Driving Record Certification
In accordance with 49 CFR 383.21, I certify that I do not hold more than one motor vehicle license. Below is the information for my current license, as well as any other licenses held within the last 3 years. I have also provided a list of all traffic violations and ordinances (excluding parking) for which I have been convicted or forfeited bond/collateral within the preceding 12 months.

Upon review of your application, your Motor Vehicle Record (MVR) will be accessed through our partner, Brehmer Insurance. By applying to Prosafe Utility Contractors, you explicitly agree to allow Brehmer Insurance to review your driving history and disclose relevant information to Prosafe Utility Contractors.

 I have read and understand the FCRA Candidate Disclosure for the Procurement of Consumer Reports form and, if applicable, the California Candidate Disclosure for the Procurement of Investigative Consumer Reports form. I have also read and understand the attached Summary of Rights under the Fair Credit Reporting Act and State Law Disclosures.13340_fcra.pdf

I understand that if employed, providing false or misleading information on my application or during interviews may lead to my termination. I also agree to follow all company rules and regulations.

I understand that the information I provide about my current and previous employment may be used, and those employers will be contacted to investigate my safety performance history as required by 49 CFR 391.23. I have the right to:

• Review information from current or previous employers.
• Have previous employers correct errors in the information and resend the corrected information to the prospective employer.
• Attach a rebuttal statement to any disputed information if I cannot agree with previous employers on its

I certify that this application is complete and all information is true and accurate to the best of my knowledge.

Note: A motor carrier may request more information than Federal Motor Carrier Safety Regulations require.

 I have read and understand the FCRA Candidate Disclosure for the Procurement of Consumer Reports form and, if applicable, the California Candidate Disclosure for the Procurement of Investigative Consumer Reports form. I have also read and understand the attached Summary of Rights under the Fair Credit Reporting Act and State Law Disclosures.13340_fcra.pdf

I understand that if employed, providing false or misleading information on my application or during interviews may lead to my termination. I also agree to follow all company rules and regulations.

I understand that the information I provide about my current and previous employment may be used, and those employers will be contacted to investigate my safety performance history as required by 49 CFR 391.23. I have the right to:

• Review information from current or previous employers.
• Have previous employers correct errors in the information and resend the corrected information to the prospective employer.
• Attach a rebuttal statement to any disputed information if I cannot agree with previous employers on its

I certify that this application is complete and all information is true and accurate to the best of my knowledge.

Note: A motor carrier may request more information than Federal Motor Carrier Safety Regulations require.

Driving Record Certification
In accordance with 49 CFR 383.21, I certify that I do not hold more than one motor vehicle license. Below is the information for my current license, as well as any other licenses held within the last 3 years. I have also provided a list of all traffic violations and ordinances (excluding parking) for which I have been convicted or forfeited bond/collateral within the preceding 12 months.

Upon review of your application, your Motor Vehicle Record (MVR) will be accessed through our partner, Brehmer Insurance. By applying to Prosafe Utility Contractors, you explicitly agree to allow Brehmer Insurance to review your driving history and disclose relevant information to Prosafe Utility Contractors.