AGREEMENT – Please read the following statement carefully.
This certifies that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. I also agree that falsified information or significant omissions may result in my disqualification now or at any time.
In connection with my application for qualification with Dickerson Florida, Inc., I understand that an investigative report will be obtained that will include information as to my character, work habits, performance, experience, drug and alcohol test results, driving record and experience, as well as any reason for termination of my qualification including any results from previous employers. Further, I understand that you will be requesting information concerning my driving record and/or information from various state agencies which maintain records concerning, criminal history, traffic offenses and accidents, as well as information concerning my previous driving record requests made by others from such state agencies. I hereby authorize Dickerson Florida, Inc. to obtain above described information, and agree that such information, and my employment history with you that I am qualified, will be supplied to other companies which subscribe to consumer reporting services.
In accordance with Section(s) 382.405, 382.413 and 391.23 of the Federal Motor Carrier Safety Regulations, I authorize any and all persons and/or institutions to provide any relevant information, including my alcohol and controlled substance training/testing, that may be required to complete my qualification and I agree to release them from any and all liability for suppling said information. Finally, prospective employers are required to notify driver applicants of their due process rights as specified in 391.23(i) regarding the information received as part of the background investigation. In accordance with section (i) (1), I understand my right to be expressly notified with Department of Transportation regulated employment during preceding three years‐via the application form or other written document prior to any hiring decision and that I have the following rights regarding the investigative information that will be provided:
- The right to review information provided by previous employers;
- The right to have errors in the information corrected by the previous employer and for that previous employer to resend the corrected information;
- The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and driver cannot agree
Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer‐provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information from the applicant within five business days of receiving the written request, If the prospective employer has not yet received the requested information from the previous employer(s), then the five business days deadline will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records.
This certifies that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge.