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driver, data entry, various paperwork

Location:
Houston, TX
Salary:
$ 900.00 week?
Posted:
December 29, 2018

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Resume:

Transco Lines, Inc

** ******* **** *****

Russellville, AR 72802

800-***-****

**-**-**** *:23:10AM CDT

In 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 Raymond L Plummer

Residence 3 years or longer (If No,

previous addresses shown below)

Yes

Address 1010 Lodgehill Lane

City, State/Province Zip/Postal Houston, TX 77090

Country United States

SSN/SIN 8430

Date of Birth

Primary Phone 713-***-****

Cell Phone 713-***-****

Preferred method of contact Primary Phone

Best time to contact you Any

Email ac72sz@r.postjobfree.com

Company Questions

GENERAL INFORMATION

What position are you applying for? Company Driver Who is your recruiter? Lane

Are you a member of a team? No

Please enter the name of your teammate

Are you a U.S. citizen? Yes

Are you legally eligible for employment in

the United States?

Yes

1

Are you currently employed? Yes

What date did your last employment end?

Do you read, write, and speak English? Yes

Have you ever worked for this company

before?

No

Enter start and end dates, location,

position, rate of pay, and reason for

leaving:

Have you ever been known by any other

name?

No

Enter name:

How did you hear about us?

Please name:

In case of Emergency, notify (list name,

address, and phone):

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 20,000 miles

Tractor and Semi-Trailer 1990 - 2014

Tractor - Two Trailers None

Other None

Which safe driving awards do you hold and

from whom?

EQUIPMENT (OWNER/OPERATORS ONLY)

Equipment Description (Tractor):

Type:

Year:

Make:

Model:

Color:

VIN:

Weight

Mileage

Fifth Wheel Height

EDUCATION

2

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:

Second Reference:

Licenses

License Number 406

State/Province TX

Country United States

License Class Class A

License Expiration Date 10-31-2016

Physical Expiration Date 08-06-2013

Current License Yes

Commercial Driver License Yes

Endorsements None

Employment / Unemployment

Interstate Distributor

Company Interstate Distributor

Start Date 10-2013

End Date 07-2014

Address 11707 21 st Ave Ct s

City, State/Province Zip/Postal Tacoma, WA 98444

Phone 253-***-****

Fax 253-***-****

Reason for leaving? Current job

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

vehicle?

Yes

3

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

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

National Carriers

Company National Carriers

Start Date 08-2012

End Date 09-2013

Address 1501 E 8th

City, State/Province Zip/Postal Liberal, KS 67901

Phone 620-***-****

Fax 620-***-****

Position Held Company Driver

Reason for leaving? Looking for Better Opportunity 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

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 35 States

Miles driven weekly 2000-2500

Pay Range (cents/mile)

4

Most common truck driven Conventional Tractor

Most common trailer Reefer Trailer

Trailer length 53 feet or more

Capital Express

Company Capital Express

Start Date 05-2012

End Date 07-2012

Address

City, State/Province Zip/Postal Jefferson City, MO Phone 573-***-****

Position Held Company Driver

Reason for leaving? Resigned on Good Terms

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?

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 48 States

Miles driven weekly 1500-2000

Pay Range (cents/mile)

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

Greatwide ATF

Company Greatwide ATF

Start Date 04-2012

End Date 05-2012

Address 2150 Cabot Blvd W

City, State/Province Zip/Postal Langhorne, PA 19047 5

Phone 800-***-****

Fax 866-***-****

Position Held DRIVER

Reason for leaving? NO PAY CHECKS

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

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 REGIONAL

Miles driven weekly 500-1000

Pay Range (cents/mile)

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

National Carriers

Company National Carriers

Start Date 01-2012

End Date 04-2012

Address 1501 E 8th

City, State/Province Zip/Postal Liberal, KS 67901

Phone 620-***-****

Fax 620-***-****

Position Held DRIVER

Reason for leaving? Looking for Better Opportunity Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? Yes

6

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 REGIONAL

Miles driven weekly 500-1000

Pay Range (cents/mile)

Most common truck driven Conventional Tractor

Most common trailer Reefer Trailer

Trailer length 53 feet or more

PTL - Paschall Truck Lines

Company PTL - Paschall Truck Lines

Start Date 12-2011

End Date 01-2012

Address 3443 US Highway 641 South

City, State/Province Zip/Postal Murray, KY 42071

Phone 800-***-****

Fax 270-***-****

Position Held DRIVER

Reason for leaving? Looking for Better Opportunity 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?

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 REGIONAL

7

Miles driven weekly 500-1000

Pay Range (cents/mile)

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

Interstate Distributor

Company Interstate Distributor

Start Date 07-2007

End Date 12-2011

Address 11707 21 st Ave Ct s

City, State/Province Zip/Postal Tacoma, WA 98444

Phone 253-***-****

Fax 253-***-****

Position Held DRIVER

Reason for leaving? resigned/ couldn't get me home 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?

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 ALL 48

Miles driven weekly 2000-2500

Pay Range (cents/mile)

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

RFK Transportation

Company RFK Transportation

Start Date 04-2000

8

End Date 06-2007

Address 5650 6th St SW

City, State/Province Zip/Postal Cedar Rapids, IA 52404 Phone 319-***-****

Fax 319-***-****

Position Held DRIVER

Reason for leaving? CO.SOLD TO WESTSIDE

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?

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 48

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

Trucking School

Start Date 02-1988

End Date 08-1988

School UNITED TRUCK MASTERS

City, State/Province City, FL

Country United States

Phone

Did you graduate? Yes

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Yes

9

Regulations while attending this truck

school?

