United States A Driver
Resume:
Crete Carrier Corporation
Lincoln, NE 68528
**-**-**** *:33:53PM CDT
IntelliApp
Thank you for your interest in Crete Carrier Corporation. To apply for a driving position, please complete our online application for qualification. 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: Homepage-Herolink
Name Vance Columbus Fitzgerald
Residence 5 years or longer (If No,
previous addresses shown below)
No
Current Address 1714 Pace Road Ext Lot 10
City, State/Province Zip/Postal Pocahontas, AR 72455 Country United States
Addresses Over last 5 years Address 1
1714 PACE RD. EXT LOT 10
POCAHONTAS, AR 72455
United States
06-2022 to 10-2023
Address 2
1052 CR 139
CORNING, AR 72422
United States
10-2020 to 06-2022
Address 3
1303 N PARK ST
Pocahontas, AR 72455
United States
11-2017 to 10-2020
SSN/SIN 1944
Date of Birth
Primary Phone 601-***-****
Preferred method of contact Text Message
Best time to contact you Night
1
Email ad1r5f@r.postjobfree.com
Yes, I agree to receive information
concerning future opportunities or
promotions from Crete Carrier Corporation
by email or other commercial electronic
communications.
Yes
Would you like to receive communication
from Crete Carrier Corporation via text
message?
By participating, you consent to receive
text messages sent by an automatic
telephone dialing system, which may
contain recruiting/advertising messages.
Consent to these terms is not a condition
of being hired, contracted, or leased. You
may opt out at any time by texting STOP to
unsubscribe. You also agree that Crete
Carrier Corporation's service provider
receives in real time and logs your text
messages with Crete Carrier Corporation.
Yes
Company Questions
GENERAL INFORMATION
Are you applying as a Company Driver? Yes
Are you applying as an Owner Operator? No
Please enter your business name, phone
number, address, city, state, and zip
Are you applying as a Driver for an Owner
Operator?
No
Please enter the name of the business you
are driving for, the business phone
number, address, city, state, and zip
Are you applying as a Student Driver? No
If you are a resident alien, please give your
alien number from your Resident Alien
Care, Form I-551
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? No
What date did your last employment end? 10/2023
Do you read, write, and speak English? Yes
Have you ever worked for this company
before?
No
2
Which company?
Do you have a current TWIC card? No
Expiration date:
Have you held a drivers license in any
other name within the last ten(10) years? If
yes, please provide the other name(s):
No
Other First Name 1:
Other Last Name 1:
Other First Name 2:
Other Last Name 2:
Other First Name 3:
Other Last Name 3:
Other First Name 4:
Other Last Name 4:
Were you referred by a Crete/Shaffer/Hunt
driver?
No
Enter the driver's first name
Enter the driver's last name
Enter the driver's driver code (if known)
How did you hear about us? TruckDriversNow
If "Other", please describe
Do you hold any safe driving awards? No
What were they and with whom did you
earn them?
In case of Emergency, notify:
Name: Kerticia Petterson
Address: 1052 CR 139
City: CORNING
State: AR
Zip: 72422
Phone Number: 870-***-****
DOT QUESTIONNAIRE
A. Have you ever been denied a license,
permit or privilege to operate a motor
vehicle?
No
Date of Denial:
3
City:
State:
Details:
If you have a second or subsequent denial,
please enter the details here:
B. Has your motor vehicle operator's
license, permit or privilege ever been
suspended or revoked?
No
Date of Suspension or Revocation:
City:
State:
Details:
If you have a second or subsequent
suspension or revocation, please enter the
details here:
C. Have you ever been disqualified from
driving a motor vehicle under the D.O.T.
regulations?
No
Date of Disqualification:
City:
State:
Details:
If you have a second or subsequent
disqualification, please enter the details
here:
D. Are you currently able to obtain a
hazardous material endorsement on your
commercial drivers license?
Yes
E. Regarding DOT Drug and Alcohol regulations, have you, within the last three (3) years preceding the date of this application:
1. Undergone an alcohol test in which a
concentration of 0.04 or greater has been
indicated?
No
Date of Test:
City:
State:
Details:
If you have a second or subsequent test,
please enter the details here:
No
4
2. Undergone a controlled substance test
in which a positive result has been
verified?
Date of Test:
City:
State:
Details:
If you have a second or subsequent
positive test, please enter the details here:
3. Refused to undergo either an alcohol or
drug test or adulterated or substituted a
test specimen for a controlled substance?
