUBSTANCES INFORMATION DURING THE PAST 3 YEARS-(by past employer)
Information about the above named applicant

YES

NO

IF YES, PLEASE PROVIDE DATE:

*Alcohol test with a result of 0.04 or greater?

   

   
.

*Verified positive controlled substances test results?
*Refusals to be tested? *Was rehabilitation completed as required?

 Our company did not complete Drug and Alcohol testing per FMCSA DOT – Part 40 and 382 requirements; during the past 3 years, on this former employee

If you answered yes to any of the above questions, please provide the name, address and telephone number of the Substance Abuse Professional on the back of this form. Also, please use the back of the form for any additional information you would like to provide.

Signature: ____________________________ Position: ____________________ Date: ____________
To be completed by the present employer after completion by previous employer

Biffs, Inc. representative (name/date) that closed this background check is _____________________________________ on_________

Biffs, Inc. received and closed this background check – form needs to include signature and date from previous employer completed above. After good faith efforts by Biffs, Inc. This form was not received from the previous employer. (include documentation showing attempts) Page 8 of 20

Disclosure and Authorization Release to Obtain Information
Our service provider, iiX an ISO Business, which Biffs Inc. uses to obtain your Driver Record requires a separate authorization form from that needed by the Federal DOT. The following two pages is their required form.

Disclosure
As a part of our hiring background and investigation, we may obtain consumer reports to prepare an investigative consumer report. The investigative consumer report may consist of contacting all listed prior employers to verify your employment history. It may also include, but not be limited to, credit information reports, criminal history reports and driving history records. Under the provisions of the Fair Credit Reporting Act (15 USC at 1681-1681u) as amended, before we can seek such reports, we must have your written permission to obtain the information. You have the right, upon written request, to a complete and accurate disclosure of the nature and scope of the investigation. You are also entitled to a copy of your Rights Under the Fair Credit Reporting Act.

Authorization and Release to Obtain Information
Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state and local laws, I hereby authorize and permit Biffs, Inc. to obtain a consumer report and/or an investigative consumer report which may include the following: 1. 2. 3. 4. My employment records; Records concerning any driving, criminal history, credit history, civil records, workers’ compensation (post-offer only) and drug testing; (For truck drivers only) In accordance with the Department of Transportation Motor Carrier Safety Regulations, Section 382.413, information concerning alcohol and controlled substances for the past 2 years; Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service records.

I understand that an “investigative consumer report” may include information as to my character, general reputation, personal characteristics, and mode of living which may be obtained by interviews with individuals with whom I am acquainted or who may have knowledge concerning any such items of information. I agree that a copy of this authorization has the same effect as an original. I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, as well as Biffs, Inc. from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information. I understand and acknowledge that under provision of the Fair Credit Reporting Act I may request a copy of any consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification. I hereby authorize Biffs, Inc. to obtain and prepare an investigative consumer report as set forth above, as part of its investigation of my employment application. This authorization shall remain in effect over the course of my employment. Reports may be ordered periodically during the course of my employment. Driving Records will be obtained at least once every twelve months per DOT regulation.

Full Name ____________________________ (please print clearly)

Signature ________________________________

Date _________________

Page 9 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

RECORD OF VIOLATION (§391.27) & REVIEW OF MOTOR VEHICLE RECORD (§391.25)
Each motor carrier shall require each driver it employs to prepare and furnish it with a list of all violations of motor vehicle traffic laws and ordinances (other than violations involving only parking) of which the driver has been convicted or on account of which he/she has forfeited bond or collateral during the preceding 3 years (at the time of employment) and then at least once every 12 months thereafter. By signing this form I authorize Biff’s Inc. to obtain a Motor Vehicle Report pursuant to §391.25 requirements.

COMPLETED BY DRIVER - CERTIFICATION OF VIOLATIONS
Legal Name of driver (please print) Employee ID Number & SSN

DOT/ NON-DOT

“PUT X”

Birth Date

Driver’s License Number

License Expiration Date

Hire Date

State

 Check box if you have no violations in the past twelve months
Date Offense Location

Type of Vehicle

I certify, by not listing any violations above, that I have not been convicted, forfeited bond, or collateral on account of any violation.

