TranSystems Corporation - LGM Construction

-->
-->
-->
-->
INSTRUCTIONS
• Use only BLACK ink or BLACK type.
Complete ALL blanks. Use N/A if applicable, giving explanation when necessary.
Be sure to obtain ALL required signatures (-->).
For more information, read email bulletin board “ Vendor-ID/Info.”
For help, call 901 797-7278.
TO BE COMPLETED BY THE VENDOR APPLICANT
APPLICANT’S NAME AGE DATE OF BIRTH HEIGHT
TO BE COMPLETED BY FEDEX REQUESTING MANAGER
TO BE COMPLETED BY SECURITY
FEDEX SECURITY VENDOR ID REQUEST
❏ Original ❏ Renewal
If Renewal, old ID number_____________
ft / in
PRESENT ADDRESS CITY STATE ZIP SOCIAL SECURITY NUMBER PRESENT TELEPHONE #(S)
DRIVER’S LICENSE NUMBER STATE LICENSE ISSUED EMERGENCY CONTACT NAME EMERGENCY CONTACT PHONE NUMBER
PREVIOUS ADDRESS(ES) FOR LAST 10 YEARS, STARTING WITH MOST RECENT ADDRESS
1. From _________ To Present Address ____________________________ City _________________ State ____ Zip _______
2. From _________ To __________ Address ____________________________ City _________________ State ____ Zip _______
3. From _________ To __________ Address ____________________________ City _________________ State ____ Zip _______
4. From _________ To __________ Address ____________________________ City _________________ State ____ Zip _______
5. From _________ To __________ Address ____________________________ City _________________ State ____ Zip _______
6. From _________ To __________ Address ____________________________ City _________________ State ____ Zip _______
NAME OF COMPANY YOU REPRESENT NAME OF COMPANY MANAGER/SUPERVISOR
COMPANY ADDRESS CITY STATE ZIP TELEPHONE NUMBER
APPLICANT’S COMPANY SUPERVISOR’S SIGNATURE (BLACK INK) DATE
CRIMINAL STATUS CHECK
Have you pled guilty to or been convicted of a CRIME in the last TEN (10) years, excluding traffic and parking tickets? ❏ Yes ❏ No
If Yes, please explain: ____________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Agencies approved to conduct background checks for vendors:
Choicepoint 800 749-9556
Blue Line Investigations 901 266-7100
National Information Agency 901 521-6763
Cargo Group Inc. 800 645-4556
FEDEX STATUS
WEIGHT
Vendors who have lived in one county for the past 10 years may
contact their local law enforcement agency. Examples:
Shelby County Sheriff’s Department
DeSoto County Sheriff’s Department
Cook County Sheriff’s Department
Have you been a FedEx employee?
Give previous FedEx job position(s):
❏ Yes ❏ No If Yes, give previous FedEx employee ID:
APPLICANT’S SIGNATURE DATE
NOTE: Vendor IDs expire one (1) year from date issued. For renewal, the Vendor or his/her company must submit the Vendor ID Request Form. Vendor and FedEx
requesting department are responsible for the actions of the Vendor while Vendor is on FedEx property and for return of expired or terminated card within
five (5) business days from receipt of new card or termination date. Any lost or stolen Vendor ID must be reported to FedEx Security at 901 797-7278.
FEDEX COMPANY
❏ Corporate ❏ Express ❏ Trade Networks ❏ Services
DATE COMPLETED FORM SENT TO SECURITY REQUESTING DEPARTMENT’S NAME COMAIL ADDRESS
CONTACT PERSON’S NAME CONTACT PERSON’S EMPLOYEE ID NUMBER CONTACT PERSON’S TELEPHONE NUMBER
PHYSICAL ADDRESS WHERE VENODR WILL BE WORKING (NOT 3-LTR ID) IS FEDEX RAMP ACCESS REQUIRED?
❏ Yes ❏ No
MANAGER’S NAME ID NUMBER TELEPHONE MANAGING DIRECTOR’S NAME ID NUMBER TELEPHONE
MANAGER’S SIGNATURE DATE MANAGING DIRECTOR’S SIGNATURE DATE
SECURITY APPROVAL
❏ Yes ❏ No
SECURITY’S RECEIPTS AND TRANSMITTALS
BADGE EXPIRATION DATE SERIAL # (CIS PROVIDES) SECURITY SIGNATURE DATE
Received Date Transmitted to and Date
1st _________________________________________ to ____________________________ Date _________________