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The R 106 form plays a crucial role in the employment verification process for truck drivers within the trucking industry. Designed to collect essential information about an applicant's past employment, the form ensures compliance with federal regulations, specifically Section 391.23 and Section 383.35 of the Federal Motor Carrier Safety Regulations. This document requires employers to provide a complete employment history, including dates of employment and job titles, along with crucial details about the candidate's work performance. It also gathers information regarding the applicant's driving history, such as the number of accidents and types of vehicles driven. The form does not shy away from sensitive topics, as it inquires about past drug and alcohol test results, which are necessary for maintaining safety standards in commercial driving. Furthermore, it includes sections for employers to indicate if they would consider rehiring the applicant and to provide any additional comments on the applicant’s previous performance. Through this careful collection of data, the R 106 form aims to establish a comprehensive view of an applicant’s suitability for a position in the highly regulated trucking sector.

R 106 Example

Social Security # _______________________________

Past Employment Verification

I hereby authorize you to release the following information to

SWIFT TRANSPORTATION

(Prospective Employer)

for the purpose of investigation as required by Section 391.23 and allowed by Section 383.35 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability that may result from furnishing such information.

Date: _____________________

Applicant’s Signature: _________________________________________________________

ALL DATES OF EMPLOYMENT, INCLUDING GAPS, MUST BE COMPLETED BEFORE APPLICANT CAN BE EMPLOYED!

Applicant’s Name: ___________________________________________________SS #: ___________________________

Employer: __________________________________________________________ Phone #: ( ) ______- ___________

Street: ________________________________________City: ________________________ State: _______Zip: _______

Contact: ____________________________________________ Their Position: ___________________________________

1.Dates employed – from: ______/______/______ to: ______/______/______Voluntary termination Forced Termination

2.Job Title: ____________________________________________________________________________________________

( ) Company Driver

( ) OTR

( ) Single

( ) Tractor Trailer

( ) Van Reefer

( ) Owner Operator

( ) OTR Short Trips

( ) Team

( ) Straight Truck

( ) Flatbed

( ) Other ____________

( ) Local

( ) Student

( ) Other ____________

( ) Tanker

3.

Reason for leaving? ______________________________________________4. Transmission Type: ( ) Manual ( ) Automatic

5. Would you rehire? Yes

No

If no, why not? __________________________________________________

6. Number of accidents? (Get as much detailed information as possible). Total number of accidents? _______

 

 

 

 

 

 

 

 

 

 

Date

Nature of Accident

 

DOT

Preventable

Non-

Injuries

Fatalities

Cost

 

 

 

 

 

Reportable

 

Preventable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAST DRUG AND ALCOHOL TEST RESULTS

The above named individual has advised us that he/she worked for your company or that he/she applied to your company for work during the previous three

(3)years. The Federal Motor Carrier Safety Regulations (FMSCR 382.413 (a)(b)(c)(e)(f) require us to obtain from your company, and require your company to provide us information concerning the above named applicant’s past drug and alcohol test results (including refusals to be tested).

1.

Has this person tested positive for a controlled substance in the last three (3) years?

Yes

 

No

2.

Has this person had an alcohol test with a Breath Alcohol Concentration of 0.04 or greater in the last three (3) years?

Yes

 

No

 

3.

Has this person refused a required test for drugs in the last three (3) years?

Yes

 

No

 

 

4.

Has this person violated other DOT drug/alcohol regulations?

Yes

 

No

 

5.Have you received information from a previous employer that this person violated DOT drug and alcohol regulations? Yes No

6.Within the last three (3) years, has this person tested positive or refused any drug or alcohol test conducted under the

authority of your company, independent of the DOT or FMCSA requirements (Company Policy Test)?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL COMMENTS

 

 

 

 

 

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Signature of Preparer: ________________________________ Print Last Name: ________________________ Date: _____/_____/_____

R-106

Revised 07/27/10

Form Characteristics

Fact Name Description
Form Purpose The R 106 form is designed to authorize the release of information about a job applicant's past employment, drug, and alcohol test results.
Governing Law This form is governed by federal regulations, specifically Section 391.23 and Section 383.35 of the Federal Motor Carrier Safety Regulations.
Social Security Number Applicants must include their Social Security number on the form to verify identity and employment records.
Authorization Clause The form includes an authorization for the prospective employer to access certain employment information while protecting the previous employers from liability.
Employment History Requirement All employment dates must be filled in, including any gaps, before the applicant can gain employment.
Drug and Alcohol Testing The form requires information on past drug and alcohol test results to ensure compliance with drug and alcohol regulations.
Rehire Question The form contains a question regarding whether a previous employer would rehire the applicant, providing insight into the applicant’s work history.
Signature Requirements An applicant must sign the form, confirming that all information provided is accurate and complete.

