PPC Partners: New Hire/Rehire Information Form

Requestor Information
Company*
Requestor Name*
First Last
Requestor Email*
Requestor Phone Number*
Desired Effective Date*
MM slash DD slash YYYY
Driver Name*
First Last
Driver Employee Number
Site (branch) for Pieper Electric*
Site (branch) for MP Systems*
Site (branch) for Metropower*
Site (branch) for Carolinapower*
New Driver or Existing Driver*
Driver's license number
License Expiration Date
MM slash DD slash YYYY
State License Issued In
Type of Driver*
- CDL-Operates vehicles with gross vehicle weight of 26,001 pounds or more. Combination weight over 26,001 pounds. FED MED CARD REQUIRED
- CMV-Operates vehicles with gross vehicle weight of 10,001 pounds or more. Combination weight over 10,001 pounds. (Anyone who will tow a trailer with a van or pickup). FED MED CARD REQUIRED.
- Driver-Operates vehicles that are 10,000 lbs. or less. Company vehicle full or part-time or a personally owned vehicle for mileage reimbursement. Must have a Background Authorization Form on file.
I understand that this driver type is required to have a Fed Med Card. The employee will have this submitted to their ADP profile within 30 days of this request, if not already uploaded.*
Type of Employee Vehicle Change*
Into Vehicle Number*
Out of Vehicle Number*
Do you have an adder change?*
What type of truck adder change would you like to request?*
Adder Amount*

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