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Location:
Salisbury, NC
Posted:
April 23, 2016

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Resume:

Cardinal

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

Concord, NC *****

**-**-**** *:19:35PM CDT

IntelliApp (C)

Applicant opted out of D&A release authorization for the following individual employers / educational institutions. Express employment temp service

Personal Information

Referral Code: leadflex_sh_614_cdlocreg_charlottenc Name Daniel James Mclaughlin, Sr.

Residence 3 years or longer (If No,

previous addresses shown below)

No

Address 707 Hidden Creek Cir

City, State/Province Zip/Postal Salisbury, NC 28147 Country United States

Addresses Over last 3 years 319 Celeste Eufola Rd

Statesville Nc 28677

3-1985 To 5-2011

Addresses Over last 3 years Address 1

707 Hidden Creek Cir

Salisbury, NC 28147

United States

06-2012 to 04-2016

Address 2

319 Celeste eufola rd

Statesville, NC 28677

United States

04-1999 to 06-2012

SSN/SIN 6631

Date of Birth

Primary Phone 704-***-****

Cell Phone 704-***-****

Preferred method of contact Primary Phone

Best time to contact you Any

Email acuhba@r.postjobfree.com

Company Questions

GENERAL INFORMATION

What position are you applying for? Company Driver Are you legally eligible for employment in

the United States?

Yes

Do you read, write, and speak English? Yes

Have you ever been known by any other

name?

No

Enter name:

Were you referred by a Cardinal /

Greatwide employee?

No

Provide the Name

What type of employee referred you?

DRIVING EXPERIENCE

Do you have either 12 months tractor

trailer experience in past 36 months OR 24

months tractor trailer experience in past 60

months?

Yes

Licenses

List all driver licenses held in the past five years (include multiple licenses if you have them).

License Number 464

State/Province NC

Country United States

License Class Class A

License Expiration Date 12-10-2018

Physical Expiration Date 11-27-2015

Current License Yes

Commercial Driver License Yes

Endorsements

Tanker Endorsement Yes

HAZMAT Endorsement No

X Endorsement No

Doubles Triples Endorsement Yes

Other Endorsement No

Employment / Unemployment

Unemployment

Start Date 03-2016

End Date 04-2016

Comment

Schneider National JCP

PLEASE DO NOT CONTACT

Company Schneider National JCP

Contact / Supervisor Name

Start Date 01-2016

End Date 02-2016

Address 1634 Salisbury Hwy

City, State/Province Zip/Postal Statesville, NC 28677 Country United States

Phone

Position Held

Reason for leaving? still there

Were you terminated/discharged/laid off? No

Is this your current employer? Yes

May we contact this employer at this time? No

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 south,southeast

Miles driven weekly 1000-1500

Pay Range (cents/mile) 36

Most common truck driven Conventional Tractor

Most common trailer Van

Trailer length 53 feet or more

Unemployment

Start Date 12-2015

End Date 12-2015

Comment

Unemployment

Start Date 08-2015

End Date 11-2015

Comment

Shuler meats inc

Company Shuler meats inc

Contact / Supervisor Name

Start Date 07-2015

End Date 08-2015

Address

City, State/Province Zip/Postal Thomasville, NC

Country United States

Phone

Position Held

Reason for leaving? HOME (FAMILY TIME)

Were you terminated/discharged/laid off? No

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 SC,NC,VA

Miles driven weekly

Pay Range (cents/mile) 35

Most common truck driven

Most common trailer Reefer Trailer

Trailer length 45 to 52 feet

Pete Dawson southern foods PDC

Company Pete Dawson southern foods PDC

Contact / Supervisor Name

Start Date 01-2015

End Date 06-2015

Address

City, State/Province Zip/Postal Statesville, NC 28677 Country United States

Phone 704-***-****

Position Held

Reason for leaving? HOURS/PAY 3RD SHIFT

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 south

Miles driven weekly

Pay Range (cents/mile) 45

Most common truck driven

Most common trailer Reefer Trailer

Trailer length 45 to 52 feet

Truckmovers

Company Truckmovers

Contact / Supervisor Name

Start Date 05-2014

End Date 01-2015

Address

City, State/Province Zip/Postal Independence, MO 64057 Country United States

Phone 816-***-****

Fax 816-***-****

Position Held

Reason for leaving? no benifits

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 northeast,south northwest

Miles driven weekly

Pay Range (cents/mile) 42

Most common truck driven

Most common trailer Other

Trailer length Other

Express employment temp service

Company Express employment temp service

Contact / Supervisor Name

Start Date 06-2013

End Date 05-2014

Address

City, State/Province Zip/Postal Moorseville, NC 28115 Country United States

Phone 704-***-****

Position Held

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

vehicle?

