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1 Year, 2 Year, 3 Year
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10 Panel
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10 Panel Plus Alcohol
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10 Panel Plus ETG
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10 Panel Plus ETG (no THC)
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10 Panel Urine Test
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10 Panel Urine Test (no THC)
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11 Panel
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12 Panel
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14 Panel
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14 Panel Hair Test
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14 Panel Nail Test
$375.00 Add to cart
15 Panel Hair Test
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16 Panel Hair Test
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16 Panel Nail Test
$410.00 Add to cart
17 Panel Hair Test
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17 Panel Nail Test
$500.00 Add to cart
5 Panel
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5 Panel (no THC)
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5 Panel Hair Test
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5 Panel Hair Test (no THC)
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5 Panel Hair Test Plus Opioids
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5 Panel Nail Test
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5 Panel Nail Test
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5 Panel Oral Test
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5 Panel Plus Alcohol
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5 Panel Plus Alcohol
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5 Panel Plus Alcohol (no THC)
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5 Panel Plus Alcohol (no THC)
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5 Panel Plus ETG
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5 Panel Plus ETG
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5 Panel Plus ETG (no THC)
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5 Panel Plus ETG (no THC)
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5 Panel Urine Test
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5 Panel Urine Test (no THC)
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7 Panel
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7 Panel Nail Test
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7 Panel Urine Test
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7 Panel Urine Test (no THC)
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9 Panel
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9 Panel Hair Test
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9 Panel Urine Test
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Add Opioids
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Alcohol
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Breath Alcohol
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Clearinghouse Help
$140.00 Add to cart
DOT Breath Alcohol Test
$70.00 Add to cart
DOT Drug Test
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DOT Drug Test + US Coast Guard License Forms
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DOT Physical
$120.00 Add to cart
DOT Physical
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ETG (alcohol)
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HHS Drug Test
$60.00 Add to cart
Nail
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Non-DOT Physical
$45.00 Add to cart
NRC (Nuclear Regulatory Commission) Drug Test
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Opioid Physical
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Oral Fluid
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Saliva (Not Yet Approved)
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Supervisor Training
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Urine
$95.00 Add to cart

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(916) 520-0244

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Suite #11
Sacramento, CA 95834

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DOT Consortium Program Enrollment Form

Step 1 of 2

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Company Name:*
Step 1: Contact Information:
Contact Name:*
Address 1:*
Address 2:
City:*
State:*
Zip:*
Phone:*
Fax:
Cell Phone:
E-mail Address:*
Company DOT Name:
DOT #
Consortium Type: Check 1 box only, Designated Employee Representative (DER) information is required*
*
- Owner Operator
- Company with 2 or more Drivers to enroll in Consortium Pool
- Company with 100 or more Drivers for a Stand-Alone Random Pool
Owner Operator:*
Driver Name:*
Driver SSN or Employee ID:*
DER Name:*
DER Phone #:*
DER Cell #:*
DER E-mail:*
* DOT pre-employment drug test must be completed before driver is added to random pool.

Step 2: Choose Enrollment Package:
*
- Basic Package ($100)
  - 1-Year Enrollment in Randoms
  - Certification of Enrollment
  - Paper CCFs or Electronic CCFs
  - $60 Drug Test / $50 Breath Alcohol
- Compliance Package ($300)
  All Benefits of Basic Package plus:
  - 2 Free Drug Tests
  - DOT Policy
  - Required Supervisor Training
  - Part 40.25 Form (Required for all drivers)
Optional Add On
*
- 2 Additional Years of Enrollment ($100)
- Part 40.25 Form ($25)
- Supervisor Training ($50/each)
- Paper Copies of 49 CFR Part 40 & 382 ($25)
- DOT Policy ($75)
- DOT Pre-Employment Drug Test ($60)
- No Additional Add-Ons = $0.00
All fees must be remitted with this form.
Add all columns on front and back on this form.
Step 3: Payment:
Please Proceed to the shop page to purchase your desired package. Your application will not be processed without purchase.
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- I have read and agree to the website Additional Products Terms

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