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Driver Information

Location:
Mableton, GA
Posted:
August 13, 2013

Contact this candidate

Resume:

Innovative Driver Services **-**-**** *:**:**AM CDT

**** ****** ****** ****.

Charlotte, NC 28217

800-***-****

IntelliApp

Thank you for your interest in Innovative Driver Services. To apply for a driving position,

please complete our online application for employment. Incomplete information will delay

the processing of your application or prevent it from being submitted.

In compliance with Federal and State equal employment opportunity laws, qualified

applicants are considered for all positions without regard to race, color, religion, sex,

national origin, age, marital status, veteran status, non-job related disability, or any other

protected group status.

Personal Information

Name Eric D Keith

Address 7210 Bridge Port Ct

Address 2 415 Fairbun Rd

City, State/Province Zip/Postal Atlanta, GA 30168

Country United States

SSN/SIN 9493

Date of Birth

Primary Phone 770-***-****

Preferred method of contact Primary Phone

Best time to contact you Morning

Email ab9of9@r.postjobfree.com

Company Questions

GENERAL INFORMATION

What position are you applying for? Company Driver

What location are you applying for? Atlanta

If "Other", please enter a location

Are you a U.S. citizen? Yes

Are you legally eligible for employment in Yes

the United States?

Are you currently employed? No

What date did your last employment end? 08/09/2013

Do you read, write, and speak English? Yes

Have you ever worked for this company No

before?

Enter start and end dates, location,

position, rate of pay, and reason for

leaving:

Do you have a current TWIC card? Yes

Expiration date: 10/13

Please enter the names of any relatives

employed here:

Have you ever been known by any other No

name?

Enter name:

How did you hear about us? JobsInTrucks

If you selected Employee Referral, Friend,

Newspaper, Website or Other above,

please list the specific source/name:

In case of Emergency, notify (list name, vondelyn keith wife7701-627-2095

address, and phone): 404-***-****

Enter a second emergency contact Anthony Maxwell912-507-7728

EDUCATION

List highest grade attended Grade 4

List highest grade completed: Grade 12

List last school attended (name, city, and m.s.carries driving school

state):

Did you complete High School? Yes

What type of completion? Diploma

PERSONAL REFERENCES

List name, address, city, state, phone number, and relationship:

First Reference: Mike Williams Ellenwood Ga

678-***-****

Second Reference: Larry Barnes Guyton Ga 912-***-****

Licenses

License Number 959

State/Province GA

Country United States

License Class Class A

License Expiration Date 09-28-2014

Physical Expiration Date 03-19-2014

Current License Yes

Commercial Driver License Yes

Endorsements

Tanker Endorsement No

HAZMAT Endorsement Yes

X Endorsement No

Doubles Triples Endorsement No

Other Endorsement No

Employment / Unemployment

G&P Trucking Company

Company G&P Trucking Company

Start Date 10-2012

End Date 08-2013

Address 126 Access Road

City, State/Province Zip/Postal Greer, SC 29053

Phone 803-***-****

Fax 803-***-****

Position Held lease purchase o/o

Reason for leaving? lack of miles to many truck problems

Were you terminated/discharged/laid off? No

Is this your current employer? Yes

May we contact this employer at this time? Yes

Did you operate a commercial motor Yes

vehicle?

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive Yes

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven southeast,southwest

Miles driven weekly 1500-2000

Pay Range (cents/mile) 84

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

Best Drivers

Company Best Drivers

Start Date 07-2012

End Date 10-2012

Address PO Box 1006

City, State/Province Zip/Postal Alcoa, TN 37701

Phone 865-***-****

Fax 865-***-****

Reason for leaving? went back otr

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor Yes

vehicle?

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive Yes

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven local

Miles driven weekly 0-500

Pay Range (cents/mile)

Most common truck driven Day Cab

Most common trailer Van

Trailer length 45 to 52 feet

FFE (FFE Transportation Services)

Company FFE (FFE Transportation Services)

Start Date 04-2012

End Date 07-2012

Address 3400 Stonewell St

City, State/Province Zip/Postal Lancaster, TX 75134

Phone 214-***-****

Fax 972-***-****

Position Held contractor lease purchase

Reason for leaving? just was not got for my family

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor Yes

vehicle?

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive Yes

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven 48 states

Miles driven weekly 2000-2500

Pay Range (cents/mile) 1.40 mile

Most common truck driven Conventional Tractor

Most common trailer Reefer Trailer

Trailer length 53 feet or more

Horizon Freight Sys

Company Horizon Freight Sys

Start Date 04-2010

End Date 04-2012

Address 6600 Bessemer Ave

City, State/Province Zip/Postal Cleveland, OH 44127

Phone 800-***-****

Fax 216-***-****

Position Held contractor

Reason for leaving? truck went down

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor Yes

vehicle?

