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  • New/ RENEWAL C/TPA Enrollment

    NIRVANA MULTI SERVICE CENTRE LLC
  • PERSONAL INFORMATION

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  • BY FILLING OUT AND SUBMITTING THIS FORM, I HEREBY SELECT NIRVANA MULTI SERVICE CENTRE LLC AS MY DESIGNATED CONSORTIA/ THIRD -PARTY ADMINISTRATORS (C/TPA)IN THE FMCSA  COMMERCIAL DRIVER'S LICENSE DRUG AND ALCOHOL CLEARINGHOUSE. I ACKNOWLEDGE THEIR WILL BE A QUERIES INTO MY TRUCKING HISTORY AND DRUG TESTING RANDOMLY. I ACKKNOWLEDGE MY C/TPA MUST REPORT MY RESULTS TO THE FMCSA. 

    I AM AWARE THAT IF I REFUSE TO DO THE TESTING, MY C/TPA MUST REPORT IT TO THE FMCSA. 

    IF I HAVE ANY POSITIVE READINGS I ACKNOWLEDGE THAT I MUST COMPLY WITH THE PLANS BEFORE RETURNING TO DUTY TO DRIVE, AND RECORDS ARE REPORTED TO THE FMCSA.  

  • Clearinghouse Consent


    Dear FMCSA Company, Owner- Operator, Driver

    Action required!

    An owner-operator—an employer that employs himself or herself as a CDL driver, typically a single-driver operation—must designate the C/TPA in the Clearinghouse. An owner-operator must run an annual limited query in the Clearinghouse. If you would like Drug Free Business to run this query on your behalf, we need the consent form below filled out and submitted to us as soon as possible so we have it on file to run the annual limited query for this year.

    • NOTICE TO DRIVER: The Commercial Driver's License (CDL) Drug & Alcohol Clearinghouse is a federal database containing information about CDL drivers who have violated the Federal Motor Carrier Safety Administration's (FMCSA's) drug or alcohol regulations in 49 CFR Part 382. Whether you have committed such a violation or not, each motor carrier for whom you drive is required to check whether the Clearinghouse has any information about you, both at the time of hire and annually. When conducting an annual inquiry, the motor carrier has the option to request a "limited" report that only indicates whether the Clearinghouse has any information about you; it does not release any violation or testing information. Before a motor carrier may request a limited report, they must have your written authorization, per §382.701 (b). This authorization may be valid for more than one year. If a limited query ever reveals that the Clearinghouse has information about you, you will be required to log in to the Clearinghouse website within 24 hours to grant electronic consent for the motor carrier to obtain your full Clearinghouse record. NOTICE TO MOTOR CARRIER: This consent form authorizes Drug Free Business to run a "limited query" to check whether the Clearinghouse has information about the driver identified below. If it does, then you must obtain a full Clearinghouse record within 24 hours, per §382.701 (b). This consent form must be retained until 3 years after the date of the last limited query you perform for this driver, based on the authorization below.


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          C/TPA OWNER OPERATOR Enrollment Product Image
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