I understand that information I provide regarding current and/or previous employers may be used, and these employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR391.12(d)(2)(ii). I understand that I have the right to:
The US Department of Transportation requires that driver applicants provide their date of birth by 49 CFR 391.21(b)(2).
If yes, please explain fully below. Conviction of a crime is not an automatic bar to
employment- all circumstances will be considered
GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN AT LEAST ONE YEAR
“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if
employed, falsified statements on this application shall be grounds for dismissal.
I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all
information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the
company from all liability for any damage that may result from utilization of such information.
I also understand and agree that no representative of the company has any authority to enter into any agreement for employment
for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an
authorized company representative.
This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the
Americans with Disabilities Act (ADA) and other relevant federal and state laws.”