No

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

Subcontractor for satellite install (Directv & Dish network) Company Subcontractor for satellite install (Directv & Dish network)

Contact / Supervisor Name

Start Date 01-2010

End Date 05-2013

Address

City, State/Province Zip/Postal Hickory, NC

Country United States

Phone

Position Held

Reason for leaving? Lack of steady 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

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,

Yes

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

Unemployment

Start Date 12-2009

End Date 12-2009

Comment Unemployed

Western Express

Company Western Express

Contact / Supervisor Name

Start Date 11-2009

End Date 11-2009

Address

City, State/Province Zip/Postal Nashville, TN 37209 Country United States

Phone 615-***-****

Fax 615-***-****

Position Held

Reason for leaving? better pay

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 otr

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven

Most common trailer Van

Trailer length 53 feet or more

WTI Transport Inc

Company WTI Transport Inc

Contact / Supervisor Name

Start Date 08-2009

End Date 10-2009

Address

City, State/Province Zip/Postal Tuscaloosa, AL

Country United States

Phone 205-***-****

Fax 334-***-****

Position Held

Reason for leaving? Log disagreement

Were you terminated/discharged/laid off? Yes

Termination Explanation Log disagreement

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 South north Midwest

Miles driven weekly

Pay Range (cents/mile) 38

Most common truck driven

Most common trailer Flatbed

Trailer length 45 to 52 feet

Unemployment

Start Date 06-2009

End Date 07-2009

Comment Unemployed

Mulberry group temp service

PLEASE DO NOT CONTACT

Company Mulberry group temp service

Contact / Supervisor Name

Start Date 06-2008

End Date 06-2009

Address

City, State/Province Zip/Postal Statesville, NC 28677 Country United States

Phone

Position Held

Reason for leaving? Out of business

Were you terminated/discharged/laid off? No

Is this your current employer? No

May we contact this employer at this time? No

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

Pay Range (cents/mile)

Most common truck driven

Most common trailer

Trailer length

Scope services

Company Scope services

Contact / Supervisor Name

Start Date 06-2008

End Date 06-2009

Address

City, State/Province Zip/Postal Cornelius, NC 28031 Country United States

Phone

Position Held

Reason for leaving? Laid off

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?

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?

Yes

Areas Driven

Miles driven weekly

Pay Range (cents/mile)

Most common truck driven

Most common trailer

Trailer length

Unemployment

Start Date 09-2007

End Date 02-2008

Comment Unemployed

JB Hunt

Company JB Hunt

Contact / Supervisor Name

Start Date 07-2007

End Date 08-2007

Address

City, State/Province Zip/Postal Lowell, AR 72745

Country United States

Phone 800-***-****

Position Held

Reason for leaving? Laid off

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

Miles driven weekly

Pay Range (cents/mile) 30

Most common truck driven

Most common trailer Flatbed

Trailer length 45 feet or longer

Southern pines (PGT TRUCKING )

Company Southern pines (PGT TRUCKING )

Contact / Supervisor Name

Start Date 08-2006

End Date 06-2007

Address

City, State/Province Zip/Postal Monaca, PA 15061

Country United States

Phone

Position Held

Reason for leaving? Local job

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

Miles driven weekly

Pay Range (cents/mile) 32

Most common truck driven

Most common trailer Flatbed

Trailer length 45 feet or longer

Fed ex Ground

Company Fed ex Ground

Contact / Supervisor Name

Start Date 05-2006

End Date 08-2006

Address

City, State/Province Zip/Postal Charlotte, NC 28214 Country United States

Phone

Position Held

Reason for leaving? Can't do team driving

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

Yes

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?