Did you perform any safety sensitive

functions at this truck school, regulated by

DOT, and subject to drug and alcohol

testing?

Yes

GPA

Hours of Instruction 140

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

been denied, suspended or revoked for

any reason?

No

2. Have you ever been convicted of driving

during license suspension or revocation, or

driving without a valid license or an expired

license, or are any charges pending?

No

3. Have you ever been convicted for any

alcohol or controlled substance related

offense while operating a motor vehicle, or

are any charges pending?

No

4. Have you ever been convicted for

possession, sale or transfer of an illegal

substance (including but not limited to,

marijuana, amphetamines, or derivatives

thereof), or are any charges pending?

No

5. Have you ever been convicted of

reckless driving, careless driving or

careless operation of a motor vehicle, or

are any charges pending?

No

6. Have you ever tested positive, or

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?

No

10

Vehicle Accident Record

Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?

Type of Accident / Incident Non-Injury

Date of Accident / Incident 07-2013

State/Province TX

Were you in a commercial vehicle? Yes

If yes, was this a Department of

Transportation recordable accident?

No

Were you at fault? No

Were you ticketed? No

Description Backed into another truck

Traffic Convictions \ Violations

Have you had any moving violations or traffic convictions in the past 3 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

convicted of, or pled "no contest" to a

felony?

No

If you have any felony convictions, do you

currently hold a minister's permit to enter

or exit Canada?

No

Have you, within the last five years, pled

"guilty" to, been convicted of, had

prosecution deferred in connection with, or

pled "no contest" to a misdemeanor?

No

Federal FCRA Summary of Rights Acknowledgment

By checking this box, I acknowledge that I

have read and understand the FCRA

Statement of Rights.

Yes

11

Pre-Employment Screening Program Important Notice

I acknowledge that I have read and

understand the above Important Notice of

Rights and also have been given the

opportunity to copy/print the notice.

Yes

User Requested Copy

User requested a copy to be sent to this

email address

ac72sz@r.postjobfree.com.

Yes

By my check of this box, I represent that I

understand and agree to the above and

that I intend to execute this document by

electronic signature in checking this box.

Yes

Signature

Full Name Raymond L Plummer

Social Security Number 8430

Date of Birth

IP Address 63.97.40.66

Signature Date/Time 07-31-2014 9:23 AM

12

DISCLOSURE AND RELEASE

In connection with your employment or application of employment (including contract for services) through Transco Lines, Inc, 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. 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:

Raymond L Plummer

Social Security #:

8430

Signed Date: 07-31-2014

Raymond L Plummer

1010 Lodgehill Lane

Houston, TX 77090

713-***-****

Gender:

13

IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE

1. In connection with your application for employment with Transco Lines, Inc ("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 Transco Lines, Inc ("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:

Raymond L Plummer

Social Security #:

8430

Signed Date: 07-31-2014

Raymond L Plummer

1010 Lodgehill Lane

Houston, TX 77090

713-***-****

Gender:

14

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.

Printed Name: Raymond L Plummer

Social Security #: 8430

Signed Date: 07-31-2014

Signed:

END OF APPLICATION

15

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

X 07-31-2014

Date

X 8430

Social Security Number

Raymond L Plummer

1010 Lodgehill Lane

Houston, TX 77090

713-***-****

Gender:

X Raymond L Plummer

Print Name (First, MI, Last)

X

Signature

I, the above mentioned signer, hereby authorize Greatwide ATF To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Transco Lines, Inc

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 Transco Lines, Inc, or to HireRight for the sole purpose of transmitting such records to Transco Lines, Inc. 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 Transco Lines, Inc or HireRight to review involves tests required by DOT. If any carrier (company/school) listed above furnishes Transco Lines, Inc 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.

16

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

X 07-31-2014

Date

X 8430

Social Security Number

Raymond L Plummer

1010 Lodgehill Lane

Houston, TX 77090

713-***-****

Gender:

X Raymond L Plummer

Print Name (First, MI, Last)

X

Signature

I, the above mentioned signer, hereby authorize PTL - Paschall Truck Lines To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Transco Lines, Inc

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 Transco Lines, Inc, or to HireRight for the sole purpose of transmitting such records to Transco Lines, Inc. 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 Transco Lines, Inc or HireRight to review involves tests required by DOT. If any carrier (company/school) listed above furnishes Transco Lines, Inc 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.

17

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

X 07-31-2014

Date

X 8430

Social Security Number

Raymond L Plummer

1010 Lodgehill Lane

Houston, TX 77090

713-***-****

Gender:

X Raymond L Plummer

Print Name (First, MI, Last)

X

Signature

I, the above mentioned signer, hereby authorize Interstate Distributor To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Transco Lines, Inc

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 Transco Lines, Inc, or to HireRight for the sole purpose of transmitting such records to Transco Lines, Inc. 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 Transco Lines, Inc or HireRight to review involves tests required by DOT. If any carrier (company/school) listed above furnishes Transco Lines, Inc 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.

18

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

X 07-31-2014

Date

X 8430

Social Security Number

Raymond L Plummer

1010 Lodgehill Lane

Houston, TX 77090

713-***-****

Gender:

X Raymond L Plummer

Print Name (First, MI, Last)

X

Signature

I, the above mentioned signer, hereby authorize National Carriers To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to Transco Lines, Inc

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 Transco Lines, Inc, or to HireRight for the sole purpose of transmitting such records to Transco Lines, Inc. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during



Contact this candidate