This certifies that I completed this application and that all entries on it and information in it are true and complete to the best of my knowledge.
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may necessary in arriving at an employment decision. I hereby release employers, schools or person from all liability in responding to inquiries in connection to my application.
In the event of employment and employee / contract driver, I understand that false or misleading information given in my application or interview(s) may result in dishcarge. I understand, also, that I am required to abide by all rules and regulations of the Company, as permitted by Law.
I acknowledge that I have read and understand the above conditions concerning the accuracy of this application.
In connection with my application for employment (including contract for services) with you, I understand that consumer reports which may contain public record information may be requested from DAC Services, Tulsa, Oklahoma, and Carolina Insurance Consultants, INC., Greenville, South Carolina. These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record of information concerning my driving record, workers' compensation claims, credit bankruptcy proceedings, criminal records, etc., from federal, state and other agencies which maintain such records; as well as information from DAC concerning previous driving record requests made by others from such state agencies, and state provided driving records.
I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC TO FURNISH THE ABOVE-MENTIONED INFORMATION
I have the right to make a request to DAC, upon proper identification, to request the nature and substance of all information; and the recipients of any reports on me which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC and I agree that such information which DAC has or obtains and my employment history with you if I am hired, will be supplied by DAC to other companies which subscribe to DAC Services.
I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.
Please fax MVR to 704-734-1780
I acknowledge that I have read and understand the above disclosure and release statement.
In connection with your application for employment with Kerns Trucking Inc.("Prospective Employer"), it may obtain one or more reports regarding your driving , and safety inspection history from the Federal Motor Carrier Safety Administration (FMCASA). If the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is take against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and acknowledge below:
I authorize Kerns Trucking Inc.("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.
I further understand that neither the Prospective Employer nor th FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqa.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.
I have read the above Notice Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this consent form, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
I acknowledge that I have read and understand the above conditions concerning background reports.