I authorize you to make such investigations and inquire of my personal, employment, financial or medical history and
other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical
history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers,
schools, health care providers and other persons from all liability in responding to inquires 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. If I
terminate my employment by my own choice within 90 days, I agree to be responsible for the cost of the Drug Test and
other associated fees involved in my background check.
I understand that information I provide regarding current and/or previous employers 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:
Review information provided by previous employers;
Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; 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
I also understand that if I terminate my employment within the first 90 days I will be responsible for $100 in pre-placement testing and associated costs.