Driver’s Signature: ______________________________________ Date: _____________________

COMPLETED BY COMPANY – ANNUAL & INITIAL REVIEW OF MVR RECORD
Biffs, Inc., shall, review the motor vehicle record of each driver employed to determine if that driver meets minimum requirements for safe driving. In reviewing a driving record, Biff’s Inc. must consider any evidence that the driver has violated applicable provisions of the FMCSR. Biffs, Inc. must also consider the driver’s accident record and any evidence that the driver has violated laws governing the operation of motor vehicles, and must give great weight to violations, such as speeding, reckless driving, and operation while under the influence of alcohol or drugs, that indicate that the driver has exhibited a disregard for the safety of the public. The review shall determine if the driver is disqualified to drive a motor vehicle pursuant to §391.15 or §383.51 of the FMCSR. This review should occur at the time of employment (for the last 3 years of driving history) and at least once every twelve months thereafter . (Please include a copy of the MVR results with this review process.)

On _______________________, 20_____, I reviewed the driving record of the above name driver in accordance with Section §391.25 of the FMCSR and find that he/she (Check One):

 
Reviewed by: Printed name Signature

Meets minimum requirements for safe Driving Is disqualified to drive a motor vehicle pursuant to Section §391.15 or §383.51 of the FMCSR.
Date

Title

Page 10 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

TRUCK DRIVER DATA & EMPLOYMENT STATUS- DRIVER DATA SHEET
Driver’s Legal Name:
Effective Date of Change: Location:

License Number

License Type

Issuing State:

SSN

Home Address City:
Person Completing Form:- Management State Zip Code:

Phone:

Fax:

Please check reason for preparation of this form and include location above:
* Upon return new forms may be needed; to bring driver back into compliance.

This section COMPLETED BY COMPANY:

 New HirePermanent Driver: Pre-employment drug-screening is necessary. Must be added to DOT random testing pool within 30 days of drug screen, if he/she will drive a
CMV subject to D&A requirements. Fill in hours of service below++. subject to D&A requirements. Fill in hours of service below++.

 Re-Employed Driver*: Pre-employment drug screening is necessary. Must be added to DOT random testing pool within 30 days of drug screen if he/she will drive a CMV  Transfer TO Driver Status*: Transferred from other duties. Pre-employment drug screening is necessary. ** Must be added to DOT random testing pool within 30 days of drug screen if he/she will drive a CMV subject to D&A requirements. Fill in hours of service below ++New Location Transferred to: _______________________

 Transfer FROM Driver* Not presently driving; performing other duties with no hours of service restrictions; employee remains in random pool unless otherwise requested.  Termination of Driver:  Permanent  Layoff*  Suspension* until _____________________  Medical Leave*: Driver on long term medical leave until ______________. Driver will be removed from random pool. Upon return new forms may be needed; to bring driver back into compliance.



Military Leave*: Driver on active military duty until ________________. Driver will be removed from random pool. Upon return new forms may be needed; to bring driver back into compliance.

 Other* (please explain)

HOURS OF SERVICE reason please note reason under employer’s name.++

(§395.8(j) (2))

⋆ Complete all sections below if the above named employee starts driving and/or returns to driver status for our company. ⋆⋆ All hours worked, (Includes all paid employment/compensation time) and dates in any employment status during the past 7 consecutive days must be recorded. ++Please record below the information for the 7 days prior to becoming (or beginning driving) for this employer. If your employment hours were zero for some

**Total hours worked last seven days (7 consecutive) - prior to driving for company initially or returning to driver status. Fill in Full and Part time may equal more than 40 hours. DAY 1 2 3 4 5 6 7 TOTAL Hours DATE XXXXXXXXXXX (00/00/00000) XXXXXXXXXXX HRS WORKED Employer’s name:
List employers name above for the hours listed for the last 7 days. If no employer name applies: write in reason (example) unemployed.

Address: City, State, Zip

I hereby certify the information provided above is correct to the best of my knowledge and belief . Driver Signature: _____________________________________ Supervisor/Witness: ____________________________________ date: _____________________ date ______________________

Page 11 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

RELEASE & DOCUMENTATION OF PRE-EMPLOYMENT TESTING INFORMATION BY DRIVER / APPLICANT - Part 40.25(j).
(This form is used to fulfill the requirement of Part 40.25(j)). An employer must ask the driver whether he/she has tested positive, or refused to test on any preemployment drug or alcohol test administered by an employer to which the driver applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past 2 years.

Date:

___________________

To be completed by driver / applicant.
During the past (2) two years, have you tested positive on a 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 the Department of Transportation (DOT) drug and alcohol testing rules?

Yes

No

During the past (2) two years, have you refused to test on a 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 the Department of Transportation (DOT) drug and alcohol testing rules?

Yes

No

If you answered yes to either of the questions above, please provide documentation of your successful completion of the return-to-duty process.

