Driver

COMPANY

VARSA INTERNATIONAL TRANSPORTATION INC

STREET ADDRESS

1021 WHITE ALDER AVE

CITY, STATE AND ZIP CODE

CHULA VISTA, CALIFORNIA, 91914

NAME

ARTURO PEDRO DE LA CRUZ LOVERA

DATE OF BIRTH

9/1/1959

SOCIAL SEC. NO.

TELEPHONE NUMBERS

EACH ADDRESS FOR THE LAST THREE YEARS (ATTACH SHEET IF MORE SPACE IS NEEDED);

ADDRESS

PRIV PIRUL #23680 R38 FRACC VILLA FONTANA, TIJUANA, BAJA CALIFORNIA, 22205

HOW LONG?

ADDRESS

HOW LONG?

ADDRESS

HOW LONG?

EXPERIENCE AND QUALIFICATIONS (ATTACH SHEET IF MORE SPACE IS NEEDED);

DRIVER LICENSES
STATE	LICENSE NUMBER	CLASS	ENDORSEMENTS	EXPIRATION DATE
BCN	BCN209768	B		9/6/2025

DRIVING
CLASS OF EQUIPMENT	TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC)	DATE FROM TO		APPROXIMATE NUMBER OF MILES (TOTAL)
Straight Truck		9/14/2001	9/19/2023	5000
Tractor-Semi Trailer
Tractor-Multiple Trailer
Other

ACCIDENTS
DATES (LAST THREE YEARS) (LIST MOST RECENT FIRST)	NATURE OF ACCIDENT (HEAD-ON, REAR END, UPSET, ETC)	FATALITIES	INJURIES

TRAFFIC CONVICTIONS AND FORFETURES
LOCATION	DATE	CHARGE	PENALTY

Note: This form is provided as a suggested format for a commercial motor vehicle driver's application for employment. A motor carrier may use any format for an application for employment which complies with 201.21.

ADVERSE LICENSING ACTIONS:

A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? No
B. Has any license, permit, or privilege to operate a motor vehicle been suspended or revoked? No

Explain below(or attach separate sheet if more space is needed);

EMPLOYMENT RECORD (ATTACH SHEET IF MORE SPACE IS NEEDED):

Note: Requires that you list your employment history' for at least the last 3 years and your Commercial Driving Experience for the Past 10 years:

NAME:

FROM:

ADDRESS:

TO:

POSITION HELD:

SALARY:

Month

INMEDIATE BOSS NAME:

PHONE:

REASON FOR LEAVING:

NAME:

FROM:

ADDRESS:

TO:

POSITION HELD:

SALARY:

Month

INMEDIATE BOSS NAME:

PHONE:

REASON FOR LEAVING:

NAME:

FROM:

ADDRESS:

TO:

POSITION HELD:

SALARY:

Month

INMEDIATE BOSS NAME:

PHONE:

REASON FOR LEAVING:

NAME:

FROM:

ADDRESS:

TO:

POSITION HELD:

SALARY:

Month

INMEDIATE BOSS NAME:

PHONE:

REASON FOR LEAVING:

APPLICANT MUST COMPLETE OR REVIEW THE ABOVE

APPLICANT'S ORIGINAL SIGNATURE MUST APPEAR BELOW

This certifies that this application was completed by me, and that all entries on ft and information in it are true and complete to the best of my knowledge.

9/19/2023

Date

(Applicant's Signature)

REQUEST FOR EMPLOYMENT INFORMATION FROM PREVIOUS EMPLOYER

PREVIOUS EMPLOYER:

ADDRESS:

Section 1 Prospective employer:

Mail:

VARSAEXEC@OUTLOOK.COM

Telephone:

6198864892

Section 2 Prospective employee:

Previous employer name:

Address:

Prospective employees name:

ARTURO PEDRO DE LA CRUZ

has made application to this company for

a position as a driver and states that he/she was employed by you as a (position):

Driver

from (starting date):

to (termination date):

Prospective employees signature:

You are hereby authorized to give to YOU COMPANY NAME all information regarding my services, character, and conduct while

in your employ and you are released from any and all liability which may result from furnishing such information to the

above name company.

Section 3 Previous employer:

1. Is the employment record with your company correct as stated above?

2. What kind of work did the applicant do?

No data

3. Did the applicant drive motor vehicles for you? Straight truck

Bus

Tractor-trailer

4. Was the applicant safe and efficient driver?

5. Give the dates of vehicles acidents in which he/she was involved.

N/A

6. Reason for leaving your employ: Discharged

Job abandonment

Resigned

7. Was the applicant's general conduct satisfactory?

8. Is the applicant competent for the position sought?

9. Did the applicant drink any alcoholic beverage while on duty?

	Excellent	Good	Fair	Poor	Very poor
Quality of work
Cooperation with others
Safety habits
Personal habits
Driving skill
Attitude

Remarks:

Reviewer Name:

Reviewer Job Position:

Date:

9/19/2023

Signature:

PART 3:

TO BE COMPLETED BY PREVIOUS EMPLOYER

PART 4a:

TO BE COMPLETED BY PROSPECTIVE EMPLOYER

This form was (check one)

Faxed to previous employer

Mailed

Emailed

Other

By:

Date:

Content

PART 4b:

TO BE COMPLETED BY PROSPECTIVE EMPLOYER

Complete below when information is obtained.

