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Roanoke

By Andrew Horn | June 10, 2020

2001 Crystal Spring Avenue Southwest
Roanoke, VA 24014

3618 Brambleton Avenue
Roanoke, VA 24018

512b Mcdowell Ave Ne
Roanoke, VA 24016

5305 Valley Park Dr
Roanoke, VA 24019

5610 Williamson Rd
Roanoke, VA 24012

602 Brandon Ave Sw Ste 222
Roanoke, VA 24015

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DOT Consortium Program Enrollment Form

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Company Name:*
Step 1: Contact Information:
Contact Name:*
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Company DOT Name:
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Consortium Type: Check 1 box only, Designated Employee Representative (DER) information is required*
*
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Driver SSN or Employee ID:*
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* DOT pre-employment drug test must be completed before driver is added to random pool.

Step 2: Choose Enrollment Package:
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- Basic Package ($100)
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- Compliance Package ($300)
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  - Part 40.25 Form (Required for all drivers)
Optional Add On
*
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- Part 40.25 Form ($25)
- Supervisor Training ($50/each)
- Paper Copies of 49 CFR Part 40 & 382 ($25)
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- No Additional Add-Ons = $0.00
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Add all columns on front and back on this form.
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