CDL DRIVER NEW EMPLOYEE PACK

Transcription

1 CDL DRIVER NEW EMPLOYEE PACK For questions or additional assistance with completing your paperwork, please reach out to: Alice Paul, HR Assistant x a p a u a i m n t l s. c o m DIGITAL DOCS COMPLETE PAPERWORK ONLINE, SAVE TIME & INSTANTLY SUBMIT! You can request a link to the forms from your recruiter anytime. UPLOAD YOUR IDs You can submit your identification for your IRS tax forms digitally too! No need to bring those sensitive documents to work with you! You can send us copies of your driver s license, medical card, social security card, birth certificate and/or passport. The secured upload portal can be used with your computer, tablet or smart phone. p o r t a l. t e n s t r e e t. c o m / a i m n a t i o n a l

2 A I M N E W E M P L O Y E E P A C K C D L D R I V E R Notes/Questions sheet Government Forms Federal I-9 form Federal W-4 form State Tax form (if applicable) Health & Benefits Forms Anthem Medical, Dental & Vision Enrollment Spouse Eligibility Form Bravo Wellness Questionnaire Dearborn Life Insurance Enrollment 401(K) Beneficiary Designation Form Affordable Health Care notice AIM New Employee Forms Driver Payroll Acknowledgement Driver Payroll Backup Instructions Direct Deposit Authorization Form ADP Pay Stub Viewing Instructions Voluntary Self Identification Form Company Communication & Emergency Contact Form AIM Photo & Video Release Form AIM Substance Form and Drug Free Workplace Policy DDTA HIPAA Release Cell Phone and Handheld Devices Policy Cell Phone Allowance Acknowledgement State Self-Certification Form (if applicable) Certificate of Violations for Annual Reviews Certificate of Driver s License Compliance Driver Statement of On-Duty Hours Driver Receipt for Federal Motor Carrier Handbook CSA Handbook and Quiz Accident & Injury Reporting Procedures Pre-Trip Inspection Requirements Form Three Points Contact Acknowledgment Form Driver Logs Orientation & Overview Driver Logs Quiz PeopleNet Video Acknowledgement Company & Driver Policy Handbook Driver Rewards Program Additional Forms (if applicable) Flatbed Securement Quiz, Handouts and Acknowledgement Forms Pallet Jack Training Quiz, Handouts and Acknowledgement Forms Spill Kit Training Quiz, Handouts and Acknowledgement Forms A I M T R A N S P O R T A T I O N S O L U T I O N S A I M L e a s i n g C o m p a n y A I M I n t e g r a t e d L o g i s t i c s A I M S e r v i c e s C o m p a n y

3 A I M N E W E M P L O Y E E P A C K C D L D R I V E R NOTES QUESTIONS FOLLOW-UP ITEMS A I M T R A N S P O R T A T I O N S O L U T I O N S A I M L e a s i n g C o m p a n y A I M I n t e g r a t e d L o g i s t i c s A I M S e r v i c e s C o m p a n y

4 Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No Expires 08/31/2019 START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination. Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.) Last Name (Family Name) First Name (Given Name) Middle Initial Other Last Names Used (if any) Address (Street Number and Name) Apt. Number City or Town State ZIP Code Date of Birth (mm/dd/yyyy) U.S. Social Security Number Employee's Address Employee's Telephone Number - - I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following boxes): 1. A citizen of the United States 2. A noncitizen national of the United States (See instructions) 3. A lawful permanent resident (Alien Registration Number/USCIS Number): 4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy): Some aliens may write "N/A" in the expiration date field. (See instructions) Aliens authorized to work must provide only one of the following document numbers to complete Form I-9: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number. QR Code - Section 1 Do Not Write In This Space 1. Alien Registration Number/USCIS Number: OR 2. Form I-94 Admission Number: OR 3. Foreign Passport Number: Country of Issuance: Signature of Employee Today's Date (mm/dd/yyyy) Preparer and/or Translator Certification (check one): I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1. (Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct. Signature of Preparer or Translator Today's Date (mm/dd/yyyy) Last Name (Family Name) First Name (Given Name) Address (Street Number and Name) City or Town State ZIP Code Employer Completes Next Page Form I-9 11/14/2016 N Page 1 of 3

5 Employment Eligibility Verification Department of Homeland Security U.S. Citizenship and Immigration Services USCIS Form I-9 OMB No Expires 08/31/2019 Section 2. Employer or Authorized Representative Review and Verification (Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.") Employee Info from Section 1 Last Name (Family Name) First Name (Given Name) M.I. Citizenship/Immigration Status List A OR List B AND List C Identity and Employment Authorization Identity Employment Authorization Document Title Document Title Document Title Issuing Authority Issuing Authority Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) Document Number Expiration Date (if any)(mm/dd/yyyy) Document Number Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Document Number Additional Information QR Code - Sections 2 & 3 Do Not Write In This Space Expiration Date (if any)(mm/dd/yyyy) Document Title Issuing Authority Document Number Expiration Date (if any)(mm/dd/yyyy) Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States. The employee's first day of employment (mm/dd/yyyy): (See instructions for exemptions) Signature of Employer or Authorized Representative Today's Date(mm/dd/yyyy) Title of Employer or Authorized Representative Last Name of Employer or Authorized Representative First Name of Employer or Authorized Representative Employer's Business or Organization Name Employer's Business or Organization Address (Street Number and Name) City or Town State ZIP Code Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.) A. New Name (if applicable) B. Date of Rehire (if applicable) Last Name (Family Name) First Name (Given Name) Middle Initial Date (mm/dd/yyyy) C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below. Document Title Document Number Expiration Date (if any) (mm/dd/yyyy) I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual. Signature of Employer or Authorized Representative Today's Date (mm/dd/yyyy) Name of Employer or Authorized Representative Form I-9 11/14/2016 N Page 2 of 3

6 LISTS OF ACCEPTABLE DOCUMENTS All documents must be UNEXPIRED Employees may present one selection from List A or a combination of one selection from List B and one selection from List C. LIST A Documents that Establish Both Identity and Employment Authorization LIST B LIST C Documents that Establish Employment Authorization OR Documents that Establish Identity AND 1. U.S. Passport or U.S. Passport Card 2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551) 3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machinereadable immigrant visa 4. Employment Authorization Document that contains a photograph (Form I-766) 5. For a nonimmigrant alien authorized to work for a specific employer because of his or her status: a. Foreign passport; and b. Form I-94 or Form I-94A that has the following: (1) The same name as the passport; and (2) An endorsement of the alien's nonimmigrant status as long as that period of endorsement has not yet expired and the proposed employment is not in conflict with any restrictions or limitations identified on the form. 6. Passport from the Federated States of Micronesia (FSM) or the Republic of the Marshall Islands (RMI) with Form I-94 or Form I-94A indicating nonimmigrant admission under the Compact of Free Association Between the United States and the FSM or RMI 1. Driver's license or ID card issued by a State or outlying possession of the United States provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 2. ID card issued by federal, state or local government agencies or entities, provided it contains a photograph or information such as name, date of birth, gender, height, eye color, and address 3. School ID card with a photograph 4. Voter's registration card 5. U.S. Military card or draft record 6. Military dependent's ID card 7. U.S. Coast Guard Merchant Mariner Card 8. Native American tribal document 9. Driver's license issued by a Canadian government authority For persons under age 18 who are unable to present a document listed above: 10. School record or report card 11. Clinic, doctor, or hospital record 12. Day-care or nursery school record 1. A Social Security Account Number card, unless the card includes one of the following restrictions: (1) NOT VALID FOR EMPLOYMENT (2) VALID FOR WORK ONLY WITH INS AUTHORIZATION (3) VALID FOR WORK ONLY WITH DHS AUTHORIZATION 2. Certification of Birth Abroad issued by the Department of State (Form FS-545) 3. Certification of Report of Birth issued by the Department of State (Form DS-1350) 4. Original or certified copy of birth certificate issued by a State, county, municipal authority, or territory of the United States bearing an official seal 5. Native American tribal document 6. U.S. Citizen ID Card (Form I-197) 7. Identification Card for Use of Resident Citizen in the United States (Form I-179) 8. Employment authorization document issued by the Department of Homeland Security Examples of many of these documents appear in Part 8 of the Handbook for Employers (M-274). Refer to the instructions for more information about acceptable receipts. Form I-9 11/14/2016 N Page 3 of 3

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23 Form W-4 (2017) Purpose. Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Consider completing a new Form W-4 each year and when your personal or financial situation changes. Exemption from withholding. If you are exempt, complete only lines 1, 2, 3, 4, and 7 and sign the form to validate it. Your exemption for 2017 expires February 15, See Pub. 505, Tax Withholding and Estimated Tax. Note: If another person can claim you as a dependent on his or her tax return, you can t claim exemption from withholding if your total income exceeds $1,050 and includes more than $350 of unearned income (for example, interest and dividends). Exceptions. An employee may be able to claim exemption from withholding even if the employee is a dependent, if the employee: Is age 65 or older, Is blind, or Will claim adjustments to income; tax credits; or itemized deductions, on his or her tax return. The exceptions don t apply to supplemental wages greater than $1,000,000. Basic instructions. If you aren t exempt, complete the Personal Allowances Worksheet below. The worksheets on page 2 further adjust your withholding allowances based on itemized deductions, certain credits, adjustments to income, or two-earners/multiple jobs situations. Complete all worksheets that apply. However, you may claim fewer (or zero) allowances. For regular wages, withholding must be based on allowances you claimed and may not be a flat amount or percentage of wages. Head of household. Generally, you can claim head of household filing status on your tax return only if you are unmarried and pay more than 50% of the costs of keeping up a home for yourself and your dependent(s) or other qualifying individuals. See Pub. 501, Exemptions, Standard Deduction, and Filing Information, for information. Tax credits. You can take projected tax credits into account in figuring your allowable number of withholding allowances. Credits for child or dependent care expenses and the child tax credit may be claimed using the Personal Allowances Worksheet below. See Pub. 505 for information on converting your other credits into withholding allowances. Nonwage income. If you have a large amount of nonwage income, such as interest or dividends, consider making estimated tax payments using Form 1040-ES, Estimated Tax for Individuals. Otherwise, you may owe additional tax. If you have pension or annuity income, see Pub. 505 to find out if you should adjust your withholding on Form W-4 or W-4P. Two earners or multiple jobs. If you have a working spouse or more than one job, figure the total number of allowances you are entitled to claim on all jobs using worksheets from only one Form W-4. Your withholding usually will be most accurate when all allowances are claimed on the Form W-4 for the highest paying job and zero allowances are claimed on the others. See Pub. 505 for details. Nonresident alien. If you are a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form. Check your withholding. After your Form W-4 takes effect, use Pub. 505 to see how the amount you are having withheld compares to your projected total tax for See Pub. 505, especially if your earnings exceed $130,000 (Single) or $180,000 (Married). Future developments. Information about any future developments affecting Form W-4 (such as legislation enacted after we release it) will be posted at Personal Allowances Worksheet (Keep for your records.) A Enter 1 for yourself if no one else can claim you as a dependent A You re single and have only one job; or B Enter 1 if: You re married, have only one job, and your spouse doesn t work; or... B { } Your wages from a second job or your spouse s wages (or the total of both) are $1,500 or less. C Enter 1 for your spouse. But, you may choose to enter -0- if you are married and have either a working spouse or more than one job. (Entering -0- may help you avoid having too little tax withheld.) C D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return D E Enter 1 if you will file as head of household on your tax return (see conditions under Head of household above).. E F Enter 1 if you have at least $2,000 of child or dependent care expenses for which you plan to claim a credit... F (Note: Do not include child support payments. See Pub. 503, Child and Dependent Care Expenses, for details.) G Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information. If your total income will be less than $70,000 ($100,000 if married), enter 2 for each eligible child; then less 1 if you have two to four eligible children or less 2 if you have five or more eligible children. If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter 1 for each eligible child. G H Add lines A through G and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) H { If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions For accuracy, and Adjustments Worksheet on page 2. complete all If you are single and have more than one job or are married and you and your spouse both work and the combined worksheets earnings from all jobs exceed $50,000 ($20,000 if married), see the Two-Earners/Multiple Jobs Worksheet on page 2 that apply. to avoid having too little tax withheld. If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form W-4 below. Separate here and give Form W-4 to your employer. Keep the top part for your records. Employee s Withholding Allowance Certificate Form W-4 Department of the Treasury Whether you are entitled to claim a certain number of allowances or exemption from withholding is Internal Revenue Service subject to review by the IRS. Your employer may be required to send a copy of this form to the IRS. 1 Your first name and middle initial Last name OMB No Your social security number Home address (number and street or rural route) 3 Single Married Married, but withhold at higher Single rate. Note: If married, but legally separated, or spouse is a nonresident alien, check the Single box. City or town, state, and ZIP code 4 If your last name differs from that shown on your social security card, check here. You must call for a replacement card. 5 Total number of allowances you are claiming (from line H above or from the applicable worksheet on page 2) 5 6 Additional amount, if any, you want withheld from each paycheck $ 7 I claim exemption from withholding for 2017, and I certify that I meet both of the following conditions for exemption. Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and This year I expect a refund of all federal income tax withheld because I expect to have no tax liability. If you meet both conditions, write Exempt here Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and complete. Employee s signature (This form is not valid unless you sign it.) Date 8 Employer s name and address (Employer: Complete lines 8 and 10 only if sending to the IRS.) 9 Office code (optional) 10 Employer identification number (EIN) For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No Q Form W-4 (2017)