______________________________________________________________________ ______________________________________________________________________ Print Legal Name of driver: ___________________________________________ Signature of driver:______________________________________________ Social Security Number:__________________________________________ Witness/Management signature:___________________________________________ Witness/Management printed name:________________________________________

Page 12 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

PART §382CONTROLLED SUBSTANCES AND ALCOHOL USE TESTING & WRITTEN POLICY RECEIPT

 CHECK BOX IF DRIVER DOES NOT OPERATE A COMMERCIAL MOTOR VEHICLE AS DEFINED BY
§382.107 Commercial motor vehicle means a motor vehicle or combination of motor vehicles used in commerce to transport passengers or property if the motor vehicle (2) Has a gross vehicle weight rating of 11,794 or more kilograms (26,001 or more pounds); or (3) Is designed to transport 16 or more passengers, including the driver; or

PART §382

(1) Has a gross combination weight rating of 11,794 or more kilograms (26,001 or more pounds) inclusive of a towed unit with a gross vehicle weight rating of more than 4,536 kilograms (10,000 pounds); or

(4) Is of any size and is used in the transportation of materials found to be hazardous for the purposes of the Hazardous Materials Transportation Act and which require the motor vehicle to be placarded under the Hazardous Materials Regulations (49 CFR part 172, subpart F).

I completed the Controlled Substances and Alcohol Use and Testing-training program provided by my employer, Biffs, Inc., in accordance with the provisions outlined in CFR 49, Part 40 and Part §382. I reviewed the Controlled Substances and Alcohol Use Policy of Biffs, Inc. As required by §382.601(b) (1-11) the following items were discussed:      Abbreviations and definitions Who is covered by the Alcohol and Drug rules found in Part §382? What is a safety sensitive function? What are the Alcohol and Drug prohibitions? Which tests are required and when will I be tested? 1. Pre-employment 2. Post-accident 3. Random 4. Reasonable suspicion 5. Return-to-duty and follow-up      What happens if I refuse to be tested? How is Alcohol and Drug testing done? What are the consequences of violating the Alcohol or Drug prohibitions--test positive? Where can I go for help? Who can answer my questions about Alcohol and Drugs? What are the effects of Alcohol and Drugs use on health, work and personal life?
CHECK BOX



DRIVER RECEIVED A COPY OF THE COMPANY’S, Biffs, Inc., WRITTEN DRUG POLICY Part §382.601(d)

___________________________________________________________________________________________________________
Driver’s Legal Signature

_______________________________________________ _
Driver Printed Name

_________________________________________________
Date –acknowledgement & completing D&A training and receipt of company policy

Page 13 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

CERTIFICATE OF LICENSE COMPLIANCE AND DRIVER NOTICE
Instructions: All drivers must read the notice and complete the certificate of compliance at time of hire. The completed certification is a permanent item of driver qualification file.

NOTICE TO DRIVERS
1. No driver may possess more than one license, and no motor carrier may use a driver having more than one license. 2. A driver convicted of a traffic violation (other than parking) must notify the motor carrier AND the state that issued the license to that driver of such conviction within 30 days. 3. If your driver’s license is suspended, revoked, or canceled, you must notify your supervisor no later than the end of the next working day following notification of driver’s license suspension, revocation, or cancellation. Failure to do this may result in termination. You must never drive a company vehicle without a valid driver’s license, if you do so, you may be terminated. 4. Any person applying for a job as a commercial vehicle driver must inform the prospective employer of all previous employment as a driver of any and all commercial motor vehicle (over 10,000 lbs) for the past 10 years, in addition to any other required information about the applicant’s employment history. 5. You are responsible for renewing your driver’s license so that you never drive a company vehicle with an expired driver’s license. You must notify your supervisor immediately if your license expires and is not renewed.

CERTIFICATION BY DRIVER
I hereby certify that I have read and understand the above driver provisions and agree to comply with all aspects of this notice per our company policy.

By signing this form, I further certify that the vehicle license listed below is the only one (license) I currently hold. driver’s legal name: (print) social security number or EID

driver’s address Present address, Include street, city, state & zip code PLEASE PRINT CLEARLY

license state:

license type/ class

license number:

driver’s signature:

date:

Any additional licenses held, have been surrendered to the states listed below. surrendered license to: state type/class license number

surrendered license to: state

type/class

license number

Page 14 of 20

8610 Hansen Ave. Shakopee, MN 55379

BIFFS, INC.