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive Yes

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven southeast

Miles driven weekly 2500-3000

Pay Range (cents/mile) 1.25/mile

Most common truck driven Conventional Tractor

Most common trailer Container

Trailer length 45 to 52 feet

Morgan Southern

Company Morgan Southern

Start Date 05-2004

End Date 04-2010

Address 1579 Valencia Ct

City, State/Province Zip/Postal Calumet City, IL 60409

Phone 404-***-****

Fax 708-***-****

Position Held driver/contractor

Reason for leaving? lack of work

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor Yes

vehicle?

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive Yes

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven otr reagional

Miles driven weekly 2000-2500

Pay Range (cents/mile) 1.00 mile

Most common truck driven Conventional Tractor

Most common trailer Container

Trailer length 53 feet or more

colorado boxbeef

Company colorado boxbeef

Start Date 01-2003

End Date 06-2004

Address 302 progress rd

City, State/Province Zip/Postal Aubundale, FL

Phone 863-***-****

Position Held deliver driver

Reason for leaving? company lost contract

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor Yes

vehicle?

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive Yes

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven southeast

Miles driven weekly 1500-2000

Pay Range (cents/mile) .050 mile

Most common truck driven Conventional Tractor

Most common trailer Reefer Trailer

Trailer length 45 to 52 feet

Arnold Transportation Services

Company Arnold Transportation Services

Start Date 04-1998

End Date 04-2003

Address 9523 Florida Mining Blvd.

City, State/Province Zip/Postal All Locations, FL 32257

Phone 904-***-****

Fax 904-***-****

Reason for leaving? company lost contract

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor Yes

vehicle?

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while employed/contracted by

this employer/contractor?

Did you perform any safety sensitive Yes

functions in this job, regulated by DOT,

and subject to drug and alcohol testing?

Areas Driven southeast

Miles driven weekly 2000-2500

Pay Range (cents/mile)

Most common truck driven Day Cab

Most common trailer Van

Trailer length 53 feet or more

Trucking School

Start Date 03-1997

End Date 05-1997

School M.s.carriers

City, State/Province Memphis, TN

Country United States

Phone

Did you graduate? Yes

Were you subject to the Federal Motor Yes

Carrier or Transport Canada Safety

Regulations while attending this truck

school?

Yes

Did you perform any safety sensitive

functions at this truck school, regulated by

DOT, and subject to drug and alcohol

testing?

GPA

Hours of Instruction 200

Border Crossing No

Log Books Yes

Federal Motor Carrier Regulations Yes

Hazardous Materials Yes

Motor Vehicle Record

1. Has any license, permit or privilege ever No

been denied, suspended or revoked for

any reason?

2. Have you ever been convicted of driving No

during license suspension or revocation, or

driving without a valid license or an expired

license, or are any charges pending?

3. Have you ever been convicted for any No

alcohol or controlled substance related

offense while operating a motor vehicle, or

are any charges pending?

4. Have you ever been convicted for No

possession, sale or transfer of a an illegal

substance (including but not limited to,

marijuana, amphetamines, or derivatives

thereof), or are any charges pending?

5. Have you ever been convicted of No

reckless driving, careless driving or

careless operation of a motor vehicle, or

are any charges pending?

6. Have you ever tested positive, or No

refused to test on a pre-employment drug

or alcohol test by an employer to whom

you applied, but did not obtain

safety-sensitive transportation work

covered by DOT agency drug and alcohol

testing rules in past three years, or have

you ever tested positive or refused to test

on any DOT-mandated drug or alcohol

test?

9

Vehicle Accident Record

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even

if not at fault)?

No Accidents

Traffic Convictions \ Violations

Have you had any moving violations or traffic convictions in the past 5 years?

No Violations

Criminal Record

Have you ever been convicted of a crime? No

Do you have any deferred prosecutions? No

Do you have criminal charges pending? No

Have you ever pled "guilty" to, been No

convicted of, or pled "no contest" to a

felony?

If you have any felony convictions, do you No

currently hold a ministers permit to enter or

exit Canada?

Have you, within the last five years, pled No

"guilty" to, been convicted of, had

prosecution deferred in connection with, or

pled "no contest" to a misdemeanor?

Federal FCRA Summary of Rights Acknowledgment

By checking this box, I acknowledge that I Yes

have read and understand the FCRA

Statement of Rights.

