Name *

First Name

Last Name

Checkbox *

DOT Drug

NON DOT Drug

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Representative Completing Update *

First Name

Last Name

Employee Name *

First Name

Last Name

Document Type *

New Hire Documents

DOT Medical Card Update

CDL/ Driver License Update

Drug/ Alcohol Program Documents

Company Representative Requesting *

Who is making the request on behalf of the company.

First Name

Last Name

Employee To Remove *

Enter name of employee being removed from company.

First Name

Last Name

Termination Date *

Enter Date Employee was Terminated

MM

DD

YYYY

Company Representative *

Company Representative Making Request

First Name

Last Name

Employee Being Added *

First Name

Last Name

Add Employee To The Following (select all) *

DOT Drug Program

Driver Qualification Program

NON DOT Drug Program

Driver Status *

The driver will need to complete the following additional actions to be added to the DOT Drug Program. Please select their current status.

Driver Has Completed Pre Employment Drug Screening

Driver Has Completed FMCSA Clearinghouse Website Registration

Driver Has Completed BOTH Pre Employment Drug Screening AND FMCSA Clearinghouse Website Registration

Driver Has NOT Completed Either, We Will Notify Johnson DOT Services Once These Are Completed

Driver Is Being Entered Into Driver Qualification Program Only

Company Representative *

First Name

Last Name