VLA TRANSPORT LLC
337W 16TH ST
SAN BERNARDINO, CALIFORNIA, 92405
JESUS MANUEL LIZARRAGA MEZA
2/12/1977
5593693533
LIZARRAGAJESUSMANUEL21@GMAIL.COM

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

PRI FRIDA KHALO FRACC VILLA DEL REAL #24228 B 78, TIJUANA , BAJA CALIFORNIA, 22205
20 AÑOS

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

DRIVER LICENSES
STATE LICENSE NUMBER CLASS ENDORSEMENTS EXPIRATION DATE
BCN BCN0220699 B INT 4/30/2026
DRIVING
CLASS OF EQUIPMENT TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC) DATE
FROM TO
APPROXIMATE NUMBER OF MILES (TOTAL)
Straight Truck 5/29/2018 5/1/2024 450000
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
5/15/2024 SOLO DAÑOS LEVES A LA UNIDAD 0 0
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:
  1. A. Have you ever been denied a license, permit, or privilege to operate a motor vehicle? No
  2. 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:

MDD LOGISTIS/MDD TRANSPORT
3/31/2023
C. OTAY MAGISTERIAL S/N 22 COL. MAGISTERIAL CP 22470 TIJUANA BC
4/15/2024
CHOFER
5000 USD Month
AMDREA
0000000000
POR REMODELACIONES DE LA EMPRESA YA NOE RA POSIBLE DEJAR LA UNIDAD EN EL ESTACIONAMIENTO
OMEGA COMPLIANCE SOLUTIONS LLC
3/22/2023
1614 PIONEER WAY EL CAJON CA 92020
3/30/2023
CHOFER
4000 USD Month
HENRY GAMIÑO
6193121545
INCUMPLIMIENTO POR PARTE DE LA EMPRESA DE LAS PRESTACINES OFRECIDAS
STEEL RIDERS TRCUKING
8/26/2021
CALLE DEL BAJIO LOTE MZ 650-181-12 COL GRANJAS FAMILIARES DEL MATAMOROS
8/29/2022
CHOFER
4800USD Month
RAFAEL ALEJANDRO GUTIERREZ SOBERANES
6642077771
MALA ADMINISTRACION DE LA EMPRESA, CAMBIO DE RAZON SOCIAL, LA EPRESA YA NO FUNCIONO
EXPO TRANSPORT
8/1/2015
CALLE VALLES #7301 RIO TIJUANA 3RA ETAPA TIJUANA BC
9/2/2019
SUPERVISOR
16000 MXN Month
ENRIQUE VARGAS VALDEZ
6642500993
EN BUSCA DE UNA MEJOR OPORTUNIDAD
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.

11/4/2024
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EMPLOYMENT RECORD (ADDITIONAL JOBS):
GAR QUI LOGISTICS
2/12/2009
AVE BONANZA 418-2 COL GRANJAS FAMILIARES MATAMOROS TIJUANA BC 22203
7/20/2015
CHOFER DE TRACTOCAMION
16000MXN Month
KEVIN GARCIA
0000000000
POR UNA MEJOR OPORTUNIDAD
Month
Month
Month
Month
Month

REQUEST FOR EMPLOYMENT INFORMATION FROM PREVIOUS EMPLOYER

PREVIOUS EMPLOYER:
ADDRESS:
Section 1 Prospective employer:
VLATRANSPORTLLC2023@GMAIL.COM
6641883044
Section 2 Prospective employee:
MDD LOGISTIS/MDD TRANSPORT
C. OTAY MAGISTERIAL S/N 22 COL. MAGISTERIAL CP 22470 TIJUANA BC
JESUS MANUEL LIZARRAGA
Driver
3/31/2023
4/15/2024
Section 3 Previous employer:
Yes
CHOFER
Yes
No
No
Yes
N/A
NO
NO
YES
YES
YES
NO
Excellent Good Fair Poor Very poor
Quality of work
Cooperation with others
Safety habits
Personal habits
Driving skill
Attitude
ANDREA
HUMAN RESOURCES
11/4/2024
signature

PART 3:
TO BE COMPLETED BY PREVIOUS EMPLOYER
DRUG AND ALCOHOL HISTORY

If driver was not subject to Department of Transportation testing requirements while employed by this employer, please check here , fill in the dates of employment from 3/31/2023 to 4/15/2024 complete bottom of Part 3. sign, and return.

