By submitting this application, I signify that I understand the information in this application will be provided to trucking company(s) for the purpose of determining my qualifications for employment. I give permission for company(s) to order MVR, DAC Reports, and do Background Check. (Required)

DISCLAIMER I certify that I personally completed this application and that all of the information is true and correct.

I hereby authorize, without liability, any person or organization, including but not limited to any educational institution, training facility or any institution, whose name I have given as a reference, or by whom I have been previously employed to furnish this company any information they may have concerning my character, habits, ability, financial responsibility, job performance, reasons for leaving employment, and all information concerning my employment or training to give such information to other companies and carriers requesting such information. Furthermore, there may be entities that the Comapny does busness with that may request investigative reports or consumer reports which apply to my background. In this case, these reports would apply to my assignment to projects related to the Customer, permission to be on the Customers' premises and to handle its products and other security concerns of the customer. I hereby release all such persons and organizations from any claims for damages of any kind, which may occur to me by reasons of furnishing such information. I hereby authorize any law enforcement agency or court of record to funish this(these) company(ies) information concerning Motor Vehicle Record, or any felony or misdemeanor of which I have been convicted.

Under the authority granted me by 49 CFR Parts 40 and 382, I hereby authorize and require my previous and/or current employers specifically listed as ewll as any other person or company provided by me in writing or by verbal interview by whom I was employed or to whom I applied for employment in the two year period preceding the date of this application to release the date, type of test and result of all drug and alcohol test taken by me, including the date and type of test for any refusals by me to take a drug or alcohol test, to the individual(s) assigned to process my application at this company. If I tested positive on any controlled substance test, had an alcohol test with a concentration of 0.04 or greater, or refused to take any drug or alcohol test, I also authorize the release of all information concerning my referral to a Substance Abuse Professional (SAP) including all records pertaining to my evaluation and treatment (if required by SAP). I authorize this release by whatever means is most expedient and agree to hold harmless any past employer or any person or company I applied with as well as their employees, agents, or representatives from all liability or damage that may arise from the release of the information specifically authorized here.

I have completed this application of my own free will and hold Trucker-Recruiter.com, it's owners, affiliates, copyright holders and other associated individuals harmless of all liability for providing this application for my use. I understand that a written and signed version of this release will be required upon successfull completion of a phone interview. I also understand I will be required to fill in a long form application for records purposes at orientation if I am selected for this position.