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Tradewinds **-**-**** **:**:**AM CDT
Arcadia, IN 46030
IntelliApp
Thank you for your interest in Tradewinds. 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
Referral Code: simbaseven
Name Aurelio Hernandez Chavez, Jr.
Residence 3 years or longer (If No, No
previous addresses shown below)
Address 801 N
City, State/Province Zip/Postal Houston, TX 77587
Addresses Over last 3 years 4102 Memorial Blvd,port Arthur Texas
77640
Addresses Over last 3 years Address 1
801 ave n
houston, TX 77587
04-2011 to 12-2014
Address 2
4102 memorial blvd
port arthur, TX 77640
01-2007 to 03-2011
Country United States
SSN/SIN 2972
Date of Birth
Primary Phone 281-***-****
Cell Phone 281-***-****
Preferred method of contact Primary Phone
Best time to contact you Any
Email acgfw0@r.postjobfree.com
Company Questions
GENERAL INFORMATION
What position are you applying for? Lease Purchase
Are you an owner / operator? No
EQUIPMENT (OWNER/OPERATORS ONLY)
Equipment Description (Tractor):
Type:
Year:
Make:
Model:
Color:
VIN:
Weight
Mileage
Fifth Wheel Height
Are you legally eligible for employment in Yes
the United States?
Are you currently employed? No
What date did your last employment end? 10/14
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: 02-23-2018
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?
What recruiter are you working with? Not working with a recruiter
In case of Emergency, notify (list name, Silvia vasquez 718 Dover place Delano
address, and phone): California 661-***-****
DRIVING EXPERIENCE
For each class of equipment, enter type of equipment (van, reefer, tank, etc.), start and
end dates, and approximate number of total miles. If no experience in a class, enter
"NONE".
Straight Truck Josh from simba seven
Tractor and Semi-Trailer Josh from Simba Seven
Tractor - Two Trailers Josh from Simba Seven
Other Josh from Simba Seven
Which safe driving awards do you hold
and from whom?
EDUCATION
List highest grade completed:
List last school attended (name, city, and
state):
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship:
First Reference: Silvia vasquez 718 Dover place Delano
California 661-***-****
Second Reference:
Licenses
License Number 302
State/Province TX
Country United States
License Class Class A
License Expiration Date 07-18-2014
Physical Expiration Date 08-08-2014
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement No
X Endorsement No
Doubles Triples Endorsement No
Other Endorsement No
Employment / Unemployment
Unemployment
Start Date 10-2014
End Date 10-2014
Comment
Delaware Logistics
Company Delaware Logistics
Start Date 01-2014
End Date 09-2014
Address
City, State/Province Zip/Postal Keller, TX
Phone
Position Held Driver
Reason for leaving? Still Working
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 OTR
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 53 feet or more
Unemployment
Start Date 11-2013
End Date 12-2013
Comment
Swift Transportation
Company Swift Transportation
Start Date 09-2013
End Date 10-2013
Address
City, State/Province Zip/Postal Phoenix, AZ
Phone 623-***-****
Position Held driver
Reason for leaving? not enough miles
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
Miles driven weekly
Pay Range (cents/mile) 038 cpm
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 53 feet or more
Unemployment
Start Date 02-2013
End Date 08-2013
Comment unemployment looking for work
Pro Transport &Leasing
Company Pro Transport &Leasing
Start Date 11-2012
End Date 01-2013
Address 5520 32nd Ave S
Address 2 5520 32nd ave s
City, State/Province Zip/Postal Grand Forks, ND 58201
Phone 800-***-****
Fax 701-***-****
Position Held Driver
Reason for leaving? laid off
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 No
vehicle?
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Anderson Trucking Service, Inc.
Company Anderson Trucking Service, Inc.
Start Date 08-2012
End Date 10-2012
Address 203 Cooper Ave N.
City, State/Province Zip/Postal St Cloud, MN 56303
Phone 800-***-****
Reason for leaving?
Were you terminated/discharged/laid off?
Is this your current employer?
May we contact this employer at this time?
Did you operate a commercial motor
vehicle?
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Mesilla Valley Transportation
Company Mesilla Valley Transportation
Start Date 10-2011
End Date 10-2012
Address 7440 Doniphan
City, State/Province Zip/Postal El Paso, TX 79912
Phone 915-***-****
Fax 915-***-****
Position Held truk Driver
Reason for leaving? not enough miles
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
Miles driven weekly 2500-3000
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 53 feet or more
lc&e
Company lc&e
Start Date 05-2004
End Date 09-2011
Address 1813 manin st,
Address 2 laporte
City, State/Province Zip/Postal Laporte, TX 77571
Phone 281-***-****
Position Held truck driver
Reason for leaving? Lak 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
Miles driven weekly 2500-3000
Pay Range (cents/mile)
Most common truck driven Other
Most common trailer Flatbed
Trailer length 53 feet or more
Shark Trucking
Company Shark Trucking
Start Date 04-2007
End Date 04-2007
Address 12106 MESA
City, State/Province Zip/Postal Houston, TX 77016
Phone 281-***-****
Reason for leaving?
