Application Form

Date
Name of your company
Full Name: Your first and last name
Phone *Your phone number
Email *Your email address
Address
Your addressStreet AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Is This a New Company?
YesNo
Are You an Owner Operator?
YesNo
Select Agency
Select your compliance programDOT (FMCSA) Trucking CompanyDOT (PHMSA) Pipeline CompanyDOT (FAA) Aviation CompanyDOT (FRA) Railroad CompanyDOT (FTA) Federal Transit CompanyDOT (USCG) US Coast GuardPUCALCNon-Mandated
Number of Employees Please indicate how many employees are currently working for the company.
Number of Supervisors
Educational Materials & Training
Employers are required to provide educational materials, written policy for drivers and training for supervisors prior to the start of testing. Only for DOT & PUC.Policy BookEmployee Handbook (1 per employee)Supervisor Book (Reasonable Suspicion)
Your Notes for TEST ON TIME
Instructions Thank you for choosing us as your primary drug and alcohol testing consultant. We are committed to providing you with quality and affordable compliance program. Please complete the application in full to avoid any delays. If you need assistance in completing the application please contact TEST ON TIME: 310-310-1088. It is our pleasure to help you every step of the way.