Pre-Employment Screening Program Important Notice

I acknowledge that I have read and Yes

understand the above Important Notice of

Rights and also have been given the

opportunity to copy/print the notice.

User Requested Copy

User requested a copy to be sent to this Yes

email address ab9of9@r.postjobfree.com.

Signature

Full Name Eric D Keith

Social Security Number 9493

Date of Birth

IP Address 174.49.115.250

Signature Date/Time 08-10-2013 4:31 AM

11

DISCLOSURE AND RELEASE

In connection with your employment or application of employment (including contract for services) through Innovative Driver Services, consumer

reports (Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services), DataFacts, InfoMart,

Sterling Direct, SLED, Chamblee or any other background screening companies used for pre-employment screening. These reports may include the

following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic

history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers

compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well

as information from HireRight concerning previous driving record requests made by others from such state agencies and state provided driving

records.

We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA").

You have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on you at

the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that

HireRight has previously furnished within the past three year period preceding your request. HireRight may be contacted by mail at P.O. Box 33181,

Tulsa, OK 74153 or by telephone at 800-***-****. You may also bring a third party with you to view the information at the HireRight offices if this

person provides proper identification.

I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA, DATAFACTS, INFOMART, STERLING DIRECT, SLED, CHAMBLEE AND ANY

OTHER PARTY OR AGENCY CONTACTED TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY

TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I.

I hereby consent to your obtaining the above information from HireRight, DataFacts, InfoMart, Sterling Direct, SLED, Chamblee or any other

background screening companies used for pre-employment screening and I agree that such information which they have or obtain in my employment

history (not DOT drug and alcohol information without a specific consent by me) with you if I am hired, will be supplied to other companies. I hereby

authorize procurement of consumer reports as set forth above.

If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you

to procure consumer reports at any time during my employment or contract period.

I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot

change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs

System at: https://dataqs.fmcsa.dot.gov.

Printed Name: Eric D Keith

7210 Bridge Port Ct

Eric D Keith

415 Fairbun Rd

Social Security #: Atlanta, GA 30168

9493 770-***-****

Gender:

Signed Date: 08-10-2013

TO BE READ AND SIGNED BY APPLICANT

This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of

my knowledge.

If, during the course of DOT mandated background checks, IDSC discovers any violations that are in direct conflict with DOT regulations

or conflict with information you provided during the application process, you may be disqualified from employment or discharged. These

background investigations may take up to thirty days to complete from the appiication date.

Customer service, driver logs and related paperwork, attendance, punctuality, appearance and SAFETY will play a significant role in each

driver's evaluation. IDSC reserves the right to terminate employment at any time.

IDSC investigates all customer complaints and service failures and strives to deliver excellent service for every one of its customers. If you

do not share this attitude and are not willing to make the commitment to deliver the best service, we will not consider you for employment

and thank you for your time.

Printed Name: Eric D Keith Signed Date: 08-10-2013

Social Security #: 9493

Signed:

END OF APPLICATION

13

IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP

ONLINE SERVICE

1. In connection with your application for employment with Innovative Driver Services ("Prospective Employer"), it may obtain one or more

reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).

When the application for employment is submitted in person, 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 taken 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.

When the application for employment is submitted by mail, telephone, computer, or other similar means, 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 must provide you within three business days of taking adverse action oral, written or electronic notification: that

adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free

telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the

specific reasons why the adverse action was taken; and that you may, upon providing proper identification,request a free copy of the

report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver

record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with

proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the

Fair Credit Reporting Act.

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 sign below:

2. I authorize Innovative Driver Services 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.

3. I further understand that neither the Prospective Employer nor the 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://dataqs.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.

4. Please note: Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report,

or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those

crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State

citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.

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.

Printed Name: Eric D Keith Signed Date: 08-10-2013

Social Security #: 9493

Signed:

14

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing

Records

And changes in Parts 390 and 391 of the FMCSA

Eric D Keith

08-10-201*-****

X X

7210 Bridge Port Ct

Date Social Security Number

415 Fairbun Rd

Atlanta, GA 30168

770-***-****

Gender:

Eric D Keith

X X

Print Name (First, MI, Last) Signature

I, the above mentioned signer, hereby authorize Horizon Freight Sys

To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances

testing/training records to Innovative Driver Services

DISCLOSURE AND RELEASE

In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and

alcohol testing records by the carriers (company/school) listed above to Innovative Driver Services, or to HireRight for the sole

purpose of transmitting such records to Innovative Driver Services. I authorize release of the following information concerning DOT

drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or

higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other

violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule

violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers

(company/school) listed above to release information about names and dates of previous employers, reasons for termination of

employment, work experience, accidents, academic history, professional credentials and other information.

The information that I have authorized Innovative Driver Services or HireRight to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Innovative Driver Services or HireRight with information concerning items (i) through (vi)

above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or

tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who

evaluated me during the past three years.

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing

Records

And changes in Parts 390 and 391 of the FMCSA

Eric D Keith

08-10-201*-****

X X

7210 Bridge Port Ct

Date Social Security Number

415 Fairbun Rd

Atlanta, GA 30168

770-***-****

Gender:

Eric D Keith

X X

Print Name (First, MI, Last) Signature

I, the above mentioned signer, hereby authorize Morgan Southern

To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances

testing/training records to Innovative Driver Services

DISCLOSURE AND RELEASE

In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and

alcohol testing records by the carriers (company/school) listed above to Innovative Driver Services, or to HireRight for the sole

purpose of transmitting such records to Innovative Driver Services. I authorize release of the following information concerning DOT

drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or

higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other

violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule

violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers

(company/school) listed above to release information about names and dates of previous employers, reasons for termination of

employment, work experience, accidents, academic history, professional credentials and other information.

The information that I have authorized Innovative Driver Services or HireRight to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Innovative Driver Services or HireRight with information concerning items (i) through (vi)

above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or

tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who

evaluated me during the past three years.

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing

Records

And changes in Parts 390 and 391 of the FMCSA

Eric D Keith

08-10-201*-****

X X

7210 Bridge Port Ct

Date Social Security Number

415 Fairbun Rd

Atlanta, GA 30168

770-***-****

Gender:

Eric D Keith

X X

Print Name (First, MI, Last) Signature

I, the above mentioned signer, hereby authorize colorado boxbeef

To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances

testing/training records to Innovative Driver Services

DISCLOSURE AND RELEASE

In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and

alcohol testing records by the carriers (company/school) listed above to Innovative Driver Services, or to HireRight for the sole

purpose of transmitting such records to Innovative Driver Services. I authorize release of the following information concerning DOT

drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or

higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other

violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule

violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers

(company/school) listed above to release information about names and dates of previous employers, reasons for termination of

employment, work experience, accidents, academic history, professional credentials and other information.

The information that I have authorized Innovative Driver Services or HireRight to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Innovative Driver Services or HireRight with information concerning items (i) through (vi)

above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or

tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who

evaluated me during the past three years.

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing

Records

And changes in Parts 390 and 391 of the FMCSA

Eric D Keith

08-10-201*-****

X X

7210 Bridge Port Ct

Date Social Security Number

415 Fairbun Rd

Atlanta, GA 30168

770-***-****

Gender:

Eric D Keith

X X

Print Name (First, MI, Last) Signature

I, the above mentioned signer, hereby authorize FFE (FFE Transportation Services)

To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances

testing/training records to Innovative Driver Services

DISCLOSURE AND RELEASE

In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and

alcohol testing records by the carriers (company/school) listed above to Innovative Driver Services, or to HireRight for the sole

purpose of transmitting such records to Innovative Driver Services. I authorize release of the following information concerning DOT

drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or

higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other

violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule

violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers

(company/school) listed above to release information about names and dates of previous employers, reasons for termination of

employment, work experience, accidents, academic history, professional credentials and other information.

The information that I have authorized Innovative Driver Services or HireRight to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Innovative Driver Services or HireRight with information concerning items (i) through (vi)

above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or

tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who

evaluated me during the past three years.

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing

Records

And changes in Parts 390 and 391 of the FMCSA

Eric D Keith

08-10-201*-****

X X

7210 Bridge Port Ct

Date Social Security Number

415 Fairbun Rd

Atlanta, GA 30168

770-***-****

Gender:

Eric D Keith

X X

Print Name (First, MI, Last) Signature

I, the above mentioned signer, hereby authorize Best Drivers

To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances

testing/training records to Innovative Driver Services

DISCLOSURE AND RELEASE

In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and

alcohol testing records by the carriers (company/school) listed above to Innovative Driver Services, or to HireRight for the sole

purpose of transmitting such records to Innovative Driver Services. I authorize release of the following information concerning DOT

drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or

higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other

violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule

violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers

(company/school) listed above to release information about names and dates of previous employers, reasons for termination of

employment, work experience, accidents, academic history, professional credentials and other information.

The information that I have authorized Innovative Driver Services or HireRight to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Innovative Driver Services or HireRight with information concerning items (i) through (vi)

above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or

tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who

evaluated me during the past three years.

Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing

Records

And changes in Parts 390 and 391 of the FMCSA

Eric D Keith

08-10-201*-****

X X

7210 Bridge Port Ct

Date Social Security Number

415 Fairbun Rd

Atlanta, GA 30168

770-***-****

Gender:

Eric D Keith

X X

Print Name (First, MI, Last) Signature

I, the above mentioned signer, hereby authorize G&P Trucking Company

To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances

testing/training records to Innovative Driver Services

DISCLOSURE AND RELEASE

In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and

alcohol testing records by the carriers (company/school) listed above to Innovative Driver Services, or to HireRight for the sole

purpose of transmitting such records to Innovative Driver Services. I authorize release of the following information concerning DOT

drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or

higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other

violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule

violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers

(company/school) listed above to release information about names and dates of previous employers, reasons for termination of

employment, work experience, accidents, academic history, professional credentials and other information.

The information that I have authorized Innovative Driver Services or HireRight to review involves tests required by DOT. If any carrier

(company/school) listed above furnishes Innovative Driver Services or HireRight with information concerning items (i) through (vi)

above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or

tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who

evaluated me during the past three years.

DISCLOSURE AND RELEASE

In connection with your employment or application of employment (including contract for services) through Innovative Driver Services, consumer

reports (Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services), DataFacts, InfoMart,

Sterling Direct, SLED, Chamblee or any other background screening companies used for pre-employment screening. These reports may include the

following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic

history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers

compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well

as information from HireRight concerning previous driving record requests made by others from such state agencies and state provided driving

records.

We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA").

You have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on you at

the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that

HireRight has previously furnished within the past three year period preceding your request. HireRight may be contacted by mail at P.O. Box 33181,

Tulsa, OK 74153 or by telephone at 800-***-****. You may also bring a third party with you to view the information at the HireRight offices if this

person provides proper identification.

I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA, DATAFACTS, INFOMART, STERLING DIRECT, SLED, CHAMBLEE AND ANY

OTHER PARTY OR AGENCY CONTACTED TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY

TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I.

I hereby consent to your obtaining the above information from HireRight, DataFacts, InfoMart, Sterling Direct, SLED, Chamblee or any other

background screening companies used for pre-employment screening and I agree that such information which they have or obtain in my employment

history (not DOT drug and alcohol information without a specific consent by me) with you if I am hired, will be supplied to other companies. I hereby

authorize procurement of consumer reports as set forth above.

If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you

to procure consumer reports at any time during my employment or contract period.

I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot

change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs

System at: https://dataqs.fmcsa.dot.gov.

Employer / Contractor / Educational Institution: Eric D Keith

7210 Bridge Port Ct

Arnold Transportation Services

415 Fairbun Rd

Printed Name: Atlanta, GA 30168

Eric D Keith 770-***-****

Gender:

Social Security #:

9493

Signed Date: 08-10-2013

21

DISCLOSURE AND RELEASE

In connection with your employment or application of employment (including contract for services) through Innovative Driver Services, consumer

reports (Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services), DataFacts, InfoMart,

Sterling Direct, SLED, Chamblee or any other background screening companies used for pre-employment screening. These reports may include the

following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic

history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers

compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well

as information from HireRight concerning previous driving record requests made by others from such state agencies and state provided driving

records.

We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA").

You have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on you at

the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that

HireRight has previously furnished within the past three year period preceding your request. HireRight may be contacted by mail at P.O. Box 33181,

Tulsa, OK 74153 or by telephone at 800-***-****. You may also bring a third party with you to view the information at the HireRight offices if this

person provides proper identification.

I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA, DATAFACTS, INFOMART, STERLING DIRECT, SLED, CHAMBLEE AND ANY

OTHER PARTY OR AGENCY CONTACTED TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY

TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I.

I hereby consent to your obtaining the above information from HireRight, DataFacts, InfoMart, Sterling Direct, SLED, Chamblee or any other

background screening companies used for pre-employment screening and I agree that such information which they have or obtain in my employment

history (not DOT drug and alcohol information without a specific consent by me) with you if I am hired, will be supplied to other companies. I hereby

authorize procurement of consumer reports as set forth above.

If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you

to procure consumer reports at any time during my employment or contract period.

I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot

change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs

System at: https://dataqs.fmcsa.dot.gov.

Employer / Contractor / Educational Institution: Eric D Keith

7210 Bridge Port Ct

M.s.carriers

415 Fairbun Rd

Printed Name: Atlanta, GA 30168

Eric D Keith 770-***-****

Gender:

Social Security #:

9493

Signed Date: 08-10-2013

22



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