{{ Cognito.resources['order-number-label'] }}: {binding displayValue}

{{ Cognito.resources['order-date-label'] }}: {binding displayValue}

{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{binding Group}
{binding Name} - {binding Description}	{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}	{binding displayValue}
{binding Name}:	{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:	({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:	{binding displayValue}

OPERATION TYPE:

ARE YOU OWNER-OPERATOR OR EMPLOYER?

Self/Employed or Employer {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Owner-Operators are those employers who employ themselves as CDL drivers, typically a single-driver operation.
Employer would be the company that employs drivers to conduct transportation on behalf of that company.

FMCSA PORTAL INFORMATION

Do you have your account login information to the FMCSA Portal? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

FMCSA Portal Set Up Choice {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Provide FMCSA Credentials Below

Enter FMCSA Portal Username ID: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enter FMCSA Portal Password: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

If you do not know your PIN number or if your PIN number is incorrect, please visit https://safer.fmcsa.dot.gov/AutoPin/index.xhtml

FMCSA PORTAL

To set up your FMCSA Portal, please select 3 security questions below and provide answers.

Answer 1: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Answer 2: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Answer 3: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

YOUR EMAIL ADDRESS WILL BE USED AS YOUR USER ID.
PLEASE TYPE IN YOUR PASSWORD

NOTE THAT PASSWORDS CANNOT CONTAIN PHRASES USED IN THE USERNAME OR EMAIL.

Password must include combination of all of the following :

- One Capital Letter
- At Least 12 Characters Long
- Numbers
- Lower Case Letters
- Must Include a Special Character
(example: !@#$%)

USER ID: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

PASSWORD: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Re-type password {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

US DOT PIN Number: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Please note that the DOT PIN number is 8 characters long and it comes in the following format: number-letter-number-number-letter-letter-number-letter.

Example: 1L34UX3P

IMPORTANT:
UPON COMPLETING SETTING UP YOUR FMCSA PORTAL, PLEASE EMAIL ADMIN@CLEARINGHOUSEPORTAL.US THE FMCSA CREDENTIALS, IN ORDER TO FINALIZE LINKING (CONNECTING) YOUR FMCSA ACCOUNT TO YOUR CLEARINGHOUSE ACCOUNT.

QUERIES:

QUERIES MUST BE CONDUCTED PRIOR TO EMPLOYMENT AS WELL AS EVERY YEAR PRIOR TO HIRING 'ANNIVERSARY'.

QUERIES APPLY TO EMPLOYER HIRING CDL DRIVERS AND OWNER-OPERATORS.

ENTER NUMBER OF DRIVERS TO QUERY {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

DRIVER(S) INFORMATION

Driver {binding ItemNumber}

Driver's Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Driver License Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Re-enter Driver License Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

The driver's that your company employs must have an active Clearinghouse Driver's Account in order to consent to be queried.

Below you have an option to add Driver's Clearinghouse Account

Does this Driver require the Driver's Clearinghouse Account? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Driver's Email Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Driver's Cell Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Driver's Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

--- TO ADD MORE DRIVERS SELECT Add Driver BELOW

OWNER-OPERATOR QUERY INFORMATION

Date of Birth {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Driver License Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Re-enter Driver License Number {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

As Owner-Operator you are required to conduct a query and CONSENT to query from the Driver's Clearinghouse Account.

Select 'Yes' to set up the Driver's Account for a fee of $60 dollars.

Otherwise you will need to set up this account on your own.

Set Up Driver's Clearinghouse Account {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RANDOM DRUG & ALCOHOL TESTING PROGRAM REQUIREMENT

Federal Applications Processor Hoffenmer (processor of this application) is approved Consortium/Third-Party Administrator (C/TPA) offering Random Drug and Alcohol Program membership.

