Welcome and thank you for your interest in driving for Xcalibur Logistics! Please fill out the attached Application making sure that all sections are completed including all requested signatures and boxes that need to be checked. Please write NE in any section that does not apply to you (example: accidents or traffic convictions). We are looking for drivers with at least 2 years of RECENT verifiable tractor trailer experience. Tanker and or Crude experience is a HUGE plus!! Please note the type of truck you ve driven (ex. flat bed, box truck, tanker, vacuum, etc.) and the product you were hauling for each of your former employers in the work history sections. Please also include a legible copy of your Medical Card (short form is fine) and the front AND back of your Driver s License. Please send all of this information back to recruiting@xcaliburlogistics.com or you can fax it to 832-320-2983 If you have any questions, concerns or need assistance with the application please contact Misty at 713-600-2663 Thank you!
DRIVER APPLICATION FOR EMPLOYMENT Name: Date: Last First Home Address: Building # Street Name Apt # City: State: Zip Code: DOB: Social Security No: Phone No: Email Address: - - Referred By: How did you hear about our company? Gender: MALE FEMALE What area of TX NM was being discussed in the posting or by the person who referred you? SOUTH TEXAS WEST TEXAS NEW MEXICO Dilley, TX Shiner, TX Jal, NM Pecos, TX PREVIOUS SEVEN YEARS RESIDENCY (ATTACH SHEET IF MORE SPACE IS NEEDED) Street APT. CITY STATE ZIP # YEARS Street APT. CITY STATE ZIP # YEARS Street APT. CITY STATE ZIP # YEARS Street APT. CITY STATE ZIP # YEARS Can you submit verification of your legal right to work in the United States? Are you 23 years old or over? Have you ever tested positive on a DOT Drug or Alcohol Test? 1 of 9
HIGH SCHOOL NAME CITY STATE EDUCATION AND TRAINING MAJOR COURSE OF STUDY CREDITS EARNED GPA GRADUATED TRADE SCHOOL COLLEGE GRADUATE SCHOOL List any other education, training, special skills, certificates or licenses. LICENSE INFORMATION Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below STATE LICENSE. TYPE EXPIRATION DATE DL ENDORSEMENTS A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? If yes, explain B. Has any license, permit or privilege ever been suspended or revoked? If yes, explain CLASS OF EQUIPMENT STRAIGHT TRUCK TRACTOR & SEMI-TRAILER TRACTOR - TWO TRAILERS OTHER DRIVING EXPERIENCE TYPE OF EQUIPMENT (van, tank, flat, etc) DATES FROM TO APPROXIMATE NUMBER OF MILES 2 of 9
ACCIDENT RECORD FOR PAST 3 YEARS (MINIMUM) (ATTACH SHEET IF MORE SPACE IS NEEDED) DATE (month year) NATURE OF ACCIDENT (head-on, rear-end, upset, etc) NUMBER FATALITIES NUMBER INJURIES CHEMICAL SPILLS TRAFFIC CONVICTIONS AND FORFEITURES FOR PAST 3 YEARS DATE CONVICTED (month year) If no traffic convictions and or forfeitures in the last 3 years check HERE VIOLATION STATE OF VIOLATION PENALTY (forfeited blood, collateral and or points) EMPLOYMENT HISTORY Applicants that desire to drive in intrastate interstate commerce must provide the following information on all employers during the previous THREE YEARS. You must give the same information for all employers you have driven a commerical motor vehicle for the SEVEN years prior to the initial THREE years (TOTAL OF TEN YEARS EMPLOYMENT RECORD). MOST RECENT JOB Name Title of Supervisor: From ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH YEAR) To Title: 3 of 9
Previous Employment Name Title of Supervisor: From To Title: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH YEAR) Previous Employment Name Title of Supervisor: From To Title: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH YEAR) 4 of 9
Previous Employment Name Title of Supervisor: From To Title: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH YEAR) Previous Employment Name Title of Supervisor: From To Title: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH YEAR) 5 of 9
Previous Employment Name Title of Supervisor: From To Title: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH YEAR) Previous Employment Name Title of Supervisor: From To Title: ANY GAPS IN EMPLOYMENT AND OR UNEMPLOYMENT MUST BE EXPLAINED. INCLUDE DATES (MONTH YEAR) 6 of 9
