Section 383.21 FMCSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license." I certify that I do not have more than one motor vehicle license, the information for which is listed below.
Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. you must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record
Must list the complete mailing address: street number and name, city, state, and zip code.
I authorize you to make sure investigations and inquires to my personal, employment, financial or medical history and other related matters as may be necessary inarriving at the employment decision. (generally, inquires regarding medical history will be made only if and after conditional offer of employment has been extended I hereby release employers, schools, health care providers and other persons from all liability in responding to inquired and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company. "I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contracted, 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: Review information provided by current/previous employers; Have errors in the information corrected by previous employers and for those previouse employers to re-send the corrected informations to the prospective employers; and 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."
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.
Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Regulations
Lie Detector Tests: Article 100, Section 95, Annotated Code of Maryland: "Under Maryland law an employer may not require or demand any applicant for employment or prospective employment or any employee to submit to or take a polygraph, lie detector or similar test or examination as a condition of employ- ment or continued employment. Any similar test or examination as a condition of employment or continued employment. Any employer who ciolates this provision is guilty of a misdemeanor and subject to a fine not to exceed $100."
Corbin Fuel Company, Inc. does not discriminate on the basis of race, color, sex, age, national origin, religion, or disability in matters affecting employment or in providing access to programs.