24 Form W-4 (2017) Page 2 Deductions and Adjustments Worksheet Note: Use this worksheet only if you plan to itemize deductions or claim certain credits or adjustments to income. 1 Enter an estimate of your 2017 itemized deductions. These include qualifying home mortgage interest, charitable contributions, state and local taxes, medical expenses in excess of 10% of your income, and miscellaneous deductions. For 2017, you may have to reduce your itemized deductions if your income is over $313,800 and you re married filing jointly or you re a qualifying widow(er); $287,650 if you re head of household; $261,500 if you re single, not head of household and not a qualifying widow(er); or $156,900 if you re married filing separately. See Pub. 505 for details $ $12,700 if married filing jointly or qualifying widow(er) 2 Enter: $9,350 if head of household $ { } $6,350 if single or married filing separately 3 Subtract line 2 from line 1. If zero or less, enter $ 4 Enter an estimate of your 2017 adjustments to income and any additional standard deduction (see Pub. 505) 4 $ 5 Add lines 3 and 4 and enter the total. (Include any amount for credits from the Converting Credits to Withholding Allowances for 2017 Form W-4 worksheet in Pub. 505.) $ 6 Enter an estimate of your 2017 nonwage income (such as dividends or interest) $ 7 Subtract line 6 from line 5. If zero or less, enter $ 8 Divide the amount on line 7 by $4,050 and enter the result here. Drop any fraction Enter the number from the Personal Allowances Worksheet, line H, page Add lines 8 and 9 and enter the total here. If you plan to use the Two-Earners/Multiple Jobs Worksheet, also enter this total on line 1 below. Otherwise, stop here and enter this total on Form W-4, line 5, page 1 10 Two-Earners/Multiple Jobs Worksheet (See Two earners or multiple jobs on page 1.) Note: Use this worksheet only if the instructions under line H on page 1 direct you here. 1 Enter the number from line H, page 1 (or from line 10 above if you used the Deductions and Adjustments Worksheet) 1 2 Find the number in Table 1 below that applies to the LOWEST paying job and enter it here. However, if you are married filing jointly and wages from the highest paying job are $65,000 or less, do not enter more than If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter -0- ) and on Form W-4, line 5, page 1. Do not use the rest of this worksheet Note: If line 1 is less than line 2, enter -0- on Form W-4, line 5, page 1. Complete lines 4 through 9 below to figure the additional withholding amount necessary to avoid a year-end tax bill. 4 Enter the number from line 2 of this worksheet Enter the number from line 1 of this worksheet Subtract line 5 from line Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here $ 8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed.. 8 $ 9 Divide line 8 by the number of pay periods remaining in For example, divide by 25 if you are paid every two weeks and you complete this form on a date in January when there are 25 pay periods remaining in Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be withheld from each paycheck 9 $ Table 1 Table 2 Married Filing Jointly All Others Married Filing Jointly All Others If wages from LOWEST paying job are Enter on line 2 above $0 - $7, ,001-14, ,001-22, ,001-27, ,001-35, ,001-44, ,001-55, ,001-65, ,001-75, ,001-80, ,001-95, , , , , , , , , ,001 and over 15 If wages from LOWEST paying job are Enter on line 2 above $0 - $8, ,001-16, ,001-26, ,001-34, ,001-44, ,001-70, ,001-85, , , , , , , ,001 and over 10 Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person who claims no withholding allowances; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. If wages from HIGHEST paying job are Enter on line 7 above $0 - $75,000 $610 75, ,000 1, , ,000 1, , ,000 1, , ,000 1, ,001 and over 1,600 If wages from HIGHEST paying job are Enter on line 7 above $0 - $38,000 $610 38,001-85,000 1,010 85, ,000 1, , ,000 1, ,001 and over 1,600 You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return. If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.

25 Employee Enrollment Application Your Anthem enrollment application is inside. It is essential that you read it carefully and complete all necessary sections. If you are a new enrollee }} Applying for health, vision and/or dental benefits, please complete Sections 1, 3, 4, 5, 6, 7, 8 and 9. Your signature is required in Section 9. }} Waiving any or all benefits, please complete Sections 1, 4, and 10. Your signature is required in Section 10. If you are adding a dependent(s) Complete Section 2 in addition to the above. It is important that you read and understand the Significant Terms, Conditions and Authorizations in Section 9. Thank you for choosing Anthem Blue Cross and Blue Shield. Note: You may be required to supply additional information. Anthem provides administrative claims payment services only, and does not assume any financial risk or obligation with respect to claims. A-77 LG-ASO Rev. 12/10 Anthem Blue Cross and Blue Shield is the trade name of: In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Ohio: Community Insurance Company. In Wisconsin: Blue Cross Blue Shield of Wisconsin ( BCBSWi ), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ( Compcare ), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association. Page 1 of 5

26 Enrollment Application Anthem provides administrative claims payment services only, and does not assume any financial risk or obligation with respect to claims. Please complete this form in ink and return to your employer. Use extra sheets of paper if necessary. All information given should apply to this employer. Anthem s Primary Care Physician (PCP) listings, for HMO/POS products can be obtained through EMPLOYER USE ONLY Group no. Sub-group no. Applicant no./dept. name Request effective date (MM/DD/YYYY) Employer name Address (please include suite no., city, state, ZIP code) ANTHEM USE ONLY Plan PCP COB m Yes m No m Yes m No Health effective date (MM/DD/YYYY) Dental effective date (MM/DD/YYYY) Vision effective date (MM/DD/YYYY) Pre-ex date (MM/DD/YYYY) Section 1. REASON FOR APPLICATION m New enrollment m Waiver m Add dependent (see Section 2) m Rehire (event date) m New hire m Annual open enrollment m COBRA Qualifying event m Conversion (event date) Section 2. STATUS CHANGE/EVENT m Event date (MM/DD/YYYY) m Marriage m Birth m Adoption* m Legal guardianship* m Other *Include legal documentation. Section 3. TYPE OF COVERAGE/PLAN Health coverage Dental coverage Vision coverage m HMO* 1 (except Ohio) m EPO (Ohio only) m PPO m POS m Blue Traditional m Anthem Essential SM Choice PPO m Blue Access SM Hospital Surgical PPO (IN, KY, OH only) m Blue Access SM Choice Hospital Surgical PPO (MO only) m Blue Preferred ASO/EPO m Lumenos Health Savings Account m Lumenos Health Reimbursement Account m Lumenos Health Incentive Account m Lumenos Health Incentive Account Plus m Anthem Essential SM PPO m Anthem Essential SM Select (MO only) m Blue Access SM Hospital Surgical PPO (MO only) m Blue Preferred Select (MO only) m Blue Preferred Plus Hospital Surgical POS (WI only) 1 Ohio only-a health insuring corporation product or HIC Anthem will facilitate the opening of a Health Savings Account in your name, if directed by your Employer. m PPO m Traditional (IN, OH only) m Dental Blue 100/200/300 m Dental Blue 100 m Vision m Employee only m Employee and spouse m Employee and child(ren) m Family coverage m No coverage m Employee only m Employee and spouse m Employee and child(ren) m Family coverage m No coverage m Employee only m Employee and spouse m Employee and child(ren) m Family coverage m No coverage Section 4. EMPLOYEE INFORMATION (*Only complete Primary Care Physician (PCP) information when enrolling in HMO or POS products.) Social security no. (required) Last name First name M.I. Age Date of birth (MM/DD/YYYY) Home address (street, city, state, ZIP code) County (KY residents include municipality) m Single m Divorced m Married Sex m M m F Home phone Work phone address Are you retired? Are you disabled? Are you hospitalized? m Yes m No m Yes m No m Yes m No Occupation Full-time hire date (MM/DD/YYYY) Income reported by Hours working per week m W2 m 1099 m Other Anthem PCP name* Anthem PCP address* Anthem PCP ID no.* New patient?* A-77 LG-ASO Rev. 12/10 m Yes m No Page 2 of 5