DOCUMENTATION FOR GAP-IN-TIME FOR PREVIOUS EMPLOYMENT CHECK VERIFICATION
Applicant Name:_________________________ Social Security #:

_______________________

The above referenced individual has made application to Biffs, Inc. as a truck driver. To comply with §382.413, , §390.15; §391.23, and §383.35 of the Federal Motor Carrier Safety Regulations, we must investigate the employment record, accidents and Alcohol and Controlled Substance Testing record of the applicant.

Due to the information provided by this driver on their application and/or the time period from a completed previous employer check did not reflect the information as provided on the application, the employment history shows a “GAP IN TIME”.

Please have the driver fill out this form to address the time period in question. ***************************************************************************************

GAP IN TIME VERIFICATION
TO BE COMPLETED BY DRIVER ONLY
(ONLY 1 SET OF DATES PER FORM)

DATES NEED VERIFIED:
FROM TO

REASON FOR GAP-IN-TIME IS DUE TO THE FOLLOWING INFORMATION: ________________________________________________________ ________________________________________________________ ________________________________________________________
DATE FORM COMPLETED :_________________________________ DRIVER NAME(printed) : _______________________________ DRIVER SIGNATURE:__________________________________

*************************************************************************************
*Management has reviewed the above information - this driver has provided for Good Faith Effort requirements.

SUPERVISOR SIGNATURE : ______ __________________________ SUPERVISOR -DATE COMPLETED : _____________________________ Page 15 of 20

Biffs, Inc. Disability & Race Survey Our company has a contractual relationship with the City of Minneapolis. In accordance with all applicable EEO and AA Laws, we report to them the progress we make regarding employment of women, people of color and people with disabilities. The information you provide will be held confidential by the EEO Officer. Race: ____ ____ ____ ____ ____ ____ ____ Asian Hispanic or Latino Black / African American Pacific Islander or Hawaii Native American Indian or Alaskan Native White Other

The law defines disability as “a physical or mental impairment that substantially limits a major life activity”. This means major life activities such as walking, seeing, hearing, speaking, breathing, learning and working. Listed below are definitions of common types of disabilities. Please read the list and check any that apply or that closely relate to your situation. If you believe you have a disability that is not found in the list below, describe it in the section “Other”. If you do not have a disability, please check “None”. _____ None _____ Hearing Impairment. Difficulty in hearing to the extent that it precludes the understanding of speech through the ear alone, with or without the use of a hearing aid. _____ Learning Disability. Difficulty in processing information due to a neurological disorder of the brain that would result in an impaired ability to do any of the following: read, spell, mathematics, concentrate, comprehend, listen or remember. _____ Mental Illness. Difficulty coping, dealing with stress or depression due to a disability that might also impair daily living skills and/or interpersonal relationships and communication. _____ Breathing Impairment. Difficulty in breathing, which can substantially limit all major life activities. This would cover such conditions such as asthma and emphysema, etc. _____ Mental Retardation. Difficulty in learning and reasoning due to below average intelligence; which might also limit the ability to function independently in all areas. _____ Mobility Impairment. Difficulty walking, running or balancing due to a physical disability; and where use of a wheelchair, cane, crutches, prosthesis or other assistive devices may also be required. _____ Visual Impairment. Includes blindness, any person with less than 20/200 in the better eye, with corrective lenses. Includes vision field loss, where field of vision is restricted to a diameter of 20 degrees or less. Also includes low vision, a condition which causes a substantial amount of sight loss due to disease, accident or other physical condition. _____ Other: ___________________________________________________________ Signed:_____________________________________ Date: ______________________ Page 16 of 20

BIFFS, INC.
8610 Hansen Ave. Shakopee, MN 55379

 SEND IN THESE REQUIRED FORMS WITH
NEW HIRE PACKET
CHECK BOX (Pre-employment results) Reminder to attach a copy of the Negative Results for the Preemployment Drug Test CHECK BOX (MVR-motor vehicle report) Reminder to attach a copy of the MVR (motor vehicle report) for initial driving review with the NH-5 form and then yearly thereafter. CHECK BOX (Driver’s License-both sides) Reminder to attach a legible copy of your Current Driver’s License (both sides) CHECK BOX (DOT Medical Card) Reminder to attach a legible copy of your Current FMCSR D.O.T. Medical Card showing the date of the exam and the expiration date for the physical. CHECK BOX (FMCSR receipt) Reminder to attach a copy of FMCSR Handbook Receipt (If your company provides FMCSR Handbook to drivers)
Thank you for your assistance. Please review your packet at this time to make sure you have signed and dated all necessary paperwork. If the paperwork is not completed correctly it will be returned for additional information.

