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Elk Grove Village

By Andrew Horn | June 8, 2020

1830 Jarvis Ave
Elk Grove Village, IL 60007

2256 Landmeier Rd
Elk Grove Village, IL 60007

2256 Landmeier Road
Elk Grove Village, IL 60007

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DOT Consortium Program Enrollment Form

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Company Name:*
Step 1: Contact Information:
Contact Name:*
Address 1:*
Address 2:
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State:*
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Company DOT Name:
DOT #
Consortium Type: Check 1 box only, Designated Employee Representative (DER) information is required*
*
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- Company with 100 or more Drivers for a Stand-Alone Random Pool
Owner Operator:*
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Driver SSN or Employee ID:*
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DER Cell #:*
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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)
  All Benefits of Basic Package plus:
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  - Required Supervisor Training
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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
All fees must be remitted with this form.
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