Information received from:

Recorded by:

Date:

Method:

Fax

Mail

Telephone

Other:

INSTRUCTIONS TO COMPLETE THE SAFETY PERFORMANCE HISTORY RECORDS REQUEST

PAGE 1 PART 1:Prospective Employee

Complete the information required in this section
Sign and date
Submit to the Prospective Employer

PAGE 2 PART 4a:Prospective Employee

Complete the information
Send to Previous Employer

PAGE 1 PART 2:Previous Employer

Complete the information required in this section
Sign and date
Turn form over to complete SIDE 2 SECTION 3

PAGE 2 PART 3:Previous Employer

Complete the information required in this section
Sign and date
Return to Prospective Employer

PAGE 2 PART 4b:Prospective Employer

Record receipt of the information
Retain the form

REQUEST FOR DRIVING RECORD

ARTURO PEDRO DE LA CRUZ

(Driver's Name)

BCN209768

(Driver's Operators License Number)

(Driver's Social Security Number)

Dear

The above named individual has made application with us for employment as a driver. Applicant has indicated that the above
numbered operator's license or permit has been issued by your state to applicant, and that it is in good standing.

In accordance with 49 C.F.R. 391.23(a)(1) of the Federal Motor Carrier Safety Regulations, we are required to make an inquiry
into the applicant's driving record during the preceding 3 years of every state in which the applicant has held a motor
vehicle operator's license or permit during those 3 years.

Therefore, please certify to us what the individual's driving record is for the preceding 3 years, or certify that
no such record exists if that be the case.

In the event this letter does not satisfy your requirements for making such inquiries, please send us instructions
and forms of yours as are necessary for us to complete our inquiry into the driving record of this applicant.

Respectfully yours,

Signature of individual making this inquiry

MAURICIO SALAS

Printed name of person making this inquiry

MANAGER

Title of person making this inquiry

VARSA INTERNATIONAL TRANSPORTATION INC

Name of Motor Carrier

6198864892

Phone Number

FAX Number

1021 WHITE ALDER AVE

Mailing Address

CHULA VISTA

City

California

State

91914

Zip Code

Note: This form is provided as a suggested format for requesting a driving record from a jurisdiction other than Texas. No format is prescribed, and each jurisdiction may have its own form.

DRIVER'S ROAD TEST EXAMINATION

Driver's Name

ARTURO PEDRO DE LA CRUZ

Phone Number

Driver's Address

priv pirul

City

Tijuana

State

Baja California

Zip Code

22205

The road test shall be given by the motor carrier or a person designated by the motor carrier. However, a driver who is a
motor carrier must be given the test by another person. The test shall be given by a person who is competent to evaluate
and determine whether the person who takes the test has demonstrated that he or she is capable of operating the vehicle
and associated equipment that the motor carrier intends to assign.

Rating of Performance

Task (as required by 49 C.F.R. 391.31)

N/A

The pre-trip inspection (as required by 49 C.F.R. 392.7)

N/A

Coupling and uncoupling of combination units, if the equipment he/she may drive includes combination units

N/A

Placing the commercial motor vehicle in operation

N/A

Use of the commercial motor vehicle's controls and emergency equipment

N/A

Operating the commercial motor vehicle in traffic and while passing other vehicles

N/A

Turning the commercial motor vehicle

N/A

Braking, and slowing the commercial motor vehicle by means other than braking

N/A

Backing and parking the commercial motor vehicle

Other, please explain:

Type of equipment used in giving the road test:

Date

Examiner's Signature

Examiner's Title

Examiner's Printed Name

If the road test is successfully completed, the person who gave it shall complete a certificate of driver's road test.

Examiner's Remarks:

Note: This form is provided as a suggested format for recording a driver's road test. A motor carrier may use any format for documenting road tests which complies with 391.31.

Instructions: If a road test is successfully completed (see previous form), the person who gave it shall com- plete a certificate of driver's road test. The original or a copy must be retained in the employing motor car- rier's driver qualification file for the person examined. A copy should be given to the person who was examined.

CERTIFICATION OF ROAD TEST UNDER 49 C.F.R. 391.31

Driver's name

ARTURO PEDRO DE LA CRUZ

Social Security No.

Operator's or Chauffeur's License No.

BCN209768

State

Baja California

Type of power unit

Type of trailer(s)

If passenger carrier, type of bus

This is to certify that the above-named driver was given a road test under my supervision on
, consisting of approximately miles of driving.

It is my considered opinion that this driver possesses sufficient driving skills to operate safely the type of commercial motor vehicle listed above.

(Signature of examiner)

(Title)

VARSA INTERNATIONAL TRANSPORTATION INC - 1021 WHITE ALDER AVE , CHULA VISTA, California, 91914

(Organization and address of examiner)

Note: This form is provided as a suggested format for certifying a driver's road test. A motor carrier may use any format for certifying road tests which complies with 391.31.

