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Fishers

By Andrew Horn | June 8, 2020

11580 Overlook Dr
Fishers, IN 46037

13050 Parkside Dr Ste 130
Fishers, IN 46038

13121 Olio Rd Ste 130
Fishers, IN 46037

7818 East 96th Street
Fishers, IN 46037

9795 E 116th St
Fishers, IN 46037

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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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Company DOT Name:
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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 #:*
DER E-mail:*
* 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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  - 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)
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- No Additional Add-Ons = $0.00
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