No
Date of Test:
City:
State:
Details:
If you have a second or subsequent
refused, adulterated, or substituted test,
please enter the details here:
4. Refused to submit to a post-accident,
random, reasonable suspicion, or follow-up
alcohol or controlled substance test?
No
Date of Test:
City:
State:
Details:
If you have a second or subsequent
refused test,please enter the details here:
5. Tested positive, or refused to test, on a
pre-employment drug or alcohol test by an
employer to which you applied for, but did
not obtain, safety-sensitive transportation
work covered by DOT agency drug and
alcohol testing rules.
No
Date of Test:
City:
State:
Details:
If you have a second or subsequent
positive or refused test, please enter the
details here:
5
6. Committed any other violation of a
Federal Motor Carrier Safety
Administration drug or alcohol regulation?
No
Date of Violation:
City:
State:
Details:
If you have a second or subsequent
violation, please enter the details here:
If you answered "yes" to any of the six (6) questions above please answer question seven (7) below. If you answered "No" to the above E 1-6 questions, please answer
"Non Applicable."
7. Following any violation of a D.O.T. drug
or alcohol regulation as indicated above,
did you successfully complete the return to
work requirements?
Non Applicable
If you answered "yes" to the question
above, please explain:
Driver Referral First Name
Driver Referral Last Name
Driver Referral Driver Code
GCLID
Licenses
List ALL licenses you have held.
License Number 361
Licensing Authority AR
Country US
License Class Class A
Original Issue Date 04-18-2022
License Expiration Date 10-09-2027
DOT Medical Card Expiration Date 05-12-2024
Current License Yes
Commercial Driver License Yes
Endorsements None
6
Employment / Unemployment
WIEDEMAN FARMS
Company WIEDEMAN FARMS
Start Date 07-2023
End Date 10-2023
Address
City, State/Province Zip/Postal Corning, AR 72422
Country United States
Phone 870-***-****
Position Held Truck Driver
Reason for leaving? GOT HARVEST DONE
Were you terminated/discharged/laid off? Yes
Termination Explanation LAID OFF
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
No
Areas Driven CORNING
Miles driven weekly 0-500
Most common truck driven Tractor-Trailer
Most common trailer Other
Trailer length 45 to 52 feet
ALPINE CONSTRUCTION LLC
Company ALPINE CONSTRUCTION LLC
Start Date 10-2022
End Date 06-2023
Address
City, State/Province Zip/Postal Pocahontas, AR 72455 Country United States
7
Phone
Position Held Truck Driver
Reason for leaving? LET GO
Were you terminated/discharged/laid off? Yes
Termination Explanation LET GO
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven POCAHONTAS 150 MILES RADIUS
Miles driven weekly 1000-1500
Most common truck driven Tractor-Trailer
Most common trailer Other
Trailer length 45 to 52 feet
W.B. RUSSELL TRANSPORT LLC
Company W.B. RUSSELL TRANSPORT LLC
Start Date 06-2022
End Date 10-2022
Address
City, State/Province Zip/Postal Piggott, AR
Country United States
Phone
Position Held Truck Driver
Reason for leaving? LET GO
Were you terminated/discharged/laid off? Yes
Termination Explanation DISCHARGED
Is this your current employer? No
May we contact this employer at this time? Yes
8
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven MISSOUR-ARKANAS
Miles driven weekly 1500-2000
Most common truck driven Tractor-Trailer
Most common trailer Other
Trailer length 32 to 44 feet
WIEDEMAN FARMS
Company WIEDEMAN FARMS
Start Date 11-2021
End Date 05-2022
Address 561 CR 131
City, State/Province Zip/Postal Corning, AR 72422
Country United States
Phone 870-***-****
Position Held Truck Driver
Reason for leaving? FINISHED HARVEST
Were you terminated/discharged/laid off? Yes
Termination Explanation LAID OFF
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
No
Areas Driven CORNING
9
Miles driven weekly 0-500
Most common truck driven Tractor-Trailer
Most common trailer Other
Trailer length 45 to 52 feet
IBEW 1516
Company IBEW 1516
Start Date 07-1992
End Date 10-2021
Address
City, State/Province Zip/Postal Jonesborgh, AR
Country United States
Phone
Position Held ELECTRCIAN
Reason for leaving? RETIRED
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
vehicle?