DRIVER PROFICIENCY (CAC 13, 1229) and
AUTHORIZED VEHICLES (CAC 12, 1234 (b)

DE LA CRUZ ARTURO PEDRO

Driver's Name

has demonstrated to me

MAURICIO SALAS - MANAGER

Name & Title

That he/she can safely operate the below named vehicles/equipment as was trained for the following:

Employee Signature

Date

9/19/2023

A LONG FORM MEDICAL EXAMINATION REPORTS IS REQUIRED

COPY OF MEDICAL EXAMINER'S CERTIFICATE HERE

Internal Instructions:

Dispatch Dept:

All new hires must be directed to the Equipment Manager, with this form, for completion of the Driver Proficiency Process

Equipment Dept:

Process completed copy of this form to Payroll for recordkeeping

General Consent for Limited Queries of
the Federal Motor Carrier Safety Administration (FMCSA)
Drug and Alcohol Clearinghouse

I ARTURO PEDRO DE LA CRUZ LOVERA hereby provide consent to VARSA INTERNATIONAL TRANSPORTATION INC to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse BCN209768 to determine whether drug or alcohol violation information about me exists in the Clearinghouse.

I understand that if the limited query conducted by VARSA INTERNATIONAL TRANSPORTATION INC indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to (COMPANY) without first obtaining additional specific consent from me.

I further understand that if I refuse to provide consent for VARSA INTERNATIONAL TRANSPORTATION INC to conduct a limited query of the Clearinghouse, VARSA INTERNATIONAL TRANSPORTATION INC must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

Employee Signature

Date

Certificate of receipt of VARSA INTERNATIONAL TRANSPORTATION INC drug and alcohol policy for DOT regulated drivers.

I certify that I am in receipt of, have read, and do understand VARSA INTERNATIONAL TRANSPORTATION INC policies, procedures, and educational materials regarding substance-abuse prevention and substance-abuse testing, as required by the Federal Motor Carrier Safety Administration.

Specifically, I certify have received detailed information setting forth: (1) the identify of the person designated to answer questions about the Company’s Drug and Alcohol Policy for DOT-Regulated Drivers (“Policy”); (2) who is covered by the regulations; (3) what is meant by “safety-sensitive functions” so that I understand what period of the workday I am required to be in compliance with the regulations; (4) what is prohibited by the regulations and by the Company’s Policy; (5) the circumstances under which I will be tested; (6) the procedures for testing; (7) the requirement that I submit to testing as required by the regulations; (8) an explanation of what constitutes a refusal to-test, and the consequences for refusing to submit to testing; (9) the consequences under the regulations and the consequences as a matter of Company policy if I violate the regulations and/or test positive; (10) the consequences if I test positive for alcohol at the level of .02 or greater; and (11) information concerning the effects of alcohol and drug abuse on my health, work, and personal life, and signs and symptoms of alcohol or drug problems. I understand that if I am concerned about my use of alcohol or controlled substances, or the use of alcohol or controlled substances by a co-worker, I can and should seek assistance from the Company’s or from an appropriate assistance program in my community.

I understand that I may have a copy of this certificate of receipt if I so request.

9/19/2023

Date

Driver's Signature

ARTURO PEDRO DE LA CRUZ LOVERA

Driver’s Printed Name

ADVERSE LICENSING ACTIONS:

EMPLOYMENT RECORD (ATTACH SHEET IF MORE SPACE IS NEEDED):

APPLICANT MUST COMPLETE OR REVIEW THE ABOVE

APPLICANT'S ORIGINAL SIGNATURE MUST APPEAR BELOW

PREVIOUS EMPLOYER:

ADDRESS:

Section 1 Prospective employer:

Section 2 Prospective employee:

Section 3 Previous employer:

PART 3:

TO BE COMPLETED BY PREVIOUS EMPLOYER

DRUG AND ALCOHOL HISTORY

PART 4a:

TO BE COMPLETED BY PROSPECTIVE EMPLOYER

PART 4b:

TO BE COMPLETED BY PROSPECTIVE EMPLOYER

INSTRUCTIONS TO COMPLETE THE SAFETY PERFORMANCE HISTORY RECORDS REQUEST

REQUEST FOR DRIVING RECORD

DRIVER'S ROAD TEST EXAMINATION

CERTIFICATION OF ROAD TEST UNDER 49 C.F.R. 391.31

DRIVER PROFICIENCY (CAC 13, 1229) and AUTHORIZED VEHICLES (CAC 12, 1234 (b)

A LONG FORM MEDICAL EXAMINATION REPORTS IS REQUIRED

COPY OF MEDICAL EXAMINER'S CERTIFICATE HERE

Internal Instructions:

General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

Certificate of receipt of VARSA INTERNATIONAL TRANSPORTATION INC drug and alcohol policy for DOT regulated drivers.

DRIVER PROFICIENCY (CAC 13, 1229) and
AUTHORIZED VEHICLES (CAC 12, 1234 (b)

General Consent for Limited Queries of
the Federal Motor Carrier Safety Administration (FMCSA)
Drug and Alcohol Clearinghouse