For more information please call the Random Enrollment Hotline: (240) 544-0909

RANDOM DRUG & ALCOHOL PROGRAM FOR EMPLOYERS

Are you and your drivers currently enrolled in Random Drug and Alcohol Testing Program? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enter the name of Random Program Administrator you're enrolled with: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enroll your Driver's in Random Drug and Alcohol Program? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RANDOM DRUG & ALCOHOL PROGRAM (OWNER - OPERATORS )

Are you currently enrolled in a FMCSA Random Drug & Alcohol Testing Program? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enter the name of Random Program Administrator you're enrolled with: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enroll in Random Drug and Alcohol Program? {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

You will be automatically enrolled under FAP Hoffenmer Random Drug & Alcohol Program - a requirement for all Owner-Operators of vehicles above 26,000 GVWR.

Pre-Employment Drug & Alcohol Test:

Owner/Operators are required to adhere to the Pre-Employment regulations for Drug & Alcohol Test.

Add Pre-Employment Test {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Enter Zip Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

RANDOM DRUG & ALCOHOL PROGRAM:

Important: As a self-employed driver (owner-operator, or O/O), you must use one or more consortia/third party administrators (C/TPAs) to manage the drug and alcohol testing program.

O/O must identify their C/TPA(s) in the Clearinghouse which automatically designates them and enables C/TPA to act on their behalf in the Clearinghouse, as required by CFR 382.705(b)(6).

By enrolling in the Random Drug & Alcohol Testing Program your company will use 'Hoffenmer' as your C/TPA (third-party administrator) to manage your Clearinghouse Portal, in fulfillment of CFR 382.705(b)(6).

Clearinghouse Registration Processing Fee: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Total For Queries {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Random Enrollment - Employer Section {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Driver count: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Random Program Fees {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

SIGNATURE & AGREEMENT

EXPEDITE {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Expedited requests are completed the following business day.

Otherwise, process of Clearinghouse registration is offered on a first-come first-served basis.

CLEARINGHOUSE REGISTRATION PROGRAM AGREEMENT CLEARINGHOUSE REGISTRATION TERMS AND CONDITIONS - PLEASE CLICK THE LINK TO REVIEW THE TERMS AND CONDITIONS.

I HAVE READ AND AGREE TO CLEARINGHOUSE REGISTRATION TERMS AND CONDITIONS {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Name of Person Completing This Application: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Job Title {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Signature Only {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

If Other, Please Type In Your Job Title: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Today's Date {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

Additional Comments: {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

Asst Agent {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }

{binding displayValue}

COMPANY INFORMATION

OPERATION TYPE:

FMCSA PORTAL INFORMATION

Provide FMCSA Credentials Below

FMCSA PORTAL

NOTE THAT PASSWORDS CANNOT CONTAIN PHRASES USED IN THE USERNAME OR EMAIL.

Password must include combination of all of the following :

QUERIES:

DRIVER(S) INFORMATION

Driver {binding ItemNumber}

OWNER-OPERATOR QUERY INFORMATION

RANDOM DRUG & ALCOHOL TESTING PROGRAM REQUIREMENT

RANDOM DRUG & ALCOHOL PROGRAM FOR EMPLOYERS

RANDOM DRUG & ALCOHOL PROGRAM (OWNER - OPERATORS )

Pre-Employment Drug & Alcohol Test:

SIGNATURE & AGREEMENT

Expedited requests are completed the following business day.

Otherwise, process of Clearinghouse registration is offered on a first-come first-served basis.

{~ Payment_Block_Label}

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-transaction-details-header'] }}

COMPANY INFORMATION

OPERATION TYPE:

FMCSA PORTAL INFORMATION

Provide FMCSA Credentials Below

FMCSA PORTAL

NOTE THAT PASSWORDS CANNOT CONTAIN PHRASES USED IN THE USERNAME OR EMAIL.

Password must include combination of all of the following :

QUERIES:

DRIVER(S) INFORMATION

Driver {binding ItemNumber}

OWNER-OPERATOR QUERY INFORMATION

RANDOM DRUG & ALCOHOL TESTING PROGRAM REQUIREMENT

RANDOM DRUG & ALCOHOL PROGRAM FOR EMPLOYERS

RANDOM DRUG & ALCOHOL PROGRAM (OWNER - OPERATORS )

Pre-Employment Drug & Alcohol Test:

SIGNATURE & AGREEMENT

Expedited requests are completed the following business day.

Otherwise, process of Clearinghouse registration is offered on a first-come first-served basis.