IFull Name* hereby provide consent to Name of Hiring Company* to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse.
I understand that if the limited query conducted by Name of Hiring Company* indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Name of Hiring Company*without first obtaining additional specific consent from me.
I further understand that if I refuse to provide consent for Name of Hiring Company* to conduct a limited query of the Clearinghouse, Name of Hiring Company* must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA's Drug and Alcohol Program Regulations.