1. I certify that this application was completed by me and that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge.
2. I understand that any misrepresentation or omission of facts called for on this application or during the application process may result in termination of the application process or my dismissal from employment at any time regardless of when the false answer or omission is discovered.
3. I authorize the Company to conduct any necessary investigations or inquiries regarding my background to the extent permitted by federal, state and local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information.
4. I understand that if offered employment, I am to abide by all rules and regulations of the Company.
5. I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause.
6. I understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), and
   compensation rate(s) will be subject to change by the Company.
7. I understand that the Company may share the information contained in this application with other Company employees for employment
   and administrative purposes and hereby consent to such transfer.
8. I consent to all of the following pre-employment processes, which are required by the Company and I further understand that the offer of employment is contingent upon my successfully completing all of pre-employment testing:
   1. Motor Vehicle Report (MVR) (review of past driving record)
   2. Drug screen (DOT and Non-DOT applicants)
   3. Previous Employer Drug and Alcohol History (DOT applicants, 49 CFR 382.413)
   4. Physical Examination and Functional Capacity Evaluation (consistent with federal and state law)
   5. Background Check
9. I agree and understand that this application for employment in no way obligates the Company to employ me.

I hereby authorize the release of information from my regulated and non-regulated drug & alcohol testing records by my previous employer(s), listed below to VERIFI, LLC and its’ subsidiaries and or agents. This release is for the purposes of investigation as required by Sections 192 & 195 of the Operator Qualification Regulations. I understand and agree to hold harmless all entities listed above that release the information requested by this release.

I hereby authorize the release of information from my regulated and non-regulated drug & alcohol testing records by my previous employer(s), listed below, to the employer and/or its agents listed above. This release is in accordance with DOT Regulation 49 CFR Parts 40.25, 16, and 4.06. I understand and agree to hold
harmless my employer, its agents, and previous employer(s) that release the following information:

1. Verified positive drug test results.
2. Alcohol test results that reflect a result of 0.04 or higher alcohol concentration.
3. Records documenting a refusal to submit to required random, reasonable cause/suspicion, post-accident, or follow-up drug or alcohol testing and/or verified adulterated or substituted drug test results.
4. Records of any determinations that I engaged in alcohol misuse, violation of DOT regulations or any drug and alcohol policies.
5. Records pertaining to any substance abuse professional evaluations conducted and rehabilitation, including follow-up testing, undertaken by me following a violation of DOT regulations.
6. Other violations of DOT drug and/or alcohol testing regulations.

Applicant Certification: I have read and fully understand this authorization to release my previous drug and alcohol test results and any non-negative test records to Verifi, LLC. In signing below, I certify that all of the information I have furnished on this form is true and complete, and that I have identified all of the companies for which I have worked in a DOT safety-sensitive, DOT regulated, or non-regulated position in the previous two/three years as applicable according to the requirements of the position for which I am applying. I also understand that I am responsible for all costs associated with any pending Substance Abuse Professional assessment, recommendations, education and treatment, including costs involving return-to-duty testing and follow-up testing yet to be completed. I also agree to hold harmless any and all parties that release the requested information in good faith.

I, the undersigned consumer, do hereby authorize The Company. and its affiliates (“The Company.”) and VERIFI, LLC (Verifi) to procure a
consumer report and/or investigative consumer report on me for the purpose of employment screening or for determining continued employment. I hereby declare that the answers to the questions on this application are correct and that any misstatement or omission of fact will be sufficient cause for rejection of my application or separation should I become employed by The Company.

These above-mentioned reports may include, but are not limited to, information as to my character, general reputation, personal characteristics and mode of living, discerned through employment and education verifications; personal references; personal interviews; my personal credit history based on reports from any credit bureau; my driving history, including any traffic citations; a social security number verification; present and former addresses; criminal and civil history/records; and any other public record.

I further authorize any person, business entity or governmental agency who may have information relevant to the above to disclose the same to The Company., by and through ISG including, but not limited to, any and all courts, public agencies, law enforcement agencies and credit bureaus, regardless of whether such person, business entity or governmental agency compiled the information itself or received it from other sources.

I have been advised and understand that under the provisions of the Fair Credit Reporting Act, 15 U.S.C. 1681, et seq., that any person who produces or causes to be prepared an investigative consumer report on any consumer, upon written request made by the consumer within a reasonable period of time after the receipt by him/her of the disclosure required by subsection (a) (1) of section 1681d, shall make a complete and accurate disclosure of the nature and scope of the investigation requested. This disclosure shall be made in writing, mailed or otherwise delivered, to the consumer not later than
five days after the date on which the request for such disclosure was received from the consumer or such report was first requested, whichever is the later. I also understand that I may receive a written summary of my rights under 15 U.S.C. § 1681 et. seq. I understand that proper identification will be required and that I should direct my requests to the company listed below in order to request a copy of my consumer report.

VERIFI, LLC., P.O. Box 1422, Sunset, Louisiana 70584, 800.367.0096; voe@2verifi.com

I hereby release and agree to hold harmless, The Company., VERIFI and any and all persons, business entities and governmental agencies, whether public or private, from any and all liability, claims and/or demands, by me, my heirs, or others making such claim or demand on my behalf, for providing a consumer report and/or investigative consumer report hereby authorized. I understand that this Authorization/Release form shall remain in effect for the duration of my employment with said Company.

Further, I certify that the information contained on this Authorization/Release form is true and correct and that my application or employment can be terminated based on any false, omitted or fraudulent information.