Saia LTL Freight (Dock) 05-21-2018 8:47:24AM CDT

11465 Johns Creek Parkway

John Creek, GA 30097
888-965-1230

IntelliApp - Dock

In compliance with Federal and State equal employment opportunity laws, qualified
applicants are considered for all positions without regard to race, color, religion, sex,
national origin, age, marital status, veteran status, non-job related disability, or any other
protected group status.

Position City State/Province

Dockworker PT North Bergen (NWK) NJ

Personal Information
Name Stacy Jones
Residence 3 years or longer (If No, Yes
previous addresses shown below)
Current Address 155-14 Jewel Avenue Apt.#3b
City, State/Province Zip/Postal Flushing, NY 11367
Country United States
SSN/SIN ###-##-5598
Date of Birth ##-##-####
Primary Phone 917-701-6952
Preferred method of contact Primary Phone
Best time to contact you Any
Email anwaarmuhammad1974@gmail.com
Yes, I want to receive information and Yes
communications from Saia LTL Freight
(Dock) concerning future opportunities or
promotions.
Yes, I want to receive text messages from Yes
Saia LTL Freight (Dock). *By participating,
you consent to receive text messages sent
by an automatic telephone dialing system.
Consent to these terms is not a condition
of hire. You may opt out at any time by
texting STOP to unsubscribe. Message
and Data Rates May Apply.
 Company Questions
GENERAL INFORMATION
What position are you applying for? Dockworker
Are you currently forklift certified? Yes
Do you have experience using a sit down Yes
forklift?
Do you have experience hostling, moving No
trailers between the yard and dock or
driving a yard mule?
Do you have freight handling experience? Yes
Do you have handling of hazmat Yes
experience?
Would you be interested in participating in No
a company-paid driver training program?
Can you provide legal documentation Yes
establishing your identity and eligibility to
be legally employed in the United States?
Will you now or in the future require No
sponsorship for employment visa status
(e.g., H-1B visa status)?
Are you currently employed? Yes
What date did your last employment end?
Do you read, write, and speak English? Yes
Have you ever worked for Saia, Westex, No
Action Express, Clark Brothers Transfer,
Connection Company, Madison Freight,
Robart Transportation or LinkEx?
Enter start and end dates, location,
position, and reason for leaving:
Please enter the names of any relatives
employed here:
Have you ever been known by any other No
name?
Enter name:
How did you hear about us? Indeed
If "Employee Referral", please enter the
employee's name
If "Other", please explain
List highest grade completed: Bachelor's Degree
List last school attended (name, city, and Ashworth College Norcross, G.A.
state):
List any skills, training, certifications or Forklift certification, Handling Hazmat
experience you may have that would aid certification
us in determining your qualification:

Employment / Unemployment
Fedex Freight
Company Fedex Freight
Start Date 04-2013
End Date 05-2018
Address 38 Porete
City, State/Province Zip/Postal North Arlington , NJ 07031
Country United States
Phone 201-467-2041
Position Held Fulltime dockworker
Reason for leaving? Still employed
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes

Lowes
Company Lowes
Start Date 02-2013
End Date 07-2013
Address 253-01Rockaway Blvd
City, State/Province Zip/Postal Rosedale, NY 11422
Country United States
Phone 516-837-4057
Position Held Seasonal Stock Associate
Reason for leaving? Seasonal
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes

Fedex Smartpost
Company Fedex Smartpost
Start Date 10-2009
End Date 12-2012
Address
Address 2 8451 Willard Drive
City, State/Province Zip/Postal Breiningsville, PA 18031
Country United States
Phone 610-973-5288
Position Held Shift Supervisor
Reason for leaving? Transferred
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes

Pathmark
Company Pathmark
Start Date 03-2005
End Date 09-2009
Address 2900 N Broad Street
City, State/Province Zip/Postal Philadelphia , PA 19132
Country United States
Phone 215-226-0231
Position Held Stock clerk
Reason for leaving? Relocated
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes

Federal FCRA Summary of Rights Acknowledgment

By checking this box, I acknowledge that I Yes
have read and understand the Summary of
Rights.