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BIFFS, INC. DISINFECTING UNIT SERVICE PROCEDURES

updated 1/27/2012

The following procedures will be done each time a portable restroom is serviced. 1. 2. 3. 4. 5. 6. 7. 8. 9. Confirm Address on paperwork for accuracy and write down any corrections. Confirm that the unit is in the proper place and is level with the ground. Check outside logos on all four sides are to be clear and easy to read. Prop open door with 5 gallon bucket full of water. Sign and date “service log sticker” in each of the units. If there is no sticker, one must be added. This is a record of service to the customer. Remove toilet paper from holder. Replace (if empty) the hand sanitizer bladder pack only if it is listed on your paperwork. If it is not, remove bladder pack. Check that the hand sanitizer operates properly. Complete repairs or replace what is needed. Check overall unit, screens, urinal and hose, seat, door handle, lock, etc. If you cannot complete repairs call dispatcher while on location.

Wear Gloves and Goggles for the next Steps. 10. Pump all waste from the tank. If frozen, add deodorizer w/ methanol, and chop. 11. Turn off vacuum pump and roll up hose. 12. Remove all rocks, all ice, and other loose debris from the tank and unit. 13. Power-wash with water if there is tough debris on the unit. 14. De-scale urinal with appropriate cleaner; brush later if needed before disinfecting. 15. Remove all graffiti with the appropriate remover. 16. Disinfect for no more than a total of 15 seconds: A) Inside of the tank. B) Apply from bottom and work up getting all inside surfaces wet, including inside of door. C) Apply to the outside front of the unit. 17. Add deodorizer tablet to water in 5 gallon bucket and pour into tank. 18. Remove nozzle using the quick disconnect, place in bucket. 19. Towel-dry toilet seat, inside roof, and door if it is needed for immediate use. 20. Replace and replenish toilet paper in the paper holder: A) Construction= If less than half a roll, replace with a full roll. Take used roll with you. B) Special Events= Always two new rolls. Take used roll with you. 21. Floors are to be clear of all debris, mud, ice, etc. and liquid removed with a squeegee. 22. Spray with fragrance. 23. Dispose of all debris that you have removed from the unit. No debris is to be left at the site. 24. Communicate on paperwork usage level and entries into GPS keypad when ready to leave. 25. Write on paperwork: Tip-over, Repair, Exchange, Missed Service, Address Change, etc.

If you need to perform the ‘No Pump Procedure’:
Partially blocked unit perform ALL traditional service steps 1 – 24 (except step 6) ‘No Pump Procedure’. Completely blocked, locked, inaccessible site, complete steps 24 – 27 only. 26. Call Dispatch as soon as you realize you may have trouble accessing a site. Dispatch will call the company, to get help or simply notify them of our attempt to complete service if a message must be left. 27. Find job superintendent, or someone on location to attempt to move vehicles to unblock unit. 28. Report confirmed missed unit to dispatch, it must be approved by manager prior to leaving the site.
W\Field Service Main\SOP’s\ServiceProceduresDisinfecting9_10.doc