No
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
No
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
No
Areas Driven
Miles driven weekly
Most common truck driven
Most common trailer
Trailer length
10
U.S. Military
Branch of Service Navy
Start Date 10-1975
End Date 10-1978
Can you obtain your DD214? Yes
Rank at discharge E 4
Vehicle Accident Record
List ALL accidents and incidents for the past five (5) years. Be sure to list everything regardless of fault, severity, or motor vehicle type, be it personal or commercial vehicle. 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
List ALL tickets for the past five (5) years.
Have you had any moving violations or traffic convictions in the past 5 years? Violation Date 06-2023
Charge / Description Inattentive Driving
Violation City JONESBORO
Violation State/Province AR
In Commercial Vehicle No
Fined? Yes
License Suspended?
License Revoked?
Perform Community Service?
Other Penalty?
Fine Amount (if any): 100 - $199
Please provide additional details including
city or county location; if speeding, speed
and zone. For any item answered "Other"
provide additional information
OTHER
11
Traffic Convictions \ Violations
List ALL tickets for the past five (5) years.
Have you had any moving violations or traffic convictions in the past 5 years? Violation Date 03-2023
Charge / Description Careless/Reckless Driving
Violation City POCAHONTAS
Violation State/Province AR
In Commercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Community Service?
Other Penalty?
Fine Amount (if any): 100 - $199
Please provide additional details including
city or county location; if speeding, speed
and zone. For any item answered "Other"
provide additional information
OTHER
Signature
Full Name Vance Columbus Fitzgerald
IP Address 2600:100b:b136:f
Signature Date/Time 10-23-2023 7:33 PM
By signing my application below, I agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature. APPLICANT'S STATEMENT
I understand that any false or misleading statements in this application will be sufficient cause for rejection of my application if Crete Carrier Corporation and its division of Shaffer Trucking, hereinafter "the Company" has not already qualified me as a driver and for immediate disqualification if it has qualified me as a driver.
If this application is for qualification as a Company Driver, I agree that the Company is not obligated to employ me. I acknowledge and agree that if I am offered employment, such offer is conditional upon my satisfactory completion of orientation and any other qualification standards or testing utilized by the Company. I further agree that, if I am employed as a Company Driver, I have the right to terminate my employment at anytime for any reason and that the Company has the same right. Any false, misleading or incomplete statement of the information requested in this application will be sufficient grounds for discharge from employment as a Company Driver.
I agree that any claim or lawsuit relating to my service with the Company or any of its divisions must be filed no more than six (6) months after the date of the employment action that is the subject of the claim or 12
lawsuit. I waive any statute of limitations to the contrary. I understand this driver qualification application, if complete, will be processed within ten (10) days after it's received by the "Company". To be qualified as a driver beyond this time period I should inquire as to whether or not applications are being accepted at that time. I agree to furnish such additional information and complete such examinations as may be required to complete my driver qualification file.
I understand that the information I provide in this application, including but not limited to the information required by 49 CFR 391.21(b)(10)(11) may be used, and my previous employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d)(e) and 49 CFR 40.25.
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. I HEREBY ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE PRECEDING APPLICANT'S STATEMENT.
THIS IS THE END OF THE APPLICATION
Signed Date: 10-23-2023 7:33 PM
Signed:
Federal FCRA Summary of Rights Acknowledgment
By checking this box, I (a) acknowledge
that I have read and understand the
federal FCRA Summary of Rights and
have been given the opportunity to
copy/print the Summary of Rights and (b)
agree to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Yes
PSP Disclosure and Authorization
By my check of this box, I represent that I
understand and agree to the above
Important Disclosure Regarding
Background Reports from the PSP Online
Service and Authorization, and, by
checking this box, I intend to execute this
document by electronic signature and
consent to the use of my electronic
signature to give effect to this document.
Yes
13
Additional Consent or Certification
By my check of this box, I represent that I
understand and agree to all of the above
disclosures, notices, authorizations,
releases, and certifications contained in
the above Disclosure and Authorization,
and, by checking this box, I intend to
execute this document by electronic
signature and consent to the use of my
electronic signature to give effect to this
document.
Yes
FCRA Disclosure
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
FCRA Authorization
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Employment Verification Acknowledgment and Release (DOT Drug and Alcohol) By my check of this box, I represent that I
understand and agree to the above
Disclosure and Authorization for Release
of Information for Employment Purposes
49 CFR Part 391.23, DOT Drug and
Alcohol Testing, and, by checking this box,
I intend to execute this document by
electronic signature and consent to the use
of my electronic signature to give effect to
this document.
