MVR
Driver Record Screening Disclosure
I hereby authorize T Newton Transportation and its designated agents and representatives to conduct a comprehensive review of my driver record
background through a consumer report and/or an investigative consumer report to be generated for employment, promotion, reassignment or
retention as an employee. I understand that the scope of the consumer report/investigative consumer report may include information about my
character, general reputation, personal characteristics, and mode of living as well as information that is not limited to, the following areas: names
and dates of previous/current employment, work experience, Bureau of Workers Compensation/Claims, criminal history records (from local, state,
federal, international and other law enforcement agencies’ records), sexual offenders lists, wants and warrants records, motor vehicle records,
military records, educational verification, license verification, credit history, civil cases, OIG/GSA, USA PATRIOT Act/OFAC, any sanction lists, FBI
finger printing, internet searches, social media information, and drug testing. Upon Request, T Newton Tranportation will supply a copy of the
completed consumer report along with a copy of an individual’s rights under the Fair Credit Reporting Act.
Authorization and Release
I , authorize the complete release of these records or data pertaining to me which an individual, company,
firm, corporation, or public agency may have. I authorize the full release of the information described above, without any reservation, throughout
any duration of my employment at (company name). I hereby release T Newton Transportation, and its agents,
officials, representatives, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and
all liability for damages of whatever kind, which may at any time, result to me, my heirs, family or associates because of compliance with this
authorization for release form. I certify that all information provided below is correct to the best of my knowledge. This authorization and consent
shall be valid in original, fax, or copy form. The following information is required by law enforcement agencies and other entities for identification
purposes when checking records. It is confidential and will not be used for any other purpose.