Certification Release
I agree with the above language Yes
 User Requested Copy
User requested a copy to be sent to this Yes
email address
anwaarmuhammad1974@gmail.com.

By my check of this box, I represent that I Yes

understand and agree to the above and
that I intend to execute this document by
electronic signature in checking this box.

Signature
Full Name Stacy Jones
IP Address 72.227.225.27
Signature Date/Time 05-21-2018 8:47 AM
By signing below I authorize Saia, Inc. and/or Saia Motor Freight Line, LLC (the
"Company") to act on my behalf to conduct a criminal background check. Further, I
understand that my employment is at will and for no definite period and may, regardless
of the date of payment of wages, be terminated at any time with or without previous
notice and with or without cause. I also understand that as a condition of employment, I
will be required to pass a controlled substance test involving a collection of my urine,
that a post offer physical may be required and I must successfully complete an E-Verify
check (subject to state law requirements). I understand that, as a continuing condition
of employment, I may be required to submit a D.O.T. recertification physical (drivers
only) and/or random controlled substance test(s), alcohol test(s), and other drug tests
as outlined in Saia's Drug and Alcohol policy. All information gathered shall be held in
strict confidence between the Company and the applicant / employee. Signing below
also certifies that this application was completed by me, and that all entries on it and
information in it are true and complete to the best of my knowledge.

Signed Date: 05-21-2018 8:47 AM

Signed:

5
 Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit
Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as
HireRight, LLC, and to the release of such background reports to the Company and its designated representatives and agents, for the
purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor
assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me
or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or
contract period.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my
employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also
understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information
service bureaus, credit bureaus, record/data repositories, courts (federal, state and local) , motor vehicle records agencies, my past or
present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the
consumer reporting agency.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I
agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background
reports that may be requested by or on behalf of the Company.

Printed Name: Stacy Jones

Stacy Jones 155-14 Jewel Avenue Apt.#3b
Flushing, NY 11367
Social Security #: 917-701-6952
###-##-5598 Gender:
Signed Date: 05-21-2018

6
 APPLICATION AGREEMENT

By checking I Agree below I authorize Saia, Inc. and/or Saia Motor Freight Line, LLC(the
"Company") to act on my behalf to conduct a criminal background check. Under the
provision of the Fair Credit Reporting Act 15 U.S.C 1681, et seq, notice is hereby given
that an investigative consumer report may be made which may include information
pertaining to your, character, general reputation, personal characteristics, and mode of
living, which will be used for employment purposes. Also, you have the right to request
the company to make a complete and accurate disclosure of the nature and scope of the
investigation requested by the company, pursuant to FMCSR 391.23, driver applicants
have the right to review information provided by previous employers, the right to have
errors in the information corrected by the previous employer and for that previous
employer to resend the corrected information. Driver applicants also have the right to
have a rebuttal statement attached to erroneous information, if the previous employer
and the driver cannot agree on the accuracy of the information. Your request must be in
writing and submitted within a reasonable time period after your application. The
company shall respond in writing, mailed or otherwise delivered, to you, not later than
five days after the date on which the request for such disclosure was received from you
or such report was first requested, whichever is later. I also authorize the investigation of
all statements contained in this application. I understand that any misrepresentation or
omission of facts called for on this application is cause for immediate dismissal. I hereby
grant permission to verify employment with current and former employers to obtain
information regarding my previous employment record. Further, I understand that my
employment is at will and for no definite period and may, regardless of the date of
payment of wages, be terminated at any time with or without previous notice and with or
without cause. I also understand that as a condition of employment, I will be required to
pass a controlled substance test involving a collection of my urine, that a post offer
physical may be required and I must successfully complete an E - Verify check(subject to
state law requirements).I understand that, as a continuing condition of employment, I
may be required to submit to a D.O.T. recertification physical(drivers only) and / or
random controlled substance test(s), alcohol test(s), and other drug tests as outlined in
Saia's Drug and Alcohol policy. All information gathered shall be held in strict confidence
between the Company and the applicant / employee. By checking "I Agree" also certifies
that this application was completed by me, and that all entries on it and information in it
are true and complete to the best of my knowledge.

