Text Box: Lake Havasu Consortium Application Single Driver Application 1674 McCulloch Bl N Lake Havasu City AZ 86403 (928) 680-1123 Drivers Name: DOB Driver Lic # CDL Exp Date Cell Phone: Physical Address Mailing Address: (if different than above) Phone Number: Fax Number: Email Address: Print Company Name Print Contact Name: PLEASE READ THE INFORMATION BELOW THEN SUBMIT YOUR APPLICATION

Responsibilities of the Driver;

Provide timely notification of any change of contact numbers, mailing addresses, or other information.

Facilitate having the randomly selected driver tested for drugs and/or alcohol within a timely manner just before, during or immediately after they perform their safety sensitive job function as laid out in the DOT Regulations

Maintain files for D.O.T. Audits to include: A copy of this application, a copy of consortium certificate that shows date of subscription, and D.O.T. U.D.S. test results.

Report to us any changes in CDL Drivers status, 

All active CDL drivers must have a pre-employment DOT Drug Test prior to entering the consortium, UNLESS they have been tested within the last 365 days. Then all we will need is a copy of the MRO reports for our files.

 

*List of Responsibilities not necessarily all inclusive. Annual Subscription and fees are Non-Refundable. Contract is for one year and is annual renewed. Pricing is subject to change. Allowing annual subscription and/or fee to lapse will result in your company being removed from the Random Consortium Selection. Your subscription with Lake Havasu Consortium will begin on the date that both the Application and Payment are processed. DOT Compliance is ultimately your responsibility. Lake Havasu Consortium pledges to be consistent with its communication and selection process in accordance with the DOT standard, so as to assist you with Random Drug Screens and Breath Alcohol compliance.

 

 

 

Level One:

Level I is designed to meet the minimum requirements to comply with federal drug and alcohol testing.

Cost;

There is an annual fee for the driver of $79.00 and $45 for each required alcohol testing. $65 for each DOT drug testing. $58 for each DOT/ CDL medical exam. . (prices subject to change without notice)

 

What’s Included;

· Certificate of Enrollment

· Driver Education Booklets

· Driver Cards

· Drug Testing Policy

· Random Testing Pool Maintenance

· Computer Generated Random Selection

· Company Notification of Random Selection

· Result Notification

· Nationally Certified Laboratories

· Nationally Certified Medical Review Officer

· Chain of Custody Set up and distribution to qualified collection sites, nationwide

· Post Accident Kits

· Maintaining records database of all testing activity

· Quarterly and Annual MIS Reports

· Semiannual Laboratory Reports

DOT Rules & Regulations Change Notification

 

Click to submit application   

A staff member will contact you for payment information and to send you your certificates.           

 

Have you had DOT DRUG Test within last 365 days,                        Yes   No   Date

 

 Any Positive DOT Drug Test within last 2 years,                                Yes  No   Date

 

 Are you currently using your CDL _______                                        Yes  No  OR

 

 

Just Maintaining License and NOT currently driving commercially,    Yes   No