Motor Vehicle Report (MVR)

Disclosure to employee/prospective employee

As part of our hiring background and investigation process, we may obtain, where permitted, one or more reports and other information about you, including driving history. If your employment falls under the Federal Department of Transportation ("DOT") and the Federal Motor Carrier Safety Administration ("FMCSA"), including 49 CFR 391.23, the report could include your driving, safety inspection, and performance history from the FMCSA.

Under the provisions of the Fair Credit Reporting Act ("FCRA"), 15 USC 1681 et seq; FMCSA regulations in the Federal Code of Regulations, including 49 CFR 40.329; and certain state laws, before we can seek such reports, where permitted, we must have your written permission to obtain the information. You have the right upon written request to a complete and accurate disclosure of the nature and scope of the investigation. You also are entitled to a copy of that documnet, entited Rights Under the Fair Credit Reporting Act.

Authorization and Release to Obtain Information

I hereby authorize Black River Trucking & Hotshot Services, LLC to obtain information, where permitted, pertaining to my driving history records. By signing below I consent to and authorize the gathering of this information by my prospective employer and those whom my prospective employer are engaded to request and obtain this information. Including from former empoyers and/or from or through the Insurance Information Exchange(iiX). I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization from liability that might otherwise result from the request for use of and/or disclosure of any or all of the information discussed above. This information may be obtained in whole or in part by iiX or its agents.

Information provided as on current valid Driver License: