Must list the complete mailing address: street number and name, city,
state and zip code.
To Be Read And Signed By Applicant
I authorize you to make sure investigations and inquires to my
personal, employment, financial or medical history and other related
matters as may be necessary in arriving as an employment decision.
(Generally, inquires regarding medical history will be made only if
and after a conditional offer of employment is has been extended.) I
herby release employers, schools, health care providers and other
persons from 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 t abide by all rules
adn regulations of the Company.
"I understand the information I provide regarding my 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 O
have the right to:
- Review information provided by current/previous employers
-
Have errors in the information corrected by previous employers and
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."