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Prior Consortium Enrollment Verification

This form must be completed by the company that is being added.

Please provide them with the following link:

https://teamcme.com/prior-consortium-enrollment-verification/

Upon completion of this form, both the management company and the company being enrolled will receive a PDF of this form’s contents via email. The email will also provide instructions for the next steps that must be taken.

Prior Consortium Enrollment Verification

Completing this form is one way for a motor carrier company to acknowledge that they have previously been in a randomized testing pool.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Consortium Management Company Information

Name of Individual Managing Your Randomized Testing*

Your Company Information

Your Name*
Consent*

Please provide the following information for each currently employed individual who was a participant.

Participant List*
First Name
Last Name
License# or Last 4 of SSN
State
 

To add participants, select the plus icon to the right. Each field must be completed.

To the best of my knowledge:

  • The company and drivers listed above participated in a compliant random testing program ending on the date provided
  • All required DOT drug and alcohol testing requirements were followed during the period of enrollment
  • There are no outstanding or unresolved testing requirements that would prevent participation in a new consortium
Consent*