Yes
Clearinghouse Release
By checking the box, I (a) acknowledge
that I have read and understand the above
Yes
14
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Summary of Rights Under 15 U.S.C. Section 1681m(a) By checking the box, I (a) acknowledge
that I have read and understand the
Summary of Rights Under 15 U.S.C.
Section 1681m(a) and have been given
the opportunity to copy/print the 1681m
Summary of Rights and (b) agree to use
an electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
INVESTIGATIVE CONSUMER REPORT DISCLOSURE
By checking this box, I represent that I
understand and agree to the above
Investigative Consumer Report
Disclosure.
Yes
User Requested Copy
User requested a copy to be sent to this
email address
ad1r5f@r.postjobfree.com.
Yes
15
DISCLOSURE FOR CONSUMER REPORTS
In connection with your employment or owner-operator (independent contractor) application, Crete Carrier Corporation and its division of Shaffer Trucking may order one or more consumer report(s) (commonly known as "background reports" or "background checks") about you from one or more consumer reporting agencies. If you are hired or engaged as an owner-operator (independent contractor), additional consumer reports may be obtained in connection with and throughout your employment for employment purposes or for the legitimate business purpose of evaluating you as an owner-operator. To the extent allowed by law, the consumer reports may include information concerning your character, general reputation, personal characteristics, mode of living, drug and alcohol test results, motor vehicle records, driving records, criminal history, public court records, employment history (including names and dates of previous employers, reason for termination of employment, work experience, and accidents), social security number validation, education, licensure, or verification of other information supplied by you. Such reports may be obtained from private and public record sources, including sanctions databases, CDLIS (including but not limited to CDLIS Central Site, CDLIS Master Pointer Record data and your driver record from the jurisdiction identified in the CDLIS data, in accordance with applicable state law and the Driver Privacy Protection Act), former employers, public court records, and federal, state, and other government agencies that maintain such records. Printed Name:
VANCE Columbus FITZGERALD
Social Security #:
1944
Signed Date: 10-23-2023
VANCE Columbus FITZGERALD
1714 Pace Road Ext Lot 10
Pocahontas, AR 72455
Gender:
16
AUTHORIZATION FOR CONSUMER REPORTS
I authorize Crete Carrier Corporation and its division of Shaffer Trucking to obtain one or more consumer report(s) or investigative consumer report(s) about me. If hired or engaged as an owner-operator (independent contractor), I understand this authorization shall remain on file and shall serve as ongoing authorization for additional consumer reports or investigative consumer reports to be obtained from any consumer reporting agency at any time during my employment or contract period without asking me for authorization again.
Printed Name:
VANCE Columbus
FITZGERALD
Social Security #:
1944
Signed Date: 10-23-2023
VANCE Columbus FITZGERALD
1714 Pace Road Ext Lot 10
Pocahontas, AR 72455
Gender:
17
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Crete Carrier Corporation and its division of Shaffer Trucking ("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. 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. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.
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 Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization. AUTHORIZATION
If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Crete Carrier Corporation and its division of Shaffer Trucking ("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 authorizing 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 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 challenge 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 understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, 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:
VANCE Columbus FITZGERALD
Signed Date: 10-23-2023
18
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to Crete Carrier Corporation and its division of Shaffer Trucking (hereinafter collectively referred to as "Crete Carrier Corporation") to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for Crete Carrier Corporation to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent.
I understand that if I refuse to provide consent for Crete Carrier Corporation to conduct a limited query of the Clearinghouse, Crete Carrier Corporation is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle.
I understand that if the limited query conducted by Crete Carrier Corporation indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to Crete Carrier Corporation unless I give additional specific consent within the Clearinghouse. However, I understand that Crete Carrier Corporation will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle. 10-23-2023
VANCE Columbus FITZGERALD Date
19
DISCLOSURE AND AUTHORIZATION
Disclosure and Authorization for Procurement/Release of Information for Employment Purposes - Background Information: Disclosure is hereby made that Crete Carrier Corporation and its division of Shaffer Trucking (hereinafter collectively referred to as "Crete Carrier Corporation") may request, for lawful employment purposes, background information about you. I hereby authorize Crete Carrier Corporation and its employees and agents to contact all of the following, without limitation, and authorize any of the following persons or entities ("Suppliers") to disclose information about me to Crete Carrier Corporation and its employees and agents: law enforcement and all other
Contact this candidate