DRIVER RELEASE, CERTIFICATION AND AGREEMENT
A. I hereby authorize Florida Trucking Association (FTA) to obtain the following information in connection with my application for the FTA-SMC Safety Management Awards Program: criminal and/or motor vehicle records (from the Florida Dept. of Highway Safety and Motor Vehicles, Federal Bureau of Investigation, or consumer reporting agency), employment records, educational records, consumer reports, personal references and other job related data provided on this application or via the interview process. I acknowledge that FTA-SMC has informed me that it may make use of this information in evaluating my application for recognition. I hereby authorize FTA-SMC to make use of the above referenced information and release FTA and any entity that provides information to FTA from liability in connection with this information.
B. I certify that all the information I have provided on this form is true and complete to the best of my knowledge. I understand that giving false information or omitting requested information could result in rejection of my application or revocation of award.
C. In consideration of my being allowed to participate in this program of the Florida Trucking Association Safety Management Council, and to be eligible for any awards and recognition offered in this program, I hereby certify and agree to the following:
1. All of the statements contained in the material submitted in support of my nomination are true. I authorize Florida Trucking Association and its representatives to make an independent check of all information contained herein.
2. I authorize Florida Trucking Association to use the above-described information about me and photographs subsequently taken under FTA direction in publicity and advertising activities. I further agree to make myself available for publicity arranged by Florida Trucking Association with newspapers, magazine writers, and radio and television journalists.
3. I understand and agree that I will travel to and attend the annual FTA SMC Awards Banquet, scheduled to take place at the TDC Banquet, June 6, 2026 in Daytona Beach, FL, or such other place or places, at such time or times, as arranged by Florida Trucking Association, if chosen as a finalist or winner in this awards program.
D. I will conduct myself in such a way as to protect and maintain the high honor bestowed upon me, and I agree that this recognition may not be used in any advertising, promotion, or exhibition except those sanctioned in writing by Florida Trucking Association.