Were you terminated/discharged/laid off?
Is this your current employer?
May we contact this employer at this time?
Did you operate a commercial motor
vehicle?
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Panther Expedited
Company Panther Expedited
Start Date 01-2007
End Date 02-2007
Address
City, State/Province Zip/Postal Seville, OH
Phone 800-***-****
Reason for leaving?
Were you terminated/discharged/laid off?
Is this your current employer?
May we contact this employer at this time?
Did you operate a commercial motor
vehicle?
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
CR England Truck Driving School
Company CR England Truck Driving School
Start Date 06-2004
End Date 12-2004
Address 4701 W 2100 South
City, State/Province Zip/Postal Salt Lake City, UT 84120
Phone 801-***-****
Reason for leaving?
Were you terminated/discharged/laid off?
Is this your current employer?
May we contact this employer at this time?
Did you operate a commercial motor
vehicle?
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Trucking School
Start Date 02-2003
End Date 04-2004
School crst
City, State/Province Huoston, TX
Country United States
Phone 800-***-****
Did you graduate? Yes
Were you subject to the Federal Motor Yes
Carrier or Transport Canada Safety
Regulations while attending this truck
school?
Did you perform any safety sensitive Yes
functions at this truck school, regulated by
DOT, and subject to drug and alcohol
testing?
GPA
Hours of Instruction
Border Crossing Yes
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 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?
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 3 years?
Violation Date 04-2014
Charge / Description Speeding
MPH Over Limit: 5
Violation State/Province CA
In Commercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Community Service?
Other Penalty?
Fine Amount (if any):
Comments:
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 minister's 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
acgfw0@r.postjobfree.com.
By my check of this box, I represent that I Yes
understand and agree to the above and
that I intend to execute this document by
electronic signature in checking this box.
Signature
Full Name Aurelio Hernandez Chavez, Jr.
Social Security Number 2972
Date of Birth
IP Address 108.236.59.113
Signature Date/Time 10-15-2014 11:50 AM
This certifies that this application was completed by me, and that all
entries on it and information in it are true and complete to the best of
my knowledge.
Signed Date: 10-15-2014 11:50 AM
Signed:
14
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) through Tradewinds, consumer reports
(Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services). 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 two year period preceding your request (3 years in California). 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. Information about HireRight's privacy practices is available at
www.hireright.com/Privacy-Policy.aspx.
I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY HIRERIGHT 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, and I agree that such information which HireRight has or obtains 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 by HireRight to
other companies which subscribe to HireRight. 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: Aurelio Hernandez Chavez, Jr.
801 N
Aurelio Hernandez Chavez, Jr.
Houston, TX 77587
Social Security #: 281-***-****
2972 Gender:
Signed Date: 10-15-2014
IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP
ONLINE SERVICE
1. In connection with your application for employment with Tradewinds ("Prospective Employer"), Prospective Employer, its employees, agents or
contractors 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 Tradewinds ("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.
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: Aurelio Hernandez Chavez, Jr.
801 N
Aurelio Hernandez Chavez, Jr.
Houston, TX 77587
Social Security #: 281-***-****
2972 Gender:
Signed Date: 10-15-2014
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
Aurelio Hernandez Chavez, Jr.
X X
801 N
Date Social Security Number
Houston, TX 77587
Gender:
Aurelio Hernandez Chavez,
X
Jr. X
Print Name (First, MI, Last) Signature
I, the above mentioned signer, hereby authorize Mesilla Valley Transportation
To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances
testing/training records to Tradewinds
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 Tradewinds, or to HireRight for the sole purpose of
transmitting such records to Tradewinds. 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 Tradewinds or HireRight to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes Tradewinds 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
Aurelio Hernandez Chavez, Jr.
X X
801 N
Date Social Security Number
Houston, TX 77587
Gender:
Aurelio Hernandez Chavez,
X
Jr. X
Print Name (First, MI, Last) Signature
I, the above mentioned signer, hereby authorize Swift Transportation
To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances
testing/training records to Tradewinds
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 Tradewinds, or to HireRight for the sole purpose of
transmitting such records to Tradewinds. 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 Tradewinds or HireRight to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes Tradewinds 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
Aurelio Hernandez Chavez, Jr.
X X
801 N
Date Social Security Number
Houston, TX 77587
Gender:
Aurelio Hernandez Chavez,
X
Jr. X
Print Name (First, MI, Last) Signature
I, the above mentioned signer, hereby authorize Delaware Logistics
To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances
testing/training records to Tradewinds
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 Tradewinds, or to HireRight for the sole purpose of
transmitting such records to Tradewinds. 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 Tradewinds or HireRight to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes Tradewinds 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 for employment
Contact this candidate