I authorize you to make investigations (including contacting current and prior
employers) into my personal, employment, financial, medical history, and other related
matters as may be necessary in arriving at an employment decision. 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 that false or misleading information given in
my application or interview(s) may result in discharge. I also understand that I am
required to abide by all rules and regulations of the Company.
I understand that the information I provide regarding my current and/or prior employers
may be used, and those employer(s) will be contacted for the purpose of investigating my
safety performance history as required by 49 CFR 391.23. I understand that I have the
right to:
- Review information provided by current/previous employers;
- Have errors in the information corrected by previous employers, and for 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.
This certifies that I completed this application, and that all entries on it and
information in it are true and complete to the best of my knowledge. Note: A motor
carrier may require an applicant to provide more information than that required by the
Federal Motor Carrier Safety Regulations.