CRIMINAL RECORD INFORMATION Felony. Have you ever been convicted of, or pled guilty or no contest to, a felony? Misdemeanor. In the past seven (7) years, have you ever been convicted of, or pled guilty or no contest to, a misdemeanor? Pending Charges. Have you been arrested for any matters for which you are currently out on bail or on your own recognizance pending trial? CRIMINAL RECORD: If you answered "Yes" to any of the above questions, please provide the date(s) and describe the criminal record so that the individual circumstances can be considered. Criminal convictions and or arrests will T automatically disqualify an applicant from employment. Xcalibur Logistics, LLC, and its affilitated entities, shall consider each record and render a decision in its sole discretion. FCRA AUTHORIZATION Notification and Authorization for Consumer Reports and Investigative Consumer Reports Pursuant to the Fair Credit Reporting Act, Title VI [15USC 1681] This document shall serve as notification to you that Xcalibur Logistics, LLC and or any of its subsidiaries (hereinafter collectively referred to as "Company") may request a consumer report for the purpose of evaluating you for employment. This authorization may also be used at a later date to obtain a consumer report or an investigative consumer report for purposes including, but not limited to, your promotion, reassignment, or retention as an employee. This authorization shall remain on file and will serve as ongoing authorization for Company to request consumer reports and or investigative consumer reports at any time during your employment period. This release and authorization acknowledges that you understand that Company may now, or at any time during your employment, conduct verifications of, including but not limited to, your education, previouls employment, credit history, driving record, military records, any public records, social security number, and previous and current addresses. Additionally, this notification is authorization to contact personal references, obtain screening for the presence of drugs or alcohol, and obtain criminal history information pertaining to you which may be maintained by Federal, State, County, or Local criminal justice agencies, court houses or criminal record repositories. This notification and release are made pursuant to the provisions of the Fair Credit Reporting Act, Title VI [15 USC 1682]. If any adverse action is contemplated based on any information contained in the consumer report or investigative consumer Company will, prior to any action being taken, provide to you the report along with a copy of your rights under this Act. I have read and understand this consent and hereby authorize Company to obtain consumer reports and or investigative consumer reports regarding my employment. SIGN HERE PRINT HERE DATE 7 of 9
INFORMATION RELEASE To be read and signed by the Applicant I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only and and after a conditional offer of employment has been extended.) I hereby release emploers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations. "I understand that information I provide regarding current and or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand I have the right to: Review information provided by current previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information." Applicant's Signature Date This certifies that, for purposes of this application process, my electronic signature is valid in place of a handwritten signature. Applicant's Signature Date For our reference, please print your name and CDL number below. Printed Name CDL Number 8 of 9
DATA FOR BACKGROUND INVESTIGATION ONLY ACKWLEDGEMENT: I understand that this form will not be retained with any permanent personnel file, and that the sole purpose of this document is to facilitate a background investigation. I further understand that the information I have provided herein will T be considered in any hiring decision, except for reasons of falsification. By my signature below, I acknowledge my understanding of these facts, and further attest that all of the information I have provided is true and correct. I hereby authorize all persons, schools, all former employers, organizations, law enforcement agencies, or any other entity having information on me, to provide, either verbally or in writing, to, Spark Energy Gas, L.P. and or any of its subsidiaries (hereinafter collectively referred to as "Company"), Swailes & Co., its agents, or assignees, all pertinent background information that has been deemed necessary for Company and or Swailes & Co. to arrive at an employment decision. Furthermore, I agree to hold Swailes & Co., its agents, assignees, and any other person or entity that releases the aforementioned information, harmless and agree to release them from any liability arising from said background investigation. A photocopy or facsimile of this original form will serve as authorization. Signature Date Print Name Here 9 of 9