DOT Application

Section 383.21 FMCSR states "no person who operates a commercial motor vehicle shall at any time have more than one driver's license." I certify that I do not have more than one motor vehicle license, the information for which is listed below.

(other than parking violations)

Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must give the same information for all employers you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record). Must list the complete mailing address: street number and name, city, state and zip code.

I authorize you to make sure investigations and inquiries to my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) 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 In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. 1 understand, also, that am required to abide by all rules and regulations of the Company. 1 understand that information provide regarding current and/or previous employers may be used, and those employers) will be contacted, for the purpose of investigating my safety performance history as required by 49 FR 391.23(d) and (e). I understand that I have the right to: Review information provided by current/previous employers Have errors in the information corrected by previous employers and for 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 employers) and I cannot agree on the accuracy of the information."

Section 40,25() As the employer, you must also ask the employee whether he or she has tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which the employee applied for, but did not obtain, safety-sensitive transportation work covered by DOT Agency drug and alcohol testing rules during the past two years. If the employee admits that he or she had a positive testora refusal to test, you must notuse the employee to perform safety-sensitive functions foryou, until and unlessthe employee documents successful completion of return-to-duty process. (see Section 40.25(b)(5) and (e))

I have read and understood the preceding Disclosure to Consumer. Under the Fair Credit Reporting Act ("FRA"), 15 U.S.C. § 1681 et seq., the regulations applicable to the federal Department of Transportation's Federal Motor Carriers Safety Administration, including 49 CFR § 40.329, the Americans with Disabilities Act and all other applicable federal, state, and local laws, I hereby authorize and permit the above named company to obtain information about me, where permitted, which may pertain to my employment records, driving history records, driving performance and safety history, criminal history, credit history, civil records, workers' compensation (post-offer only), alcohol and drug testing, verification of my academic and/or professional credentials, and information and/or copies of documents from any military service records. I understand an "investigative consumer report" may include information as to my character, general reputation, personal characteristics, and mode of living that may be obtained by interviews with individuals who may have knowledge concerning any such items of information. I authorize information to be obtained from my former employers to satisfy driver qualification regulations. DOT Drivers. I understand that Title 49 of the Federal Code of Regulations, § 391.23, requires that my prospective employer and/or its agents) may contact all former employers of a driver within the last three years under the regulation of the Department of Transportation. Information such as dates of employment, position, accident history, as well as information pertaining to my drug and alcohol testing history, may be requested from each employer in accordance with Section and and CFR CFR40.25. By signing below, I consent to and authorize the gathering of this information by my prospective employer or employer and those who my prospective employer or employer has engaged to request and obtain this information including former employers, and/or from or through a consumer reporting agency, such as Samba. I understand and acknowledge that the information provided in the consumer reports or investigative consumer reports may assist my employer or prospective employer to make a determination regarding my suitability as an employee. I further understand that, under the CRA, in the event of Adverse Action, 1 may request a copy of any consumer report from the consumer reporting agency that compiled the report, after I have provided proper identification: I agree that a copy of this authorization has the same effect as an original. Where permitted, this authorization shall remain in effect over the course of my employment and reports may be ordered periodically during the course of my employment.