27 Policyholder name Policyholder social security no. Section 5. FAMILY INFORMATION Spouse and dependents to be enrolled. Attach a separate sheet if necessary. Please read the Genetic Information Non-discrimination Act (GINA) information under Significant Terms, Conditions and Authorizations section, prior to answering questions below. 1 Relationship to employee: m Spouse m Domestic Partner (DP) Dependent name (last name, first name, M.I.) Social security no. (required for spouse or DP) Sex Date of birth Is dependent s address different than applicant s address? m Yes m No If yes, please provide full address m M m F Court ordered health care benefits? m Yes m No (If Yes, include legal documentation) Currently hospitalized or disabled? m Yes m No (If Yes, give reason) Anthem PCP name* Anthem PCP address* Anthem PCP ID no.* New patient?* 2 Relationship to employee: m Son m Daughter m Other Dependent name (last name, first name, M.I.) Social security no. Sex Date of birth Is dependent s address different than applicant s address? m Yes m No If yes, please provide full address m M m F Court ordered health care benefits? m Yes m No (If Yes, include legal documentation) m Yes m No Currently hospitalized or disabled? m Yes m No (If Yes, give reason) Anthem PCP name* Anthem PCP address* Anthem PCP ID no.* New patient?* 3 Relationship to employee: m Son m Daughter m Other Dependent name (last name, first name, M.I.) Social security no. Sex Date of birth Is dependent s address different than applicant s address? m Yes m No If yes, please provide full address m M m F Court ordered health care benefits? m Yes m No (If Yes, include legal documentation) m Yes m No Currently hospitalized or disabled? m Yes m No (If Yes, give reason) Anthem PCP name* Anthem PCP address* Anthem PCP ID no.* New patient?* Section 6. OTHER HEALTH COVERAGE Please check one: Yes (complete below) No On the day your coverage begins, list family members, including yourself, who will be covered by any other health coverage. Name of person(s) covered Relationship to employee Name of the HMO or insurance company Policy/certificate no. m Self m Spouse m Child(ren) m Yes m No Address of the HMO or insurance company Phone no. of HMO or insurance company Effective date (MM/DD/YYYY) Policyholder name Policyholder social security no. Policyholder date of birth Section 7. MEDICARE COVERAGE If you or your dependents are enrolled in Medicare or Medicaid, complete the following. 1 Name of enrollee (last name, first name, M.I.) Medicare Part A effective date Medicare Part B effective date Medicare/Medicaid ID no. ESRD onset date Medicare Part D ID no. Medicare Part D carrier Reason for Medicare entitlement Medicare Part D effective date Medicare Part D term date m Age m Disability m End stage renal disease (ESRD) m ESRD and disability 2 Name of enrollee (last name, first name, M.I.) Medicare Part A effective date Medicare Part B effective date Medicare/Medicaid ID no. ESRD onset date Medicare Part D ID no. Medicare Part D carrier Reason for Medicare entitlement Medicare Part D effective date Medicare Part D term date m Age m Disability m End stage renal disease (ESRD) m ESRD and disability *Only complete Primary Care Physician (PCP) information for HMO or POS products. A-77 LG-ASO Rev. 12/10 Page 3 of 5

28 Policyholder name Policyholder social security no. Section 8. PRIOR HEALTH COVERAGE. Please check one: Yes (complete below) No Have you been covered by Anthem within the past two (2) years? m Yes m No Group name/id no. Dates policy in effect Policy/Certificate no. Have you and/or your dependents had prior coverage with another carrier(s) in the past two (2) years? m Yes m No Section 9. SIGNIFICANT TERMS, CONDITIONS AND AUTHORIZATION (TERMS) Genetic Information Non-discrimination Act (GINA): When answering questions on this enrollment application, the information provided for each individual should include only information about that individual, and should not include any genetic information. Genetic information includes family medical history and information related to the individual s genetic testing, genetic services, genetic counseling, or genetic diseases for which the individual may be at risk. All responses pertaining to an individual will only be considered and applied to the individual in question. Health Savings Account Notice: Except as otherwise provided in any agreement between me and the financial custodian, the custodian of my Health Savings Account (HSA), I understand that my authorization is required before the financial custodian may provide Anthem Blue Cross and Blue Shield with information regarding my HSA. I hereby authorize the financial custodian to provide Anthem Blue Cross and Blue Shield with information about my HSA, including account number, account balance and information, regarding account activity. I also understand that I may provide Anthem Blue Cross and Blue Shield with a written request to revoke my authorization at any time. Please read this section carefully before signing the application. 1. I may not assign any payment under my Anthem Blue Cross and Blue Shield administered benefit plan. 2. I authorize deduction from my wages/pension, if necessary for the required payment for the benefit for which I, or any dependents have applied. 3. I am applying for the benefit selected on this application. If I select a coverage, or combination of coverages, not available to me and/or a class for which I am not eligible, I agree that my selection(s) is hereby automatically amended to be consistent with the employer s application. 4. I understand that, to the extent permitted by law, Anthem reserves the right to accept or decline this application and that no right whatsoever is created by this application. I also understand that this coverage, if approved, may exclude for pre-existing conditions. 5. I am responsible to timely notify my employer of any change that would make me or any dependent ineligible for benefits. 6. By signing this application, I agree and consent to the recording and/or monitoring of any telephone conversation between Anthem and myself. I acknowledge that I have read the Significant Terms, Conditions and Authorizations, and I accept such provisions as a condition of enrollment. I represent that the answers given to all questions on this application are true and accurate to the best of my knowledge and I understand they are being relied on by Anthem in accepting this application. I understand that any misstatements or failure to report new medical information prior to my effective date may result in a material change to benefits or rates. Any material misrepresentation or significant omission found in this application may result to denial of benefits or rescission or cancellation of my benefits. Ohio: Any person who, with intent to defraud or knowing that he or she is facilitating a fraud against an insurer, submits an application or files a claim containing false or deceptive statement is guilty of insurance fraud. Kentucky: Any person who knowingly and with intent to defraud any insurance company, health maintenance organization, self-insured plan, or other person, files an application for insurance or other form of health care coverage containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. I give this authorization for and on behalf of any eligible dependents and myself if covered by the Plan. I am acting as their agent and representative. Your health benefit plan will be administered by one of the following companies based upon the state in which your employer is located: In Indiana: Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. In Kentucky: Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. In Missouri: Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-hmo benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. In Ohio: Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. In WIsconsin: Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin ( BCBSWi ), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ( Compcare ), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Thank you for choosing Anthem Blue Cross and Blue Shield. List prior carrier(s) Dates policy in effect Please check the type of prior coverage: m Employee only m Employee and spouse m Employee and child(ren) m Employee/spouse/child(ren) Termination reason: m Divorce/legal separation m Death of spouse m COBRA coverage exhausted m Group plan terminated m Employer/group contribution ceased m Employment terminated m Other Read the TERMS section above carefully before signing. Please review your application for errors or omissions. By signing this, I am indicating that I have read and understand the language in the TERMS section of this application and agree to all of its terms. Applicant signature X A-77 LG-ASO Rev. 12/10 Date Page 4 of 5

29 Policyholder name Policyholder social security no. Section 10. WAIVER OF COVERAGE For employee and/or any eligible dependent not enrolling. Check all that apply: Waiving: m Health m Dental m Vision m Life m All Name of person waiving Already protected by coverage of: m Spouse m Parent m None Employer name Carrier: m Anthem (give certificate/policy no.) m Other carrier (give name, ID no.) Check all that apply: Waiving: m Health m Dental m Vision m Life m All Name of person waiving Already protected by coverage of: m Spouse m Parent m None Employer name Carrier: m Anthem (give certificate/policy no.) m Other carrier (give name, ID no.) Check all that apply: Waiving: m Health m Dental m Vision m Life m All Name of person waiving Already protected by coverage of: m Spouse m Parent m None Employer name Carrier: m Anthem (give certificate/policy no.) m Other carrier (give name, ID no.) Check all that apply: Waiving: m Health m Dental m Vision m Life m All Name of person waiving Already protected by coverage of: m Spouse m Parent m None Employer name Carrier: m Anthem (give certificate/policy no.) m Other carrier (give name, ID no.) Check all that apply: Waiving: m Health m Dental m Vision m Life m All Name of person waiving Already protected by coverage of: m Spouse m Parent m None Employer name Carrier: m Anthem (give certificate/policy no.) m Other carrier (give name, ID no.) I certify that I have been given an opportunity to apply for the employer s health benefits plan, and after careful consideration, have decided not to take advantage of this offer. In the event I wish to apply for such benefits hereafter, I may do so, subject to established procedures. If I am declining enrollment for myself or my dependents (including my spouse) because of other health insurance coverage, I may in the future be able to enroll myself or my dependents in this plan, provided that enrollment is requested within 31 days after other coverage ends. My dependent(s) or I may be subject to pre-existing condition restrictions or waiting periods specified in the group benefit booklet, if a dependent or I are late enrollees. The pre-existing exclusion may not apply to a dependent who is enrolled in the plan prior to his/her 19 th Birthday. In addition, if I have a dependent as a result of marriage, birth, adoption or placement for adoption. I may be able to enroll myself and my dependents provided that I request enrollment within 31 days after the marriage, birth, adoption or placement of adoption. I also understand that my dependents and I may enroll under two additional circumstances: }} Either my or my dependent s Medicaid or Children s Health Insurance Program (CHIP) coverage is terminated as a result of loss of eligibility; or }} My dependent or I become eligible for a subsidy (state premium assistance program). In these cases, I may be able to enroll myself and my dependents provided that I request enrollment within 60 days of the loss of Medicaid/CHIP or of the eligibility determination. Applicant signature X A-77 LG-ASO Rev. 12/10 Date Page 5 of 5

30 Spouse Eligibility Certification for Aim NationaLease/Aim Integrated Logistics Employees As a result of the recently negotiated Aim NationaLease/Aim Integrated Logistics agreement, each employee who has spousal coverage is required to return the attached form completed in its entirety. The Spouse Eligibility section must be completed by you and your spouse (front). The Spouse Insurance Verification Form (back) must be completed by your spouse s employer. The entire form, front & back, must be completed, signed, and returned to Human Resources by your eligibility date. I do not have a spouse. I carry family coverage for myself and my dependents. PLEASE STOP, SIGN ON THE REVERSE SIDE AND RETURN FORM. My Spouse is: Employed Not Employed Is group medical insurance available to your spouse through his/her employment? Yes No I HEREBY ELECT HEALTH COVERAGE FOR MY SPOUSE AS FOLLOWS: My spouse WILL enroll in his/her employer s health benefit plan. My Spouse WILL NOT enroll in his/her employer s health benefit plan. I understand my spouse will remain as a covered dependent under the Aim NationaLease/Aim Integrated Logistics plan and that I will pay $ per month by payroll deduction for my spouse s coverage. My spouse WILL enroll in my health plan since he/she is not employed or has benefits available to him/her (employer must complete the back if employed). I HEREBY CERTIFY THAT THE EMPLOYEE AND SPOUSE INFORMATION ON THIS FORM IS CORRECT, and understand that, to ensure benefits are coordinated properly between employers and plans Aim NationaLease/Aim Integrated Logistics will verify the accuracy of information by conducting audits, contacting me, and contacting my spouse s employer. I further certify my election and authorization above. I FURTHER CERTIFY that if my spouse s status changes, I understand I must notify Aim NationaLease/Aim Integrated Logistics within 30 days of that change. If an employee or dependent, or anyone acting on behalf of either, makes a false statement or withholds relevant information that results in providing coverage or payment in claim, Aim NationaLease/Aim Integrated Logistics and/or its insurer may recover any amounts wrongfully paid, including legal fees. Employees Signature Date Aim NationaLease Human Resources Department 1500 Trumbull Avenue Girard, OH Fax: (330)

31 Spouse Insurance Verification Form TO BE COMPLETED BY THE EMPLOYER OF THE SPOUSE OF THE AIM NATIONALEASE/AIM INTEGRATED LOGISTICS EMPLOYEE (Aim NationaLease/Aim Integrated Logistics employee name) SPOUSE S EMPLOYER INFORMATION EMPLOYEE S NAME (Spouse of Aim NationaLease/Aim Integrated Logistics Employee) SOCIAL SECURITY NUMBER: DATE OF BIRTH: MAILING ADDRESS: BELOW THIS LINE TO BE FILLED OUT BY THE EMPLOYER Do you offer employer-sponsored group medical insurance to employee? Yes No If your answer is YES, please have your employer complete ALL applicable sections below. MEDICAL INSURANCE PLAN INFORMATION PLAN/GROUP # CONTRACT YEAR: From: To: DATE OF OPEN ENROLLMENT PERIOD: FOR EFFECTIVE DATE OF INSURANCE COMPANY NAME: MAILING ADDRESS I HEREBY CERTIFY THAT THE ABOVE EMPLOYER AND PLAN INFORMATION IS CORRECT Spouse s Employer Title Area Code/Phone Administrator Signature Aim NationaLease Human Resources Department 1500 Trumbull Avenue Girard, OH Fax: (330)

32 The following questionnaire will determine how many wellness credits you will receive. See the Benefits Compensation Book for further details. I have used nicotine product(s) within the last 12 months: o Yes o No Once enrolled in the Anthem Blue Cross Blue Shield plan, I will participate in the online Health Risk Assessment that Anthem provides at o Yes o No Name Signature Date This form must be turned in with your Anthem BCBS application in order to accurately adjust your contribution level.