Guidelines on Utilizing R 106

Completing the R 106 form is an important step in providing necessary employment verification. Following the steps below will help ensure that the form is filled out correctly. Be sure to provide accurate information, as it is crucial for the prospective employer’s evaluation.

  1. Obtain the R 106 form: Make sure you have the most recent version of the form, dated 07/27/10.
  2. Fill in your Social Security Number: Write your Social Security number clearly at the top of the form.
  3. Provide your full name: Write your name in the designated space, ensuring it matches your identification documents.
  4. Enter employer information: Fill in the employer's name, phone number, street address, city, state, and zip code.
  5. Enter the contact person’s information: Write the name and position of the contact person at your former job.
  6. List employment dates: Provide the start and end dates of your employment, including any gaps in employment.
  7. State your job title: Fill in your job title as it appeared on your work records.
  8. Indicate the type of work: Check the boxes that best describe your job type and vehicle operated.
  9. Explain your reason for leaving: Provide a brief statement about why you left your last job.
  10. Select transmission type: Indicate whether you operated a manual or automatic transmission.
  11. Respond to rehire question: Indicate whether you would be eligible for rehire and provide an explanation if not.
  12. Detail accident history: List any accidents you were involved in, along with detailed information about each incident.
  13. Fill in drug and alcohol test results: Answer the questions regarding past drug and alcohol tests honestly based on your knowledge.
  14. Add any additional comments: Use the empty space for any further information relevant to your employment verification.
  15. Signature of the preparer: Ensure the person filling out the form signs it, along with their printed last name and the date.

What You Should Know About This Form

What is the purpose of the R 106 form?

The R 106 form is used to authorize a prospective employer to obtain verification of an applicant’s past employment and drug/alcohol testing history. This form ensures compliance with the federal regulations that govern the safety and qualifications of commercial drivers.

Who needs to fill out the R 106 form?

The applicant seeking employment in the commercial driving industry must complete the R 106 form. This includes providing relevant information about their previous employment and authorizing past employers to release details to the new potential employer.

What kind of information is required on the R 106 form?

The form requests the applicant's personal details, including their Social Security number, past employment history, job titles, reasons for leaving previous jobs, and details regarding previous drug and alcohol tests. All dates of employment, including any gaps, must be completed to move forward with employment requirements.

Why is it crucial to list all employment dates, including gaps?

Listing all employment dates, including gaps, is essential because the federal regulations require a complete employment history for verification purposes. This thoroughness helps ensure that the prospective employer can assess the applicant’s qualifications accurately and make informed hiring decisions.

What happens if an applicant has a positive drug test?

If an applicant tests positive for a controlled substance or has a Breath Alcohol Concentration of 0.04 or greater in the last three years, that information will be disclosed to the prospective employer. This could significantly impact the applicant's chances of getting hired as it raises compliance concerns with federal safety regulations.

What is the significance of the "Would you rehire?" question?

This question provides insight into the applicant's past performance and reliability. A negative response can signal potential issues concerning the applicant's work ethic, behavior, or qualifications, making employers cautious about proceeding with hiring.

How does the form protect previous employers?

The R 106 form includes a liability release that protects the previous employers from any legal repercussions resulting from sharing information about the applicant's employment history and drug and alcohol test results. This encourages honesty and transparency during the verification process.

What kind of accidents need to be reported on the R 106 form?

The applicant must provide details about all accidents, including the total number, the date of each accident, the nature of the incident, and whether it was preventable or resulted in injuries or fatalities. This information is crucial for assessing driving competency and safety considerations.

Is it mandatory for employers to provide information requested on the R 106 form?

