Answering yes to these questions does not constitute an automatic rejection for employment Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

I certify that my answers are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries to my personal, employment, educational, financial and other related matters as may be necessary for an employment decision. I hereby release employers, schools or individuals from all liability when responding to inquiries in connection with my application.

In the event I am employed, I understand that false or misleading information given in my application or interview(s) may result in discharge.

By signing this statement I certify that: 

• This application for employment / contract was completed by me and that all entries on it and the information contained within it are true and correct to the best of my knowledge.
• As required by 383.21 of the FMCSR's, I only have one motor vehicle operator's license. 

Furthermore, I authorize you (the company or agencies) to make such investigation and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment / contract decision. I hereby release any and all of; the employers, the schools, the health care providers, the Company and their subsidiaries, as well as the other persons associated with this appliction for employment/contract and the subsequent process and procedures from all liability in response to inquires and the releasing of information in connection with my application. In the event of employment/contract, I understand that false or misleading information given in my application or interview(s) may be considered fraud and could be constructed as criminal, and may be grounds for termination and permanent discharge from this company. I understand that I am required to abide by all rules and regulations of the Company as outlined in the Company policies and statements. 

 

I understand that information I provide regarding current and or previous empoyers 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:

1. Review information provided by previous employers;
2. Have errors in the information corrected by previous employers and for those employers to resend the corrected information to the prospective employer; and
3. 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.