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36 Beneficiary Designation 401(k) Plan Use black or blue ink when completing this form. For questions regarding this form, contact Service Center at Aim Leasing Company 401(k) Plan A Participant Information Account extension identifies funds transferred to a beneficiary due to death, alternate payee due to divorce Social Security Number Account Extension or a participant with multiple accounts. / / Last Name First Name M.I. Date of Birth ( ) Street Address Personal Phone Number ( ) City State Zip Code Work Phone Number Address Married Unmarried B Primary Beneficiary Designation (Attach an additional sheet to name additional beneficiaries.) If I am married, my Plan requires my spouse as primary beneficiary for 100% or my spouse consents to my beneficiary designation. % / / % of Account Balance Primary Beneficiary Name Relationship Social Security Number Date of Birth Street Address City State Zip Code % / / % of Account Balance Primary Beneficiary Name Relationship Social Security Number Date of Birth Street Address City State Zip Code % / / % of Account Balance Primary Beneficiary Name Relationship Social Security Number Date of Birth Street Address City State Zip Code Contingent Beneficiary Designation % / / % of Account Balance Contingent Beneficiary Name Relationship Social Security Number Date of Birth Street Address City State Zip Code % / / % of Account Balance Contingent Beneficiary Name Relationship Social Security Number Date of Birth Street Address City State Zip Code % / / % of Account Balance Contingent Beneficiary Name Relationship Social Security Number Date of Birth Street Address City State Zip Code C Signatures and Consent Participant Consent I have completed, understand and agree to all pages of this Beneficiary Designation form. Subject to and in accordance with the terms of the Plan, I am making the above beneficiary designations for my vested account in the event of my death. If I have more than one primary beneficiary, the account will be divided as specified. If a primary beneficiary predeceases me, his or her benefit will be allocated to the surviving primary beneficiaries. Contingent beneficiaries will receive a benefit only if there is no surviving primary beneficiary, as specified. If a contingent beneficiary predeceases me, his or her benefit will be allocated to the surviving contingent beneficiaries. If I fail to designate beneficiaries, amounts will be paid pursuant to the terms of the Plan or applicable law. This designation is effective upon execution and delivery to Plan Administrator/Trustee. If any information is missing, additional information may be required prior to recording my designation. This designation supersedes all prior designations. Beneficiaries will share equally if percentages are not provided and any amounts unpaid upon death will be divided equally. Primary and contingent beneficiaries must separately total 100% in whole percentages. ][STD FBENED ][06/09/14 ][Page 1 of 2 ][B01: ][MITA/

37 Last Name First Name M.I. Social Security Number Number Important Notice: In accordance with ERISA and/or Plan Document, if I am married and I elect a primary beneficiary other than my spouse or in addition to my spouse, my spouse must consent by signing the Spousal Consent section of this form. Any person who presents false or fraudulent information is subject to criminal and civil penalties. Participant Signature Spousal Consent Dates of the participant s spouse signature and notarization must match. Date (Required) I, (name of spouse), the current spouse of the participant, hereby voluntarily consent to the participant s primary beneficiary designation above and understand its effect. I understand that my spouse s beneficiary designation means that I will not receive 100% of his or her vested account balance under the Plan and that my spouse s election is not valid unless I consent to it. I understand that by consenting to the beneficiary designation, I give up my right to a qualified survivor annuity. I hereby voluntarily consent to the primary beneficiary(ies) named on the previous page. I understand that my consent is irrevocable unless my spouse revokes the waiver election, changes the beneficiary designation, or designates me to receive 100% of his or her vested account balance. Spouse Signature Witness of Spouse s Signature Date (Required) The spouse s signature must be witnessed by a Notary Public. Statement of Notary NOTE: Notary seal must be visible. State of ) The consent to this request was subscribed and sworn (or affirmed) to before me on this day of, year, by )ss. (name of spouse) proved to me on the basis of satisfactory evidence to be the person who County of ) appeared before me, who affirmed that such consent represents his/her free and voluntary act. SEAL Notary Public Signature My commission expires D Mailing Instructions Participant forward to Employer Employer DO NOT send this form to the Service Center as beneficiary records are not maintained. Please retain this for your records. ][STD FBENED ][06/09/14 ][Page 2 of 2 ][B01: ][MITA/

38 Tartan Insurance or info@tartanagency.com

39 3. Employer nam e 4. Employer Identification Num ber (EIN) Aim Leasing Company Employer address 6. Em ployer phone num ber 1500 Trumbull Ave C ity 8. State 9. ZIP cod e Girard OH W ho can w e contact about employee health coverage at this job? Tartan Insurance Agency 11. Phone number (if different from above) 12. Em ail address info@tartanagency.com Current full time employees who satisfied the company's probationary period. Spouse, natural children, adopted children, stepchildren, spouse's children and anyone under legal guardianship.

40 PF 1 Rev 8-10 AIM INTEGRATED LOGISTICS/AIM SERVICES PAYROLL ACKNOWLEDGEMENT FORM To: From: All New Drivers Payroll Department We would like to take this opportunity to welcome you to Aim Integrated Logistics. It is common to have questions regarding the payroll process and to know when to expect your first paycheck. In order for you to be paid on time the following instructions explain how our payroll process works for your first check and every check thereafter. After you have completed your first week of work you will do one of the following things: You will turn your paperwork in to an onsite supervisor who will either process the payroll there or will send it to the payroll department. Please have all paperwork to your supervisor by Monday following the week worked so that they can forward to the payroll department by Tuesday. If you mail your paperwork in weekly via United States Postal Service, place in mailbox on Saturday (Sunday the latest) after the week worked to guarantee that payroll department receives by Tuesday. The payroll department should have all paperwork no later then Wednesday following the week worked. During your second week of work, the payroll department receives and processes all the paperwork from the previous week and sends the finalized payroll information to the outside companies that print the checks. Those companies deliver the paychecks to our office on the Wednesday of your third week of work. We send any nondirect deposit checks out in the mail that same day. You should receive your check or direct deposit on Friday of the same week. Keep in mind that this check is for your first week of work and is dated for Friday of the week, even though you may receive it on Thursday. Please remember that if we do not receive paperwork on time you will not be paid. Once you do turn your paperwork in we will process it with the week we are currently working on. You will not be paid immediately due to late paperwork there will be no exceptions. Hopefully this memo will help you to better understand our payroll system and clarify when to expect your first check and checks thereafter. If you are ever uncertain about where or who to turn your paperwork into, or if you need more mailing envelopes and self addressed stickers to mail in your paperwork, please call Terri Horn (ext. 107) or Kim Slater (ext. 135) at Employee s Signature Print Employee s Name Date Witness Date Retain in Employee s Personal File

41 Driver Logs/Payroll Back-up Instructions 1. To begin with, you must first register for web access if you haven t done so already. The registration process is straightforward; you click Register at the top of the web page at 2. This will take you to the registration form which asks for a little information allowing us to confirm your identity and configure your account. The fields with a red asterisk are required, and it is suggested that you use a password of at least medium strength to protect your account. Once completed, you click submit and you will be informed via to the address you supplied once your account has been created. If you have not heard back within 2 business days, please contact your dispatcher or a Human Resources representative to clear up the issue.

42 3. After receiving the , you may login to our website and access the employee zone to check on benefits, emergency information, and other resources. To get to the Driver Payroll Backup report, simply use the menu selection Employee Zone Payroll/Taxes Driver Payroll Backup as shown below. 4. Once on this screen, choose the week ending date or date range you would like to review and enter your 4 digit employee ID and the last 4 digits of your Social Security Number and click Run Report. The default output is a PDF file, you may choose to receive it as an Excel file or as a Word file if you desire. Once done, just click Logout and close your browser.

43 PF 4 Rev 1/16 DIRECT DEPOSIT AUTHORIZATION I hereby authorize AIM (hereinafter called Company ), to initiate credit entries and to initiate, if necessary, debit entry adjustments for any credit entries in error to my account indicated below and to the depository name below (hereinafter call Depository ), to credit and/or debit the same to such account. DEPOSITORY NAME/BRANCH CITY, STATE, ZIP CODE CHECKING Routing Number NET CHECK Account Number $ SAVINGS Routing Number NET CHECK Account Number $ Through our payroll system, you can have funds directly deposited into a maximum of 3 accounts and any combination of checking and savings accounts however, PLEASE USE ONE FORM PER ACCOUNT. This authorization is to remain in full force and effect until the Company has received written notification from me of its termination in such time and in such manner as to afford Company and Depository a reasonable opportunity to act on it. In addition, should your employment with the company terminated, all direct deposits will be cancelled. Once the authorization form is received by the Company, the information will be verified (pre-noted) before the program is initiated. For accuracy, the Company will run two trial transactions with the Company s financial institution and your designated financial institution. It will take approximately three weeks for the first direct deposit to your account. PRINT NAME SIGNATURE DATE Attach a voided or cancelled check here it is required for processing. Photocopies of either one will due also. NO DEPOSIT SLIPS.

44 VIEW YOUR PAYSTUBS ONLINE The ADP site is very case sensitive, so please enter and remember information that is capitalized and/or lowercase. How to Register on ADP ipaystatements: 1. Go to 2. Enter registration code: aimleasing-aim 3. First Name, Last Name 4. Select Last 4 Digits of SSN, EIN, or ITIN a. enter last 4 of your SSN b. enter last 4 of your SSN again to verify 5. Enter Birth month and day 6. When the pop up appears, click on Register now 7. Enter your contact information 8. Create your user ID and password 9. Confirm password 10. Enter 3 question and answers 11. Click Register now It will then ask you for your contact information like your , it will then you an activation code that you must retrieve from your and then enter into the screen. Once you enter that code it will give you your sign in information. Once you are complete you will use the same website but you will now hit LOG IN and enter your user name and password. AIMHR ADP

45 PF 6 Rev 7-13 VOLUNTARY SELF IDENTIFICATION NAME DATE OF BIRTH Sex: (Circle) Male Female SOCIAL SEC # XXX XX - POSITION APPLIED FOR / CURRENT POSITION RACE/ETHNICITY: Hispanic or Latino A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture of origin regardless of race. White (Not Hispanic or Latino) A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) All persons who identify with more than one of the above five races. The employer is subject to certain governmental recordkeeping and reporting requirements for the administration of civil rights laws and regulations. In order to comply with these laws, the employer invites employees to voluntarily self- identify their race and ethnicity. Submission of this information is voluntary and refusal to provide it will not subject you to any adverse treatment. The information obtained will be kept confidential and may only be used in accordance with the provisions of applicable laws, executive orders, and regulations, including those that require the information to be summarized and reported to the federal government for civil rights enforcement. When reported, data will not identify any specific individual. ****************************************************************************** *Note to supervisor: If this form is not completed by the applicant, do a visual identification and make notes here: SUPERVISOR SIGNATURE DATE VETERAN STATUS (please check one): I am not a veteran I am a special disabled veteran I am a veteran of the Vietnam era I am a veteran who served on active duty in the U.S. military during a war or in campaign or expedition for which a campaign badge has been authorized I am a recently separated veteran (veterans within one year from discharge or release from active duty) MUST BE RETURNED TO HUMAN RESOURCES EMPLOYEE SIGNATURE DATE

46 C O M P A N Y C O M M U N I C A T I O N & E M E R G E N C Y N O T I F I C A T I O N F O R M Employee Name: Date of Birth: / / Address: City: State: Zip: Home #: ( ) Mobile #: ( ) FOR INTERNAL COMMUNICATION: company-wide broadcasts, notifications and memos. ie. open enrollment, united way, general social media. Name: Phone#: ( ) Please add my family member to company communication. Name: Relationship: Phone#: ( ) EMERGENCY CONTACT: Name: Relationship: Home #: ( ) Mobile #: ( ) Work #: ( ) ALTERNATE EMERGENCY CONTACT: Name: Relationship: Home #: ( ) Mobile #: ( ) Work #: ( ) PLEASE USE THE BACK OF THE FORM IF YOU WOULD LIKE TO ADD ANY ADDITIONAL CONTACTS. Please complete this form and return it Human Resources in Girard, OH.