Yes, under federal regulations, employers are required to provide the information requested about an applicant’s past employment and drug and alcohol test records. This is to ensure that prospective employers have all necessary information to evaluate the qualifications and safety history of commercial drivers accurately.

What should applicants do if they have questions about the R 106 form?

If applicants have questions about filling out the R 106 form or require clarification on any section, they should reach out to the prospective employer or a designated HR representative. It’s important to fully understand the form to ensure accurate and truthful information is provided.

Common mistakes

Filling out the R 106 form can be daunting, and it's easy to make mistakes along the way. Many individuals overlook small details that can lead to major complications in their employment verification process. Here are five common mistakes that people often make when completing this form.

One frequent error is the failure to fill in all dates of employment, including gaps. The form clearly states, “ALL DATES OF EMPLOYMENT, INCLUDING GAPS, MUST BE COMPLETED BEFORE APPLICANT CAN BE EMPLOYED.” Omitting this information can stall the hiring process and raise questions about an applicant's work history. Take the time to gather this information accurately to avoid unnecessary delays.

Another common mistake involves missing signature requirements. The applicant's signature and date are essential to authorize the release of employment information. Without these, the form is incomplete and may be rejected by potential employers. It’s a simple step, yet one that can halt progress in securing a job.

People also frequently overlook the importance of providing complete answers to questions regarding drug and alcohol testing. The form asks specific yes/no questions around past tests. Leaving these blank can raise red flags. Being forthright will not only ensure compliance with regulations but also build trust with prospective employers.

Additionally, applicants sometimes fail to provide clear reasoning for leaving previous jobs. The section asking for the “Reason for leaving” can be tricky, but vague or incomplete answers may prompt further scrutiny. Clearly stating the reason, whether it’s voluntary termination or not, is crucial for transparency.

Lastly, individuals often neglect to give thoughtful consideration to additional comments. This section can serve as a valuable opportunity to explain circumstances or highlight strengths. Leaving it blank deprives applicants of a chance to present themselves positively. Taking advantage of this space can set someone apart from the competition.

Avoiding these pitfalls will simplify the process of employment verification and help candidates move forward with confidence. The R 106 form may seem straightforward, but careful attention to detail ensures a smoother path to employment.

Documents used along the form

When completing the R 106 form, there are several accompanying forms and documents that can facilitate the verification process. Understanding these documents can help streamline the hiring process and ensure compliance with federal regulations. Below are common forms that may be used alongside the R 106 form.

  • Employment Verification Form: This document serves to confirm an applicant's employment history. It includes details about job titles, dates of employment, reasons for leaving, and more, allowing employers to authenticate the information provided by the applicant.
  • Drug and Alcohol Testing Consent Form: This form allows employers to obtain consent from job candidates to conduct drug and alcohol testing. It is essential for ensuring compliance with the federal regulations and maintaining a safe workplace.
  • DOT Medical Examination Certificate: This certificate confirms that a driver has passed a physical examination and meets the health standards set by the Department of Transportation. It is vital for positions requiring driving commercial vehicles.
  • Background Check Authorization Form: Applicants use this form to give permission to employers to conduct background checks. This includes criminal history and other relevant checks that inform employers about the candidate's suitability.
  • Form MCS-150: This is the Motor Carrier Identification Report required by the Federal Motor Carrier Safety Administration. It provides vital information about the company's operation, including the types of vehicles used and the services offered.
  • License and Endorsement Verification: This document verifies that the applicant possesses the necessary driver's licenses and endorsements required for the operation of specific commercial vehicles. It ensures compliance with local and federal driving requirements.
  • W-2 Insurance Authorization Form: This form allows employers to confirm whether an applicant has been covered by workers’ compensation insurance. It may be requested to review the applicant's history with workplace injuries and claims.
  • Incident Report Forms: If the applicant has had accidents during their previous employment, incident report forms provide detailed information about those occurrences. This documentation is vital for assessing the applicant’s driving record and safety practices.

Each of these forms plays a crucial role in the hiring process, particularly for positions that involve operating commercial vehicles. Employers benefit from meticulous verification, ensuring they make informed hiring decisions while adhering to relevant regulations.

