Initial DRIVER APPLICATION with MVR & PSP releases

Dakota Lines, Inc.

Initial Driver Application with MVR & PSP/DOT inspection releases
Applicants Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Birth Date*

MonthDayYear
Date
Commercial Driving Experience *
number of years
Drivers License #*
Drivers License state*
Drivers License Expiration Date*

MonthDayYear
Date

Position Applied For*
If you drive for a truck owner enter truck owners name
Rate of Pay expected?
Who referred You*
Name preferred or CB Handle, saw truck etc.
Is there any reason you may NOT be able to perform the functions of this job for which you have applied?*
Type "NONE" if you feel you qualify

PSP/CSA DOT Inspection release
Date

MonthDayYear
Date
Name

First NameLast Name
Signature

Clear

PART II - CONSUMER REPORT DISCLOSURE AND RELEASE

In connection with my application for employment (including contract for services) with the employer named above. I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma. These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records, as well as information from DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records. I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION OBTAINED UNDER PART I. I have the right to request from DAC, upon presentation of proper identification, the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC, and I agree that such information which DAC has or obtains, and my employment history (not DOT Drug and Alcohol information without a specific consent by me) with you if I am hired, will be supplied by DAC to other companies which subscribe to DAC Services. I hereby authorize procurement of consumer report(s). If hired or contracted this authorization, for Part II reports only, shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment or contract period.
Date

MonthDayYear
Date
Signature

Clear

Driving Record Release
I hereby authorize you to release the applicants driving record to Dakota Lines, Inc. & I grant consent to Dakota Lines, Inc. to look at my driving record, for purposes of investigation as required by Section 391.23 of the Federal Motor Carrier Safety Regulations. You are released from any and all liability, which may resut from furnishing such information.
Drivers License #*
Drivers License State*
Drivers License Expiration Date*

MonthDayYear
Date
Date

MonthDayYear
Date
Name

First NameLast Name
Signature*

Clear
Should be Empty:

Dakota Lines, Inc.

Driving Record Release