In connection with my application to the company, I understand that the Fair Credit Reporting Act, Public Law 91-508 &
104-208 requires that I be advised that routine inquiry may be made during the company's initial or subsequent processing which
will provide applicable information concerning character and general reputation. I also understand that investigative
background inquiries as required by the Federal Motor Carrier Safety Regulations 391.23 may be made on me including
previous employers, along with schools, consumer credit, criminal convictions, motor vehicle records, and other reports.
These reports will include information as to my character, work, habits, performance, education, compensation, and experience
along with reasons for termination of employment from previous employers. Furthermore, I understand that the company may
be requesting information from various federal, state, and other agencies which maintain records concerning my past activities
relating to my driving, credit, criminal, civil, and other experiences as well as claims involving me in the files of insurance
companies. I authorize without reservation, any party or agency contacted to furnish the above mentioned information and
release all parties involved from liability and responsibility for doing so. This authorization and consent shall be valid in
original, fax, email, other electronic form, or copy form.
I release and agree to hold harmless any individual, company, business institution or government agency from all liability with
regard to furnishing information to this company. I agree to release and hold harmless this company from all liability with
respect to the receipt of such information.
I certify that this application was only completed by me, and that all entries on it and the information I have furnished on this
application form is true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of
my personal, employment, financial, or medical history. (Generally, inquiries regarding medical history will be made only and if
a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other
persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of
employment, I understand false or misleading information given in my application or in interview(s) may result in discharge. I
understand also, that I am required to abide by all rules and regulations of the company if a conditional offer of employment is
I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be
contacted, for the purpose of investigating my safety performance history as required by 49CFR 391.23. I have a right to:
Review information provided by current previous employers; have errors in the information corrected by previous employers
and those previous employers to resend the corrected information to the prospective employer; and have a rebuttal statement
attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.