Driver was subject to Department of Transportation testing requirements from 3/31/2023 to 4/15/2024

  1. Has this person had an alcohol test with the result of 0.04 or higher alcohol concentration?
    YES NO
  2. Has this person tested positive or adulterated or substituted a test specimen for controlled substances?
    YES NO
  3. Has this person refused to submit to a post-accident, random, reasonable suspicion, or follow-up alcohol orcontrolled substance test?
    YES NO
  4. Has this person committed other violations of Subpart B of Part 382, or Part 40?
    YES NO
  5. If this person has violated a DOT drug and alcohol regulation, did this person complete a SAP-prescribed rehabilitation program in your employ, including return-to-duty and follow-up tests? If yes, please send documentation back with this form.
    YES NO
  6. For a driver who successfully completed a SAP's rehabilitation referral and remained in your employ, did this driver subsequently have an alcohol test result of 0.04 or greater, a verified positive drug test, or refuse to be tested?
    YES NO

In answering these questions, include any required DOT drug or alcohol testing information obtained from prior previous employers in the previous 3 years prior to the application date shown on page 1.

JESUS MANUEL LIZARRAGA
MDD LOGISTIS/MDD TRANSPORT
C. OTAY MAGISTERIAL S/N 22 COL. MAGISTERIAL CP 22470 TIJUANA BC
0000000000
11/4/2024
PART 4a:
TO BE COMPLETED BY PROSPECTIVE EMPLOYER
This form was (check one)
Faxed to previous employer
Mailed
Emailed
Content
PART 4b:
TO BE COMPLETED BY PROSPECTIVE EMPLOYER

Complete below when information is obtained.

Fax
Mail
Email
Telephone
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
JESUS MANUEL LIZARRAGA
BCN0220699
RECORD DMV (DMV PRINT OUT)
:

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,

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LEONEL GARIBALDI VALENZUELA
OWNER
VLA TRANSPORT LLC
6641883044
337W 16TH ST
San Bernardino
California
92405

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

JESUS MANUEL LIZARRAGA
5593693533
PRI FRIDA KHALO FRACC VILLA DEL REAL
TIJUANA
Baja California
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)

YES

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

YES

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

YES

Placing the commercial motor vehicle in operation

YES

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

YES

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

YES

Turning the commercial motor vehicle

YES

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

YES

Backing and parking the commercial motor vehicle

NO

Other, please explain:

TRAILER 53 FEET
Date
11/4/2024
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OWNER
LEONELL GARIBALDI VALENZUELA

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

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

JESUS MANUEL LIZARRAGA
BCN0220699
Baja California
TRACTOR TRUCK
TRAILER 53 FEET
NO
This is to certify that the above-named driver was given a road test under my supervision on
11/4/2024 , consisting of approximately 10 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.

LEONELL GARIBALDI VALENZUELA
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OWNER
VLA TRANSPORT LLC - 337W 16TH ST , San Bernardino, California, 92405

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)

LIZARRAGA JESUS MANUEL
has demonstrated to me
LEONEL GARIBALDI VALENZUELA - OWNER

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

Straight truck

Informed on who to report safety concerns to

Tractor & trailer combination

Trained on how to secure a load. Tiedown procedure

Tank vehicle

Trained on spotting an improperly loaded vehicle

Vehicles 10,000 pounds to 26,000 pounds GVWR

Trained on safe use of mirrors & blind spois

Vehicles 26,001 pounds and more GVWR

Standard shift transmission

Properly hook up a trailer

Automatic transmission only

Safely operate a dump vehicle

Air brakes endorsement

Trained to perform a walk around inspection

Hazardous materials endorsement

Other

Employee Signature
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Date
11/4/2024
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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 JESUS MANUEL LIZARRAGA MEZA hereby provide consent to VLA TRANSPORT LLC to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse BCN0220699 to determine whether drug or alcohol violation information about me exists in the Clearinghouse.

I understand that if the limited query conducted by VLA TRANSPORT LLC 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 VLA TRANSPORT LLC to conduct a limited query of the Clearinghouse, VLA TRANSPORT LLC must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

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11/4/2024

Certificate of receipt of VLA TRANSPORT LLC drug and alcohol policy for DOT regulated drivers.

I certify that I am in receipt of, have read, and do understand VLA TRANSPORT LLC 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.

11/4/2024
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JESUS MANUEL LIZARRAGA MEZA