Street Address Line 2
State / Province
Postal / Zip Code
Experience and Background:
How many years of CDL Class A experience do you have?
Do you own/lease your own truck? If yes, please specify YEAR/MAKE
Do you own/lease your own trailer? If yes, please specify YEAR/MAKE
In accordance with the provisions of Section 604 (b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D,Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413 and 391.25 of the Federal Motor Carrier Safety Regulations. Do you consent to have Amerixpress, Inc., obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA), and other background check screening entities for the sole purpose of employment?
CDL Class A Number
CDL Class A State
Provide your signature authorizing Amerixpress, Inc., and its agents/staff to obtain such reports
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