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I authorize you to make such investigation and inquiries of my personal, employment financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries 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. 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.

* 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 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.

*Click this to agree to the authorization:

Personal Employment History

Position Applying For

Owner/Operator Truck Information

Employment History

Current Employer

Previous Employer 1

Previous Employer 2

Abstract on File

* : Yes     No

Accident Record for the Last Three Years

Accident Record for the Last Three Years

Have you ever been denied a license, permit or priviledge to operate a motor vehicle? *
Yes     No

Has any license, permit or any privilege ever been suspended or revoked? *
Yes     No

How would you like us to contact you?

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