47 E M P L O Y E E P H O T O & V I D E O R E L E A S E F O R M I hereby grant AIM Leasing Company the right to use photographs and/or video recordings taken of me by agents or employees of the company for training, promotional or advertising purposes related to AIM Leasing Company. This permission includes, without limitation, the right to reproduce these images and/or video in various printed publications, displays, electronic/online media, broadcast opportunities and other means, where applicable. I understand that all photos and/or video recordings taken are without compensation to me, the undersigned, and are the property of AIM Leasing Company. (Signature) (Date) (Printed or Typed Name) (Phone) (Address) (City, State, Zip)

48 Controlled Substances and Alcohol Abuse Employee Name DQ-C/M5 Rev-1/16 Date 1) This signed receipt of and agreement to comply with the provisions contained in our Drug Free Workplace Policy (Policy located in your employee handbook that s provided to you). a. (CDL APPLICANTS): Under the terms of the Department of Transportation Controlled Substances and Alcohol Use and Testing Part 382, we are required to establish a drug and alcohol abuse policy for operators of commercial motor vehicles subject to CDL requirements of part 383. This includes drivers and mechanics. I understand the following testing is required to meet regulations: Pre-Employment, Random (as managed by DDTA Services Inc.), reasonable suspicion, post accident, return to duty, and follow up. Please Initial to indicate that: You have received this statement, you have read it and or been informed of its content, and you agree to abide by the policy in all respects. (Initials) 2) Consent & Release form for ALL Employees & Applicants: as an AIM employee or applicant I acknowledge that the Company s policy requires me to submit to drug testing and /or alcohol testing based on the requirements of this policy. This program is to promote safety and I freely and voluntarily consent to participate in all aspects of the testing program. I hereby release the Company, its employees, agents and contractors from any and all liability what so ever arising from these requests for testing, from the actual testing procedures, and from decisions made concerning my application for employment or resultant discipline based upon drug and/or alcohol test results. (Initials) 3) Retest Policy: In the event that test results are contested, I understand that the cost of the retest in my responsibility. (Initials) 4) Reimbursement of post offer screens: I understand that should I choose to terminate my employment relationship with Aim Nationalease / Aim Integrated Logistics (hereafter called The Company) within 30 days of my start date, The Company is authorized to deduct the costs of any Post Offer drug screen ($50.00) and / or post offer physical ($50.00) from my final pay. (Initials) JJ Keller Alcohol and Drug Handbook Employee s Certified Receipt 5) This is to certify that I have been provided educational materials required by Section and my employer s policies and procedures with respect to meeting the Part 382 Requirements. The materials include detailed discussion of the following items: The Designated Person to answer questions about the materials The category of drivers subject to Part 382 Sufficient information about the safety sensitive functions and periods of workday that compliance is required. Specific information concerning prohibited driver conduct Circumstances under which a driver will be tested Test Procedures, driver protection, the integrity of the testing process, and safeguarding the validity of the test. The requirements that the test is administered in accordance with Part 382 An explanation of what is considered a refusal to test and the consequences The consequences of Part 382 Subpart B violations including removal from safety sensitive functions and Part 40 Subpart O procedures. The consequences for drivers found to have an alcohol concentration of >.02 but <.04 Information in the affects of alcohol and controlled substances on: i. Individual health iv. Signs and symptoms of a problem ii. Work v. personal life iii. Available methods of intervening when a problem is suspected Acknowledged and Agreed: Employee Signature Employer Signature Date Date Retain in Employee s Confidential File

49 D.D.T.A. SERVICES, INC. DQ-C/M 4 Rev P.O. BOX 461, East Palestine, OH (330) or (800) AUTHORIZATION FOR RELEASE OF INFORMATION (Please Print) I hereby authorize D.D.T.A. Services, Inc.,* its Medical Review Officer, and staff to release the following information from the health record(s) of: (Patient Name) (SSN) (Patient Address) (Date of Birth) INFORMATION TO BE RELEASED: [X] Drug Screen results (pertaining to DOT or company policy drug collections) [X] Breath Alcohol result (pertaining to DOT or company policy breath-alcohol testing) covering the period(s) of service from: to (Date) (Date) INFORMATION IS TO BE RELEASED TO: AIM NationaLease / AIM Integrated Logistics 1500 Trumbull Avenue, Girard, OH Purpose of Disclosure: Company Policy (Drug Free Workplace Program) Expiration Date of Authorization: This authorization is effective through / / unless revoked or terminated by the patient or the patient's personal representative. Right to Terminate or Revoke Authorization: You may revoke or terminate this authorization by submitting a written revocation to us at the above address, Attention: Compliance Officer. Please understand that disclosures made in good faith may have already occurred in reliance on this authorization. Potential for Re-disclosure (to AIM only): Information that is disclosed under this authorization may be disclosed again by the person or organization to which it is sent. The privacy of this information may not be protected under the federal privacy regulations. This facility, its employees and officers, and providers are released from legal responsibility or liability for the release of the above information to the extent indicated and authorized herein. Information concerning substance abuse or HIV testing will not be requested or released without specific written authorization for the release of such information. Please SIGNATURE/PATIENT REPRESENTATIVE: Sign ONLY PRINT NAME: DATE: RELATIONSHIP TO PATIENT: Self WITNESS: DATE: **HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT** *D.D.T.A. Services, Inc. acts as the Third Party Administrator for AIM's Drug and Alcohol Program

50 Federal Cell Phone Ban & AIM Company Policy PF 5 Rev 8-12 FMCSR Using a hand-held mobile telephone. (a)(1) No driver shall use a hand-held mobile telephone while driving a CMV. (2) No motor carrier shall allow or require its drivers to use a hand-held mobile telephone while driving a CMV. Effective January 3, 2012, all Aim employees are prohibited from using any hand-held mobile device while operating any Aim-owned vehicles with a GVWR greater than 10,000 lbs. A final rule was issued by the Federal Motor Carrier Safety Administration prohibiting interstate truck and bus drivers from using hand-held cell phones while operating any commercial motor vehicle. Hands free use of a mobile telephone is allowed using either a wired or wireless ear piece or the speaker function of the phone. Dialing a mobile phone is prohibited. You can initiate, answer, or terminate a call by touching a SINGLE BUTTON on a mobile phone, ear piece, steering wheel, or instrument panel while in the driving position and properly restrained by a seat belt; you are not permitted to REACH for a mobile telephone. Push-to-talk function on a mobile phone is also prohibited. You cannot hold the phone, nor are you permitted to continuously hold a button necessary for the push-to-talk feature through a mobile phone. Driver fines for violating the rule are up to $2,750 for each offense and up to $11,000 to the carrier. AIM Policy & Procedure Handbook. 507 CELLULAR PHONES & OTHER COMMUNICATION DEVICES Safety must be the primary consideration of every Operator while behind the wheel of a vehicle. Excessive distractions of any kind can divert the attention of the Operator and help create unsafe driving conditions. Using cell phones or other communication devices while driving distracts the Operator and unnecessarily creates unsafe driving conditions. Effective immediately, employees of AIM are prohibited from using communication devices of any sort (whether purchased by Aim or the employee) while driving a company, personal or rental vehicle to conduct company business. If you must use a communication device to conduct company business while driving, pull over to a location where it is legal to stop and safe to proceed with your conversation or to operate the device. A hands- free cell phone is to be used at all times when available. In the interest of public and personal safety, several state and local governments have enacted laws and ordinances or proposed legislation regulating cellular phone usage in vehicles. Violation of these laws may expose the individual to criminal and/or civil penalties. AIM will not reimburse employees for fines they incur as a result of using a communication device to conduct company business. Violation of this policy could result in disciplinary action, up to and including termination of employment. I have read, understand, and agree to abide by the contents of this Federal Regulation and Aim policy. Driver s Name (Print) Driver s Signature Date Supervisor s Name (Print) Supervisor s Signature Date

51 CELL PHONE ALLOWANCE AIM requires drivers to be available by cellular phone while on a route assignment or on call, subject to applicable hands free compliance. In an effort to ensure drivers are available by cellular phone AIM has 2 means of ensuring drivers are available: (1) Drivers are eligible for a $25.00 per month cell phone allowance, or (2) Drivers may receive a company-issued cell phone. In accordance with this policy all drivers must select a program during orientation to be enrolled in the proper program, subject to account blackouts, established by AIM. Full Name: Driver Account Assignment: Cell Phone Option: (select one) Company Issued Cell Phone Personal Cell Phone Allowance My cell phone number is - - Cell Phone Allowances will be applied to the first full pay period immediately after date of hire. Cell Phone Allowances are paid as $5.77 cents per week untaxed and are placed in your pay check weekly. This amounts to $25.00 per month or $ per year. The reimbursement comes in the same means as your paycheck, either direct deposit or paper check. If for some reason you are inactive on payroll, this payment will become inactive during that time. Drivers may lose their Cell Phone Allowance if: Transferring to an account with a company black-out Repeated issues with accessibility (phone calls not answered, phones turned off due to a lack of minutes or payment) Acknowledged and Agreed: Employee Signature Authorized Employer Signature Date Date THIS FORM MUST BE RETURNED TO KIM SLATER IN DRIVER PAYROLL. PF 14