Similar forms

  • Form 1003: This is a standard employment application form often required by employers to gather personal information, employment history, and references from job applicants.
  • Form I-9: This document verifies an employee's identity and authorization to work in the United States. Employers use it to confirm compliance with immigration laws.
  • W-2 Form: This form reports an employee's annual wages and the taxes withheld from their paychecks. It is important for tax reporting purposes.
  • Background Check Authorization Form: This form allows an employer to conduct background checks on a prospective employee, including criminal history and previous employment verification.
  • Release of Information Form: This document grants permission for employers to obtain specific information about a job candidate from previous employers or other sources.
  • Medical Examination Consent Form: Often required in safety-sensitive positions, this form gives employers the right to conduct medical examinations and drug testing.
  • Drug Testing Consent Form: This document provides consent for drug testing as part of the hiring process. It outlines what tests will be done and how results will be handled.
  • Employment Records Request Form: Employers may use this form to request employment history and records from previous employers during the hiring process.
  • Driver's Qualification File (DQF) Form: Necessary for drivers in the transportation industry, this form collects information to ensure compliance with federal regulations.

Dos and Don'ts

When filling out the R 106 form, it is crucial to approach the task with care and attention to detail. Below is a list of best practices as well as common pitfalls to avoid.

  • Do ensure all sections are completed: Make sure every required field, including dates of employment and contact information, is filled out accurately.
  • Do provide truthful information: Honesty is essential. Any false information can lead to disqualification from employment.
  • Do clarify gaps in employment: If there are periods of unemployment, provide explanations to avoid misunderstandings.
  • Do review the form before submission: Double-check for any errors or missing information to minimize complications.
  • Do sign and date the form: An unsigned form may be considered incomplete, which can delay processing.
  • Don’t leave questions unanswered: Blank responses can raise red flags and may result in the form being rejected.
  • Don’t provide unclear references: Ensure that any references included are capable of providing definitive information about your past employment.
  • Don’t rush through the process: Taking your time to fill out the form can significantly reduce the likelihood of errors.
  • Don’t ignore instructions: Read all provided guidelines carefully. They contain crucial information about completing the form properly.

By adhering to these do’s and don’ts, you can help ensure a smoother application process and increase your chances of a favorable outcome.

Misconceptions

  • Misconception 1: The R 106 form is only needed for new hires.
  • This form is necessary for all applicants, regardless of whether they are new hires or reapplying after a break in employment. Past employment verification helps maintain safety standards.

  • Misconception 2: Employers do not have to provide all past employment details.
  • According to federal regulations, all dates of employment, including any gaps, must be documented. Incomplete information can delay or prevent employment.

  • Misconception 3: The form is not legally binding for previous employers.
  • When a candidate signs the form, they authorize their past employers to disclose relevant information. Employers are released from liability, making compliance crucial.

  • Misconception 4: Only recent drug and alcohol tests are relevant.
  • The form requires information regarding drug and alcohol tests conducted over the past three years. This timeline is important for assessing a candidate's eligibility safely.

  • Misconception 5: Employers cannot refuse to provide information based on company policy.
  • Employers are required by law to respond to inquiries about past drug and alcohol test results. This requirement ensures proper evaluation of prospective employees.

  • Misconception 6: The R 106 form does not need additional comments.
  • Additional comments can provide valuable context about an applicant's previous employment. They help prospective employers make informed decisions based on comprehensive data.

Key takeaways

Filling out the R 106 form is an important step for individuals seeking employment within the transportation industry. Here are key takeaways that can guide applicants through the process:

  • Accurate completion is essential. All fields, including dates of employment and reasons for leaving, must be filled out completely.
  • Employers rely on the information provided. Gaps in employment history should be clearly noted to avoid confusion during the verification process.
  • The form includes a section for drug and alcohol testing history. Employers must comply with Federal Motor Carrier Safety Regulations when reporting this information.
  • An applicant's consent is required. The form includes a release for previous employers to share employment history and test results.
  • Verification of past employment is critical. Employers will use the information to determine an applicant's eligibility for hire.
  • Understanding your employment history is vital. Be prepared to discuss the nature of past jobs and any incidents or accidents.
  • Potential employers may inquire about rehiring. Responses can affect employment prospects, so it's important to answer honestly.
  • Payment of attention to details can make a difference. Clearly legible handwriting and complete sentences enhance the professionalism of the form.