Page 18 of 20

BIFFS WINTER DISINFECTING UNIT SERVICE PROCEDURES (for 32 degrees or below)
The following procedures will be done each time a portable restroom is serviced. 29. Confirm Address on paperwork for accuracy and write down any corrections. 30. Confirm that the unit is in the proper place and is level with the ground. 31. Check outside logos on all four sides are to be clear and easy to read. 32. Prop open door with 5 gallon bucket full of service solution. 33. Sign and date “service log sticker” in each of the units. If there is no sticker, one must be added. This is a record of service to the customer. 34. Replace (if empty) the hand sanitizer bladder pack only if it is listed on your paperwork. If it is not, remove bladder pack. 35. Check that the hand sanitizer operates properly. 36. Complete repairs or replace what is needed. Check overall unit, screens, urinal and hose, seat, door handle, lock, etc. If you cannot complete repairs call dispatcher while on location. Wear Gloves and Goggles. 37. Pump all waste from the tank. 38. Remove all rocks, all ice, and other loose debris from the tank and unit. 39. De-scale urinal with appropriate cleaner; brush later if needed before disinfecting. 40. Remove all graffiti with the appropriate remover. 41. Pressurize the PumpUp Foaming Sprayer. 42. Remove brush from container holding disinfectant, spray and brush areas that need it. 43. Spray the following areas: D) Inside of the tank. E) Toilet seat surfaces. F) Urinal and wall below it. G) Handle areas inside and outside of unit. 44. Add winter service solution in 5 gallon bucket to the restroom tank. 45. Replace and replenish toilet paper in the paper holder: C) Construction= If less than half a roll, replace with a full roll. Take used roll with you. D) Special Events= Always two new rolls. Take used roll with you. 46. Hand Sanitizer, check that it is loaded and fully operational. 47. Floors are to be clear of all debris, mud, ice, etc. and liquid removed with a squeegee. 48. Dispose of all debris that you have removed from the unit. Leave no debris at the site. 49. Communicate on paperwork usage level and entries into GPS keypad when ready to leave. 50. Write on paperwork: Tip-over, Repair, Exchange, Missed Service, Address Change, etc. If you need to perform the ‘No Pump Procedure’: Partially blocked unit perform ALL WINTER service steps 1 – 22 (except step 9) ‘No Pump Procedure’. Completely blocked, locked, inaccessible site, complete steps 23 – 25 only. 51. Call Dispatch as soon as you realize you may have trouble accessing a site. Dispatch will call the company, to get help or simply notify them of our attempt to complete service if a message must be left. 52. Find job superintendent, or someone on location to attempt to move vehicles to unblock unit. 53. Report confirmed missed unit to dispatch, it must be approved by manager prior to leaving the site.
W/Field Service Main/ SOP’s/ServiceProceduresWINTERDisinfecting4_11.doc updated 4/2011

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W\Field Service Main\SOP’s\ServiceProceduresCurrent\ServiceProceduresTraditional9_10.doc

BIFFS, INC. TRADITIONAL UNIT SERVICE PROCEDURES

updated 9/2010

The following procedures will be done each time a portable restroom is serviced. 54. Confirm Address on paperwork for accuracy and write down any corrections. 55. Sign and date “service log sticker” in each of the units. If there is no sticker, one must be added. This is a record of service to the customer. 56. Replace and replenish toilet paper in the paper holder: E) Construction= If less than half a roll, replace with a full roll. Take used roll with you. F) Special Events= Always two new rolls. Take used roll with you. 57. Replace (if empty) the hand sanitizer bladder pack only if it is listed on your paperwork. If it is not, remove bladder pack. Check that it operates properly. Wear Gloves and Goggles for the next Steps. 58. De-scale urinal with appropriate cleaner, let set, scrub later (step 7). 59. Pump all waste from the tank. If frozen, add deodorizer w/ methanol, and chop. 60. Remove all rocks, all ice and other loose debris from the tank and the unit. 61. Clean and scrub all surfaces, including urinal, with appropriate brush, squeegee and deodorizer solution. Don’t forget to clean inside of front door frame and hand sanitizer dispenser. 62. Add fresh deodorizer solution to the tanks. (5 gallon bucket weighs approximately 35 pounds) H) Light-medium used units = 5-6 gallons I) Heavy used units = 7-10 gallons J) Special Events = 7-10 gallons K) Partially blocked unit = up to 5 gallons to re-fresh 63. Towel-dry all surfaces, including ledges above the screens and doors. Don’t use towels on floors. 64. Floors are to be clear of all debris, mud, ice, etc. and liquid removed with a squeegee. 65. Spray with fragrance. 66. Remove all graffiti with the appropriate remover. 67. Complete repairs or replace what is needed. Check overall unit, screens, urinal and hose, seat, door handle, lock, etc. If you cannot complete repairs call dispatcher while on location. 68. Confirm that the unit is in the proper place and is level with the ground. 69. Check outside logos on all four sides are to be clear and easy to read. 70. Dispose of all debris that you have removed from the unit in your waste bucket. No debris is to be left at the site. 71. Communicate on paperwork and entries into GPS keypad when ready to leave. If service is successfully completed check usage level box to indicate usage. 72. Write on paperwork: Tip-over, Repair, Exchange, Missed Service, Address Change, etc.

If you need to perform the ‘No Pump Procedure’:
Partially blocked unit perform ALL service steps 1 – 22 (except step 6) ‘No Pump Procedure’. Completely blocked, locked, inaccessible site, complete steps 19 – 22 only. 73. Call Dispatch as soon as you realize you may have trouble accessing a site. Dispatch will call the company, to get help or simply notify them of our attempt to complete service if a message must be left. 74. Find job superintendent, or someone on location to attempt to move vehicles to unblock unit. 75. Report confirmed missed unit to dispatch, it must be approved by manager prior to leaving the site.

Page 20 of 20