DISCLOSURE AND AUTHORIZATION LANGUAGE and MOTOR VEHICLE RECORD RELEASE & AUTHORIZATION FORM / Ultimate Fleet Service Inc.

The position you are about to apply for is OTR Driver with a temperature-controlled trailer.
Name

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Please upload pictures of your CDL and medical card ( Front and Back )

Browse Files

Cancelof
Driver's License #
Social Security Number:
Years of Experience:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
What is your preferred method of payment ?
Are you registered with the FMCSA Clearinghouse ?
Do you have violations on your FMCSA Clearinghouse account ?
Please specify what kind of violations below:
From the truck pictures shown below, which is the most suitable for you ?
Signature:

MOTOR VEHICLE RECORD RELEASE & AUTHORIZATION FORM

With my signature below I authorize and allow Ultimate Fleet Service Inc to run my Motor Vehicle Report (MVR).

I understand the company will use these records to evaluate my suitability to fullfil driving duties that may be related to the position for which I am applying / applied already.

I also consent to the review, evaluation and other use of any MVR I may have provided to the company.

This authotization is good until revoked by me in writting.

The authorization is given the satiscaction of Public Law 18 USC 2721 et. Seq.," Federal Drivers Privacy Protection Act", and is intended to constitute written consent as required by this act.

In accordance with the provisions of Sections 604 and 607 of the Fair Credit Report Act , Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title ll, Subtitle D, Chapter 1, of Public Law104-208), I hereby certify the following:

1. The consumer (applicant) has authorized in writing the procurement of this report;

2.The consumer (applicant) has been informed in a separate written disclosure that a consumer report may be obtained for employment purposes;

3.The information requested below will be used for a "permissible purpose" (i.e., information for employment purposes) and will be used for no other purpose;

4.The information being obtained will not be used in violation of any federal or state equal opportunity law or regulation;

5.Before taking an adverse action based in whole or in part on the report the consumer (applicant) will receive a copy of the requested report and the summary of consumer rights as provided with the report by the consumer reporting agency.

I also hereby certify that this report request and above applicant's release notice meet the definition of "permissible uses" of state motor vehicle records under the provisions of the Driver's Privacy Protection Act of 1994 (Public Law 103-322, Title XXX, Section 300002(a)).

Name

First NameLast Name
Date

MonthDayYear
Date
Signature:
Should be Empty:

The position you are about to apply for is OTR Driver with a temperature-controlled trailer.

MOTOR VEHICLE RECORD RELEASE & AUTHORIZATION FORM