52 DQ 5 Rev MOTOR VECHICLE DRIVER S CERTIFICATION OF VIOLATIONS/ANNUAL REVIEW OF DRIVING RECORD Pre-Employment MOTOR CARRIER INSTRUCTIONS: Each motor carrier shall at least once every 12 months, 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 12 months (Section ). Drivers who have provided information required by Section need not repeat that information on this form. DRIVER REQUIREMENTS: Each driver shall furnish the list as required by the motor carrier above. If the driver has not been convicted of, or forfeited bond or collateral on account of any violation which must be listed, he/she shall so certify (Section ). COMPLETED BY DRIVER CERTIFICATION OF VIOLATIONS NAME OF DRIVER: (PRINT) DATE OF HIRE TERMINAL (CITY AND STATE) DRIVER S LICENSE NUMBER STATE EXPIRATION DATE I certify that the following is a true and complete list of traffic violations required to be listed (other than those I have provided under Part 383) for which I have been convicted or forfeited bond or collateral during the past 12 months. (If you have had no violations, check the following box - None) DATE OFFENSE TYPE OF VEHICLE OPERATED LOCATION If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation (other than those I have provided under Part 383) required to be listed during the past 12 months. Date of Certification (Today s Date) Driver s Signature COMPLETED BY MOTOR CARRIER ANNUAL REVIEW OF DRIVING RECORD MOTOR CARRIER INSTRUCTIONS: Review the Certification of Violations listed above and other information described in Section of the Federal Motor Carrier Safety Regulations. Complete the information requested below. I have hereby reviewed the driving record of the above named driver in accordance with Section and find that he/she: Meets minimum requirements for safe driving Is disqualified to drive a motor vehicle pursuant to Section Does not adequately meet satisfactory safe driving performance Action taken with driver: Reviewed by: Robert J. Thibodeau Safety Director Date AIM 1500 Trumbull Avenue Girard, OH , ext 155

53 Motor Vehicle Driver s DQ 6 Rev 8-10 CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS MOTOR CARRIER INSTRUCTIONS: The requirements in Part 383 apply to every driver who operates in intrastate, interstate, or foreign commerce and operates a vehicle weighing 26,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding. The requirements in Part 391 apply to every driver who operates in interstate commerce (or intrastate where applicable) and operates a vehicle weighing 10,001 pounds or more, can transport more than 15 people, or transports hazardous materials that require placarding. DRIVER REQUIREMENTS: Parts 383 and 391 of the Federal Motor Carrier Safety Regulations contain some requirements that you as a driver must comply with. These requirements are in effect as of July 1, They are as follows: 1) Number of driver s licenses: No person who operates a commercial motor vehicle shall at any time have more than one driver s license. If you have more than one license, keep the license from your state of residence and return the additional licenses to the states that issued them. DESTROYING a license does not close the record in the state that issued it; you must notify the state. If a multiple license has been lost, stolen, or destroyed, close your record by notifying the state of issuance that you no longer want to be licensed by that state. 2) Notification of Driver s License Suspensions: Section of the Federal Motor Carrier Safety Regulations requires that you notify your employer before the end of the following business day of any suspension, revocation, cancellation, lost privilege, or disqualification of your driver s license. 3) Notification of convictions: Any time you have been convicted of violating a state or local traffic law (other than parking), you must report such conviction, in writing, within 30 days to: 1) your employing motor carrier, and 2) the state which issued your license (if the violation occurs in a state other than the one which issued your license). The following license is the only one I possess: Driver s License No. State: Exp. Date: DRIVER CERTIFICATION: I certify that I have read and understand the above requirements. Driver s Name (Print): Driver s Signature: Date: Notes: Witness Signature: Retain in Employee s DOT File

54 Use a good pen with dark ink. Never write words in the grid area. For any spot with no info to record, leave blank. 1) Date your log, include the year 1a) If you have multiple consecutive days off (i.e. weekends or vacations) only date log for the first day off. Record total # of days off at the bottom where indicated, and include the info in the remarks section below grid. 8) The shipper/commodity section (at bottom of log) must be completed with both pieces of info; if you are empty, indicate such: Ex: MLCO/Food or Firestone/insulation (A bill of lading # can be used in place of the above info) 9) Sign your log at the end of each day, never beforehand. Must use name as it appears on your license & it must be legible. (If you have a co-driver or trainee, print his/her name below your signature, but sign your own log) 10) DVIR to be completed at end of day (never for a pre-trip); - ONLY when defects are found, shall a DVIR be prepared and presented to the shop for repairs (Rule 12/18/14). 11) Recap; Use side of log or inside cover, whichever is preferable to you. Be aware of your available hours; Aim is on 70/8. (Only lines 3 and 4 are calculated for your recap) On Duty: All time spent inspecting a unit; show 15 minutes for a pre-trip and post-trip every day. If you are on an overnight trip, show your post trip before hitting the bunk or going off duty. Show a pre-trip before hitting the road again. On Duty: All time spent traveling to the clinic & time spent at the clinic for a random drug screen, or post-a On Duty: All time in a roadside inspection LOGS: ORIENTATION The logs go through a scanner, and each image is read by a computer program. 4) Record your 4-digit ID number (if you do not know your number, leave the space blank ) (NO leading zeroes, no # signs, no letters, no dashes -- just 4 numbers) 5) The grid must be completed, no time left blank. Log it as you go, must match trip reports On Duty: All time at the scene of an accident until released by the officer DRIVER COPY Do your best not to tear the sheets; do not use staples or a three-hole punch -- these can cause the scanner to jam. Keep to the white center lines when drawing in the grid (do not draw on the existing black line at the bottom); use a ruler 2) Record total miles for end of day (must match trip reports) 3) Record tractor and trailer #'s; multiple trailers can be recorded in the remarks section 6) Each line must be totaled to the right of the grid; one digit per box; decimals are provided; fractions cannot be read 6a) Line 1 always equals for off-duty logs; do not forget to draw your line across the grid and sign the log 7) Every location from start to finish must be recorded; Never abbreviate a city name; Use state abbreviations On Duty: All time at a shipper/receiver either assisting in the delivery or exchanging paperwork On Duty: Fueling or load checks; if under 15 minutes you must flag the time and record number of minutes Ex: Fueling, Girard, OH, 6 minutes

55 HOURS OF SERVICE 1) You have 11 hours available to drive. 2) You must not drive after 8 hours of coming on duty unless you have taken a 30 minute break on Line 1. **Short-haul drivers are exempt from this rule (if you are released by the 12th hour at your normal work location AND have not driven past 100 air miles (115 miles in any one direction). 3) You must not drive after 14 hours of coming on duty (Lines 1, 2, 3, and 4 add into the 14 hour block). Ex: if you begin at 6am with a pre-trip, then 8pm is the 14th hour of your day and you may not drive. Tip: mark the 14th hour with a tick mark each time you begin so you know what time to look forward to. 4) You must take 10 consecutive hours off in order to start your 11 or 14 again * If you are using the bunk, take 10 straight hours on line 2; if you have no sleeper, take 10 hours on line 1. * You can switch back and forth between lines 1 and 2 for 10 hours. It is legal as long as you do not go to lines 3 or 4 during that 10-hour period. **Any period on line 1 or 2 less than 10 hours will count against your 14 hour day 5) The 16-hour exception can only be used by drivers who begin and return to the same location each day. To use the rule: a) You must have returned to the normal work reporting location for the previous 5 duty tours AND b) have been released from duty at that location within 16 hours AND c) have not used the exception in the previous 7 days. 6) Two hour additional driving exception: Can only be used in unforeseeable circumstances; forecasted weather and road closures do not count. The two hours is not intended for you to finish your route. It is only a time limit to allow you to get to the first available safe haven. 7) ALL hours-of-service violations occur on Line 3: Driving. a) if you are driving past 11 hours b) if you are driving past the 14th hour of your day c) if you are driving past the 70th hour in an 8-day period 8) The 34-hour restart is optional and complies with the July 1, 2013 regulation (at least through 9/30/2015). Otherwise, use a standard Recap to figure the hours of availability. I have received, read, understand, and agree to comply with the above instructions for completing my driver's daily log as well as meet all criteria for records-of-duty status as written in section 395 of the Federal Motor Carrier Safety Regulations. In addition, I have been thoroughly trained on section 395 in order to stay in compliance with the regulations contained therein. If I have any questions regarding log compliance I will contact Cathy Jones, Safety & DOT Compliance, at , ext. 134 or Bob Thibodeau, Safety Director, at , ext. 155 (or Bob's cell at ). Driver's Signature Print Witness Signature Print Date

56 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 DAY 1 (Yesterday) DATE Issuing State: HOURS WORKED TOTAL HOURS 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 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. (Circle 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. WITNESS Driver s Signature Company Representative Date Date Υ Retain in Employee s DOT File Υ

57 DQ 8 Rev FEDERAL MOTOR CARRIER SAFETY REGULATIONS I hereby acknowledge that I have received a copy of the Federal Motor Carrier Safety Regulations, 49 CFR parts 40 and 382, 383 and of the Department of Transportation. I agree to familiarize myself with these regulations and to comply with all the provisions of these regulations. I will also follow all company procedures as required by the Motor Carrier. Name of Driver Date AIM Integrated Name of Motor Carrier Company Representative Signature FMCSR Rev. Date

58 Name Date / / PF 13 Rev 1-15 Received JJ Keller s CSA Handbook (complete guide for CMV drivers): Signature Quiz - 17-item CSA quiz 1. The Comprehensive Safety Analysis (CSA) enforcement model changes how a driver and carrier comply with the Federal Motor Carrier Safety Regulations (FMCSRs): a. True. b. False. 2. Comprehensive Safety Analysis (CSA): a. Is a replacement for SafeStat. b. Is a means of scoring driver and carrier safety-related events during roadside inspections and crashes. c. Has a scored database for both the carrier and driver. d. All of the above. 3. Only those violations resulting in an out-of-service order are calculated into a BASIC Score. a. True. b. False. 4. The driver s score in the Driver s Safety Measurement System (DSMS) adds points to his/her license. a. True. b. False. 5. All violations occurring at a roadside inspection are: a. Categorized into one of six BASICs. b. Given a severity weight in relation to crash causation. c. Time weighted. d. All of the above. 6. The DSMS database: a. Is accessible to the general public. b. Cannot be challenged by the driver. c. Is only accessible by enforcement personnel. d. Is carried over to the next employer s CSMS score. 7. Drivers are not subject to any interventions under CSA. a. True. b. False 8. True or False? Any time a driver has contact with a trained officer, data is gathered for the Safety Measurement System (SMS)? A. True B. False

59 9. Severity Weighting is: A. The value of how much a violation hurts your driving record B. The amount out of compliance a driver or carrier is in the SMS C. The process of assigning a numerical value to a violation in the SMS D. The process of assigning a penalty to a particular violation 10. Time weighting is: A. How much time it takes for a violation to enter the SMS B. How many times a driver has received a particular violation C. A way of putting more emphasis on more serious violations D. A way of putting more emphasis on recent violations than past violations 11. True of False? As a driver's violations get older, they automatically diminish in value due to the passing of time. A. True B. False 12. The two "standalone" BASIC's are: A. Unsafe Driving and Fatigued Driving B. Unsafe Driving and Driver Fitness C. Driver Fitness and Fatigued Driving D. Vehicle Maintenance and Cargo Related 13. True of False? The Driver Fitness BASIC does not refer to the physical fitness of a driver, but rather the qualifications of the driver. A. True B. False 14. An out-of-service penalty or "kicker" is added to the severity weight of violations placed in particular BASICs, which means what? A. The severity weight is increased by 1 B. The severity weight is increased by 2 C. The severity weight is increased by 3 D. The severity weight is increased by A "relevant inspection" is" A. Any inspection you passed with flying colors B. Any inspection you didn't pass with flying colors C. Not severity-weighted and time-weighted in the SMS D. One that was conducted and documented by a trained officer 16. True or False? FMCSA has a range of intervention tools that only apply to carriers. A. True B. False 17. The surest way to generate low BASIC Scores is by: A. Driving defensively B. Knowing the regulations C. Continuing to upgrade your training D. All of the above