7
Printed Name: Stacy Jones Signed Date: 05-21-2018
Social Security #: ###-##-5598

Signed:

8
 Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit
Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as
HireRight, LLC, and to the release of such background reports to the Company and its designated representatives and agents, for the
purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor
assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me
or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or
contract period.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my
employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also
understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information
service bureaus, credit bureaus, record/data repositories, courts (federal, state and local) , motor vehicle records agencies, my past or
present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the
consumer reporting agency.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I
agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background
reports that may be requested by or on behalf of the Company.

Employer / Contractor / Educational Institution: Stacy Jones

Pathmark 155-14 Jewel Avenue
Apt.#3b
Printed Name: Flushing, NY 11367
Stacy Jones 917-701-6952
Gender:
Social Security #:
###-##-5598
Signed Date: 05-21-2018

9
 Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit
Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as
HireRight, LLC, and to the release of such background reports to the Company and its designated representatives and agents, for the
purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor
assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me
or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or
contract period.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my
employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also
understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information
service bureaus, credit bureaus, record/data repositories, courts (federal, state and local) , motor vehicle records agencies, my past or
present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the
consumer reporting agency.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I
agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background
reports that may be requested by or on behalf of the Company.

Employer / Contractor / Educational Institution: Stacy Jones

Lowes 155-14 Jewel Avenue
Apt.#3b
Printed Name: Flushing, NY 11367
Stacy Jones 917-701-6952
Gender:
Social Security #:
###-##-5598
Signed Date: 05-21-2018

10
 Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit
Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as
HireRight, LLC, and to the release of such background reports to the Company and its designated representatives and agents, for the
purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor
assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me
or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or
contract period.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my
employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also
understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information
service bureaus, credit bureaus, record/data repositories, courts (federal, state and local) , motor vehicle records agencies, my past or
present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the
consumer reporting agency.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I
agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background
reports that may be requested by or on behalf of the Company.

Employer / Contractor / Educational Institution: Stacy Jones

Fedex Smartpost 155-14 Jewel Avenue
Apt.#3b
Printed Name: Flushing, NY 11367
Stacy Jones 917-701-6952
Gender:
Social Security #:
###-##-5598
Signed Date: 05-21-2018

11
 Authorization of Background Investigation

I have carefully read and understand this Disclosure and Authorization form and the attached summary of rights under the Fair Credit
Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as
HireRight, LLC, and to the release of such background reports to the Company and its designated representatives and agents, for the
purpose of assisting the Company in making a determination as to my eligibility for employment (including independent contractor
assignments, as applicable), promotion, retention or for other lawful employment purposes. I understand that if the Company hires me
or contracts for my services, my consent will apply, and the Company may obtain background reports, throughout my employment or
contract period.

I understand that information contained in my employment or contractor application, or otherwise disclosed by me before or during my
employment or contract assignment, if any, may be used for the purpose of obtaining and evaluating background reports on me. I also
understand that nothing herein shall be construed as an offer of employment or contract for services.

I hereby authorize law enforcement agencies, learning institutions (including public and private schools and universities), information
service bureaus, credit bureaus, record/data repositories, courts (federal, state and local) , motor vehicle records agencies, my past or
present employers, the military, and other individuals and sources to furnish any and all information on me that is requested by the
consumer reporting agency.

By my signature below, I also certify the information I provided on and in connection with this form is true, accurate and complete. I
agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background
reports that may be requested by or on behalf of the Company.

Employer / Contractor / Educational Institution: Stacy Jones

Fedex Freight 155-14 Jewel Avenue
Apt.#3b
Printed Name: Flushing, NY 11367
Stacy Jones 917-701-6952
Gender:
Social Security #:
###-##-5598
Signed Date: 05-21-2018

12