I AUTHORIZE YOU TO MAKE SUCH INVESTIGATIONS AND INQUIRIES OF MY PERSONAL EMPLOYMENT, FINANCIAL OR MEDICAL HISTORY, AND OTHER RELATED MATTERS AS MAY BE NECESSARY FOR ARRIVING AT AN EMPLOYMENT DECISION. (GENERALLY, INQUIRIES REGARDING MEDICAL HISTORY WILL BE MADE ONLY IF AND AFTER 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 THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW(S) MAY RESULT IN DISCHARGE, I UNDERSTAND, ALSO THAT I AM REQUIRED TO ABIDE BY ALL RULES AND REGULATIONS OF THE COMPANY.

"I UNDERSTAND THAT INFORMATION I PROVIDE REGARDING CURRENT AND/OR PREVIOUS 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(D) AND (E). 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
• 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"

ALL APPLICANTS WISHING TO DRIVE IN INTERSTATE COMMERCE MUST PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PRECEDING THREE YEARS. YOU MUST GIVE THE SAME INFORMATION FOR ALL EMPLOYERS FOR WHOM YOU HAVE DRIVEN A COMMERCIAL VEHICLE SEVEN YEARS PRIOR TO THE INITIAL THREE YEARS (TOTAL OF TEN YEAR EMPLOYMENT RECORD)

YOU ARE REQUIRED TO LIST THE COMPLETE MAILING ADDRESS: STREET NUMBER AND NAME, CITY, STATE, AND ZIP CODE

ALL APPLICANTS WISHING TO DRIVE IN INTERSTATE COMMERCE MUST PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PRECEDING THREE YEARS. YOU MUST GIVE THE SAME INFORMATION FOR ALL EMPLOYERS FOR WHOM YOU HAVE DRIVEN A COMMERCIAL VEHICLE SEVEN YEARS PRIOR TO THE INITIAL THREE YEARS (TOTAL OF TEN YEAR EMPLOYMENT RECORD)

YOU ARE REQUIRED TO LIST THE COMPLETE MAILING ADDRESS: STREET NUMBER AND NAME, CITY, STATE, AND ZIP CODE

ALL APPLICANTS WISHING TO DRIVE IN INTERSTATE COMMERCE MUST PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PRECEDING THREE YEARS. YOU MUST GIVE THE SAME INFORMATION FOR ALL EMPLOYERS FOR WHOM YOU HAVE DRIVEN A COMMERCIAL VEHICLE SEVEN YEARS PRIOR TO THE INITIAL THREE YEARS (TOTAL OF TEN YEAR EMPLOYMENT RECORD)

YOU ARE REQUIRED TO LIST THE COMPLETE MAILING ADDRESS: STREET NUMBER AND NAME, CITY, STATE, AND ZIP CODE

OR

Amount of Experience

Amount of Experience

Amount of Experience

The undersigned applicant represents that the information provided herein is true and correct. I furth understand that by applying for insurance, I authorize Scottsdale Insurance to verify the information provided above.

As an applicant, applying to perform safety-sensitive functions for our company, you are required by CFR Part 40.25(j) to respond to the following questions.

My signature below certifies that the information provided is true and correct.

I HEREBY AUTHORIZE YOU TO RELEASE THE FOLLOWING INFORMATION FOR THE PURPOSE OF INVESTIGATION AS REQUIRED BY 49 CFR 391.23 OF FEDERAL MOTOR CARRIERS SAFETY REGULATIONS. INFORMATION REQUESTED MAY INCLUDE ALL EMPLOYMENT OR CONTACT INFORMATION CONCERNING MY PERFORMANCE, FITNESS, AND ABILITY. YOU ARE HEREBY RELEASED FROM ANY AND ALL LIABILITY THAT MAY RESULT FROM FURNISHING SUCH INFORMATION.

I ALSO HEREBY AUTHORIZE YOU TO RELEASE THE FOLLOWING INFORMATION FOR THE PURPOSE OF INVESTIGATION. I authorize Zumba Transportation and Logistics Corporation to contact my previous employer(s) or carrier(s) in accordance with the current US DOT rules and regulations as set forth in 49 CFR 382.413 in order to obtain the following information for the preceding two years:

1. An alcohol test with a result of 0.04 alcohol concentration or greater
2. A verified positive controlled substances test results: and
3. Refusals to be tested.

I fully understand the above and do hereby give my consent to obtain the information required by 49 CRF 382.413.

ROADSIDE INSPECTIONS (Optional): Was the applicant involved in any negative roadside inspections in the last 12 months? If so, please list the dates and types of violations discovered.

ALCOHOL AND DRUG HISTORY

If the answer to any of the above is yes, please identify the Substance Abuse Professional that administered treatment as required by the U.S. Department of Transportation.