60 Breg International Sign-off Sheet Company Name This is to verify that Printed Name has been trained in the proper use of the Breg International Spill Kit as designed for commercial motor vehicles, and has viewed the Breg International Spill Kit video. Driver Signature Date / / Instructor Signature Printed Name

61 Accident & Injury Reporting Procedures All Employees: 1. All injuries, possible injuries and near misses are to be reported. They are to be reported as soon as possible after the injury to your immediate supervisor or manager as soon as reasonably possible after becoming aware of the injury/illness. 2. We encourage you to report all injuries, possible injuries and near misses without fear of retaliation so that we can determine the root cause of the injury or illness and work together to create a safer work environment. 3. If your immediate supervisor is not available injuries can be reported to the following personnel: Mark Mitcham, Director of Insurance (800) x-129 mmitcham@aimntls.com Bob Thibodeau, Director of Safety (800) x-155 (330) cell bthibodeau@aimntls.com Deb Neff, Insurance Specialist (800) x-127 dneff@aimntls.com 4. Injuries on an off shift can be reported to Central Operations at (800) , if it is a serious injury they will contact Mark Mitcham at home. Although our ultimate goal is not to have injuries we need to be prepared in the event of an injury so that our most valuable assets, our employees, receive the medical treatment they need to resume their pre-injury activities. Additional Information for Employee Operating Aim Equipment: Situation: As an AIM employee you are involved in an accident. Remember the defintion of an accident is: An event that causes monitary damage to Aim equipment An event that causes an area or piece of equipment to be different than you found it 1. Check yourself and any other parties for injuries in case an ambulance is needed; if so, dial 911 then call Aim as soon as you are able. 2. Check to make sure that the scene is secure and put out your emergency triangles if needed. 3. Call 911 and ask for police and/or EMT personnel to respond to the scene. 1 P a g e Employee retains pages 1-3 for their records, signs and returns page 4 to HR. AIMNEF PF 8 -Rev 01/16/2015

62 4. Take pictures of the accident scene (not just the specific damage but debris). Take wide angle shots that capture the landscape and the vehicles in relation to their surroundings. Try to get pictures before vehicles have been moved. If the accident involves another commercial vehicle take pictures of its DOT number. Use the entire roll of film. Take pictures of all damage, even minor damage and deer strikes. 5. Put your name and date on the camera. 6. Make sure to replace your accident kit upon return to your domicile. 7. Get as much information as possible. You will need: i. Driver Name ii. Truck and Trailer Number (or Vehicle Number) iii. Account or facility assigned. 1. If you are an Elite Fleet driver, list the account you are working for that day iv. Vehicle 2 information (if applicable) 1. Name of vehicle owner 2. Name of driver 3. Contact phone number 4. Insurance information 5. Policy number 6. Contact number for Insurance Agent 7. License plate information v. Location of accident (City and State) vi. Time of accident vii. Is the Aim equipment drivable? viii. Is the other vehicle drivable? ix. Police Department that responded 1. Department phone number 2. Crash/Incident Report Number 8. Contact Bob Thibodeau Bob Thibodeau, Director of Safety (800) x-155 (330) cell bthibodeau@aimntls.com 9. If Bob Thibodeau is unavailable, call Central Operations at a. Central Operations is staffed 24x7x365 b. Voic s are not acceptable. You must continue to call until you speak with an Aim representative 10. Make sure to turn in your accident kit to the Safety Department in Girard ASAP a. Turn it in at domicile to the supervisor b. Fax directly to Diane DelBene i. Fax # ii. If the accident kit is faxed make sure to turn your camera into your supervisor or nearest Aim Facility 2 P a g e Employee retains pages 1-3 for their records, signs and returns page 4 to HR. AIMNEF PF 8 -Rev 01/16/2015

63 11. Contact the Safety Department for guidelines on drug testing a. Ask if the test must be DOT or NON DOT b. Confirm the clinic name, location, hours, and phone number Please ensure that you follow this protocol for any and all Aim employees that are involved in an accident or incident, regardless of fault, preventability, or severity. Aim may need to involve our insurance company, legal professionals, or other parties as soon as the accident occurs. If you have any questions, please direct them to your regional manager or any member of the Field Support Center s safety department. IMPORTANT NUMBERS Aim Field Support Center Automated Switchboard Bob Thibodeau Extension 155 Accidents or Injuries Cathy Jones Extension 134 Accidents or Log Book Questions Diane DelBene Extension 138 Accidents or Incidents Central Operations Extension 124 Any Questions Mark Mitcham Extension 129 Injuries or Near Misses Debra Neff Extension 127 Injuries or Near Misses Road Rescue Breakdowns/Equipment issues as a result of an accident ACKNOWLEDGMENT RECEIPT of Accident & Injury Reporting Requirements & Procedures: This is to certify that, I,, have received, reviewed, and understand Aim s accident and injury reporting requirements and procedures that were provided to me. I will comply with its contents, practices, and promote safety. Employee Signature Date Aim Representative 3 P a g e Employee retains pages 1-3 for their records, signs and returns page 4 to HR. AIMNEF PF 8 -Rev 01/16/2015

64 PF 9 Rev 8-12 Pre-Trip Inspection Requirements Driver (Print) Account Date / / Supervisor As part of your pre-trip inspection, you are required to be certain that each of the following items are present, current, and legible. 1) Registrations for both the tractor and trailer 2) Registration sticker on license plate 3) Insurance Card 4) IFTA license/sticker 5) Federal Annual Inspection for both the tractor and trailer 6) PUCO Tax Receipt 7) Rental Contract on substitute or extra units 8) Driver s License: # St. Exp. / / Medical Card Exp. / / 9) Log Book 10) Camera and Accident Kit (to be kept on driver s person while on-duty for AIM) 11) Previous day s DVIR 12) Spill Kit 13) Drug Test Kit (for Colorado account drivers) *If any of the above items are missing or expired, please contact Central Operations before you leave-out, at I understand that it is my responsibility as part of my mandatory pre-trip inspection to verify that all items are present and currently valid on any unit or equipment I operate. I further understand that I will be held responsible for any write-ups, fines or other actions served in response to these items not being present and/or valid during any roadside inspection, or other form of official inspection as conducted by a law enforcement agency or company official. Driver s Signature Supervisor s Signature Safety Department Representative Rev. 08/2010 CJ

65 PF 1 Rev 1-15 Three Points of Contact Rule What is the 3 Point Contact Rule? How do many driver injuries occur? These two questions and their answers are closely connected. Many drivers get hurt entering or exiting their trucks or climbing on or off their trailers. The 3 Point Contact Rule is used to reduce the chance of driver injury from happening. To ensure that you do not slip or fall while entering or exiting your cab make sure you have contact with 2 Hands and 1 Foot or 1 Hand and 2 Feet. This means that both feet should be planted firmly on the steps with one hand grabbing a solid object such as a steering wheel or grab handle. The other scenario is to have both hands on a grab handle(s) or steering wheel and one foot on the step as you enter or exit the truck. This is the 3 Point of Contact Rule. Your hands need to be empty. Drivers, please remember it is safer to exit the cab facing inward rather than exiting facing outward. By exiting forward you increase the risk of slipping and causing injury to your back and head. If you do not already exit and enter the cab facing inward, start this habit today. Practice the 3 points of contact rule! Your hands need to be empty. Climbing off your trailer is another dangerous activity. Make sure you are using 3 solid points of contact when climbing on and off your trailer. Always be sure of your footing and hand grasps as conditions change with regard to weather, surface, load, and trailer configurations. Be sure your deck plates are secure and free of debris. If you do not have a deck plate, do not stand on the frame rails to hook your air and electrical lines. Keep both feet on the ground. The goal is to remain safe and injury free. You do not do yourself or your family any good if an injury sidelines your ability to work and perform tasks around the home. AFTER SAFELY EXITING YOUR CAB WITH YOUR FEET ON THE GROUND WALK SAFELY AND CAREFULLY WITHOUT TRIPPING OR FALLING. REMEMBER ALWAYS USE THE 3 POINTS OF CONTACT RULE. Expect the unexpected. BE SAFE. I have read, understand, and agree to abide by the 3 Points of Contact Rule. Fuel Levels and Cab Lockouts (Initials) As part of your pre-trip inspection, you as a professional driver must check the conditions of the fuel tanks. You must do a visual inspection of your fuel tanks. You must look into the tank to be certain that it contains enough fuel (as determined by you the driver), that the cap has an intact rubber gasket, and that the cap is secure. Do NOT rely on the fuel gauge! You must do a visual check that you have enough fuel. This is required as part of any CDL pre-trip inspection and it is a company policy. Each time you exit your cab you must be certain to have a key to enter your cab. In the event of a lockout call Road Rescue for assistance. ANY DRIVER THAT RUNS OUT OF FUEL OR LOCKS THEMSELVES OUT OF THEIR CAB MAY BE RESPONSIBLE FOR THE COST OF THE SERVICE CALL. (Initials) Print Sign Date

66 SMITH SYSTEM PF 18 Rev -11 FIVE KEYS TO SPACE CUSHION DRIVING: QUIZ Name Date / / Please read the following questions carefully. Take your time since many questions may contain more than one answer that is somewhat valid. Mark only the single best answer to each question, and as you do so, keep in mind that some questions may require you to draw conclusions based on the information you have learned about the Smith System. The recommended quiz taking time is 10 minutes. If you do not know the answer to a question, we suggest that you move on and come back to it if time permits. 1. Getting the "Big Picture" requires: 7. The distance drivers look ahead should vary A. Maintaining a proper following distance depending on speed. B. Checking your mirrors approximately every A. True 5-8 seconds. B. False C. Looking well ahead of your vehicle D. All of the above 8. Obtaining eye contact insures that people will not do the unexpected. 2. Besides stopping distance and reaction time, A. True the proper following distance provides: B. False A. Room to increase your speed if it becomes necessary 9. Which of the following is not one of the 5 Keys? B. Swerving room when you encounter the A. Get the Big Picture unexpected B. Make Sure They See You C. Assurance that people will not "cut you off" C. Detect Problems Early D. Increased visibility & additional time to D. Leave Yourself an Out make decisions 10. The best time to tap your horn is: 3. Following a large vehicle too closely most directly A. When drivers make mistakes affects your ability to use which Key? B. When you are angry & wish to vent your A. Aim High in Steering emotions B. Keep Your Eyes Moving C. Early enough to warn others & still have time C. Leave Yourself an Out to avoid conflict if they do not respond properly D. Make Sure They See You D. Whenever there is sudden, unexpected movement nearby 4. The vision defined as an "early warning system" is: A. Central cone 11. A 15-second eye-lead time is defined as: B. Peripheral A. The distance between you & the vehicle in C. Clear front of you D. Investigative B. The frequency of mirror checks in a quarter of a minute 5. A negative affect of a "fixed stare" is: C. The distance, measured in seconds, that your A. Vision becomes blurred eyes lead your vehicle B. Central cone vision is diminished D. Your total space cushion measured in seconds C. Peripheral vision is deminished D. None of the above 12. When you slow or stop your vehicle, from which direction is danger most likely to come? 6. The Smith System suggests use of the mirrors A. The front - you should scan ahead every: B. The sides - you should scan intersections as you A. 2 seconds touch the brake B seconds C. The rear - you should check your mirror as you C. Whenever your peripheral vision detects touch the brake movement in any mirror D. None of the above D. 5-8 seconds

