Form R 106 PDF Details

Form R 106 is a tax form used by businesses in the United States to report income earned and expenses incurred during the previous year. This form is used to calculate the net profit or loss of a business, which is then reported on the owner's individual income tax return. The deadline for filing Form R 106 is April 15th each year. If you're a business owner in the US, it's important to understand how Form R 106 works and how to use it correctly. In this blog post, we'll go over what information is required on this form, how to calculate your net profit or loss, and when you need to file it. We'll also discuss some common mistakes that people make when filling out this form.

You will discover more details relating to the form r 106 by checking out the table we prepared for you.

QuestionAnswer
Form NameForm R 106
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesswift transportation employment verification, Reportable, Flatbed, furnishing

Form Preview Example

Social Security # _______________________________

Past Employment Verification

I hereby authorize you to release the following information to

SWIFT TRANSPORTATION

(Prospective Employer)

for the purpose of investigation as required by Section 391.23 and allowed by Section 383.35 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability that may result from furnishing such information.

Date: _____________________

Applicant’s Signature: _________________________________________________________

ALL DATES OF EMPLOYMENT, INCLUDING GAPS, MUST BE COMPLETED BEFORE APPLICANT CAN BE EMPLOYED!

Applicant’s Name: ___________________________________________________SS #: ___________________________

Employer: __________________________________________________________ Phone #: ( ) ______- ___________

Street: ________________________________________City: ________________________ State: _______Zip: _______

Contact: ____________________________________________ Their Position: ___________________________________

1.Dates employed – from: ______/______/______ to: ______/______/______Voluntary termination Forced Termination

2.Job Title: ____________________________________________________________________________________________

( ) Company Driver

( ) OTR

( ) Single

( ) Tractor Trailer

( ) Van Reefer

( ) Owner Operator

( ) OTR Short Trips

( ) Team

( ) Straight Truck

( ) Flatbed

( ) Other ____________

( ) Local

( ) Student

( ) Other ____________

( ) Tanker

3.

Reason for leaving? ______________________________________________4. Transmission Type: ( ) Manual ( ) Automatic

5. Would you rehire? Yes

No

If no, why not? __________________________________________________

6. Number of accidents? (Get as much detailed information as possible). Total number of accidents? _______

 

 

 

 

 

 

 

 

 

 

Date

Nature of Accident

 

DOT

Preventable

Non-

Injuries

Fatalities

Cost

 

 

 

 

 

Reportable

 

Preventable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PAST DRUG AND ALCOHOL TEST RESULTS

The above named individual has advised us that he/she worked for your company or that he/she applied to your company for work during the previous three

(3)years. The Federal Motor Carrier Safety Regulations (FMSCR 382.413 (a)(b)(c)(e)(f) require us to obtain from your company, and require your company to provide us information concerning the above named applicant’s past drug and alcohol test results (including refusals to be tested).

1.

Has this person tested positive for a controlled substance in the last three (3) years?

Yes

 

No

2.

Has this person had an alcohol test with a Breath Alcohol Concentration of 0.04 or greater in the last three (3) years?

Yes

 

No

 

3.

Has this person refused a required test for drugs in the last three (3) years?

Yes

 

No

 

 

4.

Has this person violated other DOT drug/alcohol regulations?

Yes

 

No

 

5.Have you received information from a previous employer that this person violated DOT drug and alcohol regulations? Yes No

6.Within the last three (3) years, has this person tested positive or refused any drug or alcohol test conducted under the

authority of your company, independent of the DOT or FMCSA requirements (Company Policy Test)?

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL COMMENTS

 

 

 

 

 

_______________________________________________________________________________________________________________________________

_______________________________________________________________________________________________________________________________

Signature of Preparer: ________________________________ Print Last Name: ________________________ Date: _____/_____/_____

R-106

Revised 07/27/10

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