67 13. Selecting the proper lane relates most closely to 20. Which situation should require increased following using which Key? distance? A. Aim High in Steering A. Poor weather conditions B. Get the Big Picture B. Having a tailgater C. Keep Your Eyes Moving C. When a large vehicle is in front of you D. Leave Yourself an Out D. All of the above E. Make Sure They See You 21. Which part of your "space cushion" is the most 14. It is wise to avoid letting your eyes pause on an difficult to control? object for more than: A. The front A. 4 seconds B. The left B. 2 seconds C. The right C. 5-8 seconds D. The rear D. 15 seconds 22. Obtaining space, visibility and time, are primary 15. The "Smith System " is designed to help goals of the Smith System. compensate for: A. True A. The poor judgment of others B. False B. Changing conditions C. Foul weather conditions 23. Which Key provides for communication with D. All of the above other drivers? A. Get the Big Picture 16. The single largest factor in most motor B. Leave Yourself an Out vehicle collisions is: C. Make Sure They See You A. Poor weather D. Aim High in Steering B. Driver error C. Vehicle condition 24. Peripheral vision provides about what degree of D. Fatigue visibility for the average person? A How many types of warning devices are available B. 90 on most vehicles? C. 180 A. Three D. 360 B. Four C. At least five 25. What is the best way to avoid a backing accident? D. Two A. Back in first B. Select a spot that makes backing unnecessary 18. In most cases, how far should you back your C. Use a guide to assist you in the backing task vehicle? D. Sound your horn before backing A. Until you align your vehicle with the direction you wish to travel B. No farther than is necessary C. Until you hear the sound of breaking glass D. Until you have cleared all fixed objects by at least six feet For Office Use Only Reviewed by Date / / Correct Answers of 25 = % Pass Fail 19. Which part of the space cushion is easiest to control? A. The rear B. The sides C. The front D. Drivers are unable to control any of them

68 DRIVER S DAILY LOG: QUIZ Name Date / / DIRECTIONS: Circle the letter of the best answer. 1) What is the maximum number of driving hours allowed in a 14-hour window? a. 10 b. 8 c. 11 2) If the maximum number of driving hours is met, one must break for consecutive hours to remain legal. a. 11 b. 10 c. 14 3) I can continue on line 4 (On duty: Not driving) after 14 consecutive hours on duty. a. True b. False 4) If the sleeper-berth provision is used, one sleeper period must be at least hours to count toward a legal break. a. 8 b. 5 c. 1 5) True or False: As seen in this diagram, sleeper-berth hours (line 2) can be added to off-duty hours (line 1), combining for a legal break. 1 6hrs Off Duty a. True b. False 2 4hrs Sleeper 3 4 6) Which of the following must be recorded on the driver s daily log as On duty: Line 4? a. Random Drug Screens d. Pre- and post-trip inspections b. DOT Roadside Inspections e. All time preparing bills of lading c. Time spent at the scene of an accident f. All of these items 7) True or False: It is legal to abbreviate city names of locations recorded on the log. a. True b. False 8) True or False: It is required to record shipper/commodity or bill of lading information on the log. a. True b. False 9) I must complete a Driver Vehicle Inspection Report each day whether or not a defect is noted: a. True b. False 10) At what time is the DVIR prepared according to (a)? a. Before a duty tour b. In the middle of a route c. At the end of a duty tour CJ 6/22/15 1

69 11) Once you have come on duty which gridlines count toward the 14-hour rule? a. Lines 3 and 4 b. Lines 1 and 2 c. All of the above 12) Which gridlines are used to calculate the recap (70hours/8 days)? a. Lines 1 and 2 b. Lines 3 and 4 c. All of the above 13) How often may a 34-hour restart be used? a. as often during the week as necessary b. once per week c. never 14) After coming on duty, when is a driver required to take a minimum half-hour break? a. within or just after the first 8 hours b. there is no requirement c. after 11 hours 15) Does a half-hour break count against the 14-hour window or extend the work hours? a. a break extends work hours b. a break counts against the 14 16) When are you required to sign your log? a. before I begin my trip b. at the completion of my day s work c. it s not necessary 17) Company trip sheets are not Federal documents; therefore, logs do not have to match delivery times or locations from the trip sheets. a. True b. False 18) What items below are considered supporting documentation? a) Dispatch records d. Cash advance receipts b) Lumper receipts e. Traffic citations c) Scale tickets f. All of these items 19) True or False: Work performed outside the employ of the motor carrier for compensation must be recorded on Line 4: On duty. a. True b. False 20) Which of the following forms of compensation must be recorded on Line 4: On duty? a. Building the neighbor s deck for cash d. All of these situations b. Self employed landscaping service e. None of these situations c. Changing oil/brakes on daughter s car for a carton of cigarettes 21) If I am driving a truck equipped with an ELD (electronic logging device) I do not have to carry a paper log book. a. True b. False 22) Each commercial vehicle equipped with an ELD is required to have on board an instruction sheet pertaining to the device. a. True b. False Employee Signature Safety Dept. (Name of Reviewer) CJ 6/22/15 2

70 PF 15 rev 1/15 DRIVER NAME: DATE: ACCOUNT: People Net Training Videos Please check off next to the video viewed: Automated Work Flow Video EDriver Logs Video Driver Signature Witness Signature

71 A c k n o w l e d g m e n t R e c e i p t A I M E m p l o y e e / O p e r a t o r P o l i c y & P r o c e d u r e H a n d b o o k This is to certify that I have received the company handbook and understand that it provides important information about the company. The handbook will also be posted on our website in the Employee Zone. Should you have any questions or concerns regarding any of the material in the handbook please contact your immediate Supervisor or Human Resources. The handbook is designed to acquaint you with the Company and provide you with information about working conditions, employee benefits and some of the policies affecting your employment. You should read, understand, and comply with all provisions of the handbook. It describes many of your responsibilities as an employee and outlines the programs developed by the Company to benefit employees. Other handbooks or manuals may also provide you with important information about your position and responsibilities. One of our objectives is to provide a work environment that is conducive to both personal and professional growth. The Company s intent is to comply with all applicable federal, state, and local laws and regulations. Where local, state, or federal law conflicts with a policy in this handbook, the applicable law supersedes any conflicting Company policy. Although all the information in the handbook is important and useful there are a few items below we wanted to review with you: All Employees will receive, please indicate receipt for the items listed below: I acknowledge receipt of the combined AIM Employee / Operator Policy & Procedure Handbook Aim Employee and Operator Policy & Procedure Handbook: (Please review the book and chapters.) Work Rules and Disciplinary Action Safe Driving Practices Hours of Service & Record of Duty Status Accident Instructions Vehicle Inspections Personal Safety Dispatch Procedures Drive Trip Reports Cellular Phones & Other Communication Devices Pre-trip, Post-trip and Enroute Inspections including Pre-trip Inspection Requirements: ONLY 1 Tractor or 1 Trailer should be WRITTEN on a SINGLE DVIR Sheet Video Acknowledgement: I acknowledge that I have watched and understand the following videos and all of my questions have been answered. Drug & Alcohol Video (All Employees) Sexual Harassment Video & Policy (All Employees) Smith System Video & Quiz CSA Video, Book, & Quiz Log Quiz Accident Kit & Camera: I acknowledge that I have received an accident kit & camera. I understand and agree to have the camera and report form with me at all times I am on duty. I understand what is required of me should I be involved in any accident and understand it should be immediately reported to the Safety Department and my manager; no voic . Cameras are not assigned to the truck but to each driver. Employee Signature Printed Name Date AIM Representative Signature Printed Name Date PF 3 Rev 12-16

72 1500 Trumbull Ave Girard, OH I am excited to announce the upgrade of the AIM Drive for Gold program to the new platform on January 2 nd The program is similar but has been upgraded to include a better shopping experience! Some of the changes include new items (live shows/concert tickets, more travel options, and sale items), advanced search feature (you can now narrow your search by point value!) and a real time tracking of your orders. The AIM Driver Rewards site will also have a new web address Your account will be transferred to the new platform on December 28 th 2015, and will be temporarily unavailable until January 1 st You will no longer be able to access your account using the old web address ( The AIM Driver Rewards program is a small token of our appreciation and is intended to reward and recognize individuals for their years of service, productivity, survey completions and safe driving. All full time account and elite fleet Aim Integrated drivers are eligible and will be automatically enrolled in this program. The program is simple. You will be awarded points in several categories like safe driving, company safety training or exceeding customer requirements to name just a few. You will have an online account that will automatically keep track of your points. You may redeem your points for merchandise at the online store. As points accrue, so does the value of your account. You will be able to exchange these points for thousands of products such as, electronics, power tools, housewares and name brand clothing. As part of the program you will be asked to participate in an online survey about your employment experience at Aim. The survey, as well as the entire program, is being administered by a third party. The survey is anonymous and only statistical data will be provided to management. Tom Fleming Aim Integrated Logistics

73 AIM DRIVER REWARDS PROGRAM ACCESS IS EASY!!! You will need to register your account the first time. G o t o : h t t p s : / / a i m d r i v e r r e w a r d s. c o m / i n v i t a t i o n. a s p x Enter your AIM + Driver # in the box to enroll. Once registered, please use aimdriverrewards.com. Once logged in, you will see the following tabs: Home this will show you your total reward points available along with special news from your company and special offers available. View this page often to keep up with current events. My Account this is where you see a detailed list of all reward points you have earned, redeemed and balance. You can also view orders you have placed. Shopping this is where you will redeem your points. There are thousands of name brand items. Some even include in-store pickup! Rewards this page describes the reward categories and how you can earn points. Learning this is where you will be able to earn points by completing company quizzes and surveys. Contact this is where you can the website support staff any questions you may have regarding the website, an order you placed or a reward points discrepancy. Profile this is where you will change your contact information, , shipping address and password. FAQ this has answers to the most Frequently Asked Questions. These are the reward categories and points you can earn! Reward Items Schedule Points Daily Trivia Daily 100 On Time Trip Sheets Weekly 500 Accurate & Timely Log Books Monthly 1,000 Completion of Safety Message / Quiz Monthly 2,000 Worked over major holiday - (New Year s Day, Memorial Day, July 4th, Labor Day, Per Occurrence 3,000 Thanksgiving Day and Christmas Day) Clean Level 1 DOT Inspection Per Occurrence 15,000 Clean Level 2 DOT Inspection Per Occurrence 10,000 Clean Level 3 DOT Inspection Per Occurrence 5,000 Orientation Completion Per Occurrence 4,000 Company Safety Training / Meeting Quarterly 2,000 No Preventable Accidents Quarterly 2,500 No WC Injuries Quarterly 2,500 Driver of the Quarter - by Region Quarterly 40,000 Years of Service at 6 Months Semi-Annually 10,000 Early renewal of medical card Annually 5,000 Driver Appreciation Week Annually 5,000 Driver Appreciation Week - 5 Fun Raffles Annually 50,000 Driver of the Year (Candidates will be selected from the winners of the Driver of the Quarter) Annually 60,000 Safe Driver Award Annually Varies Survey Completion Annually 4,000 **Reward categories are subject to change at the discretion of management.