Yes

Areas Driven

Miles driven weekly

Pay Range (cents/mile) 17

Most common truck driven

Most common trailer Doubles / Triples

Trailer length 40 to 41 feet

DM Bowman

Company DM Bowman

Contact / Supervisor Name

Start Date 02-2006

End Date 05-2006

Address

City, State/Province Zip/Postal Williamsport, MD 21795 Country United States

Phone 800-***-****

Fax 301-***-****

Position Held

Reason for leaving? Failure to report incident

Were you terminated/discharged/laid off? Yes

Termination Explanation Failure to report a incident 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

Miles driven weekly

Pay Range (cents/mile) 32

Most common truck driven

Most common trailer Dry Van

Trailer length 45 feet or longer

Cargo Transporters

Company Cargo Transporters

Contact / Supervisor Name

Start Date 10-2005

End Date 02-2006

Address

City, State/Province Zip/Postal Claremont, NC 28610 Country United States

Phone 828-***-****

Fax 828-***-****

Position Held

Reason for leaving? Better job

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?

No

Areas Driven

Miles driven weekly

Pay Range (cents/mile) 30

Most common truck driven

Most common trailer Dry Van

Trailer length 45 feet or longer

Dana/Spicer co

Company Dana/Spicer co

Contact / Supervisor Name

Start Date 02-2004

End Date 02-2005

Address

City, State/Province Zip/Postal Statesville, NC 28677 Country United States

Phone

Position Held

Reason for leaving? Company closed

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?

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

Crts inc

Company Crts inc

Contact / Supervisor Name

Start Date 04-2003

End Date 01-2004

Address

City, State/Province Zip/Postal Troutman, NC 28679 Country United States

Phone

Position Held

Reason for leaving? Laid off

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?

No

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 03-2005

End Date 10-2005

School Trans tech

City, State/Province Claremont, NC

Country United States

Phone

Did you graduate? Yes

Were you subject to the Federal Motor

Carrier or Transport Canada Safety

Regulations while attending this truck

school?

Yes

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

Border Crossing No

Log Books No

Federal Motor Carrier Regulations No

Hazardous Materials No

Education

School Name Career learning institute

Start Date 03-2008

End Date 05-2008

City, State/Province Columbus,, IN

Country United States

What did you study? HVAC

Phone

Graduation Date 05-2008

Education

School Name Trans tech inc

Start Date 08-2005

End Date 10-2005

City, State/Province Conover, NC

Country United States

What did you study? CDL School

Phone

Graduation Date 10-2005

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) while on duty, 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

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

Federal FCRA Summary of Rights Acknowledgment

By checking this box, I acknowledge that I

have read and understand the Summary of

Rights.

Yes

Drug and Alcohol Release

I agree with the above language Yes

Certification Release

I agree with the above language Yes

PSP Release

I agree with the above language Yes

User Requested Copy

User requested a copy to be sent to this

email address acuhba@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 Daniel James Mclaughlin, Sr.

IP Address 71.68.72.55

Signature Date/Time 04-04-2016 2:19 PM

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: 04-04-2016 2:19 PM

Signed:

In connection with my application for employment with submission to Cardinal Logistics Management Corporation / Greatwide Dedicated Transport, that Cardinal Logistics Management Corporation / Greatwide Dedicated Transport and their respective agents may conduct an investigation into my background including my character, general reputation, work habits, performance and experience, along with reasons for termination of employment from previous employers.Further, I understand that inquiries may be conducted regarding my criminal record and driving history. I understand that truthfulness of every answer on my application may be verified. Further, I authorize respective agents to contact personal references; both listed as well as developed, companies, schools, medical facilities, law enforcement agencies and all state and federal government agencies, to furnish Cardinal Logistics Management Corporation / Greatwide Dedicated Transport any information they may have concerning me. In exchange for Cardinal Logistics Management Corporation / Greatwide Dedicated Transport considering me for employment or contract work, I hereby release Cardinal Logistics Management Corporation / Greatwide Dedicated Transport its agents and any persons or institutions who may be contacted as described herein from any liability as a result of the reporting of such information. I specifically waive any written notice from any present or former employer or customer who may provide information based upon this authorization. A photocopy of this authorization should be accepted with the same authority as the original.

I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all Federal Motor Carriers Safety Regulations and company policies. I understand that information I provided regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

• Review information provided by previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and

Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

I hereby acknowledge that I have been given a stand-alone consumer notification that a report may be requested and used for the purpose of evaluating me for employment, contract work, promotion, reassignment or retention. I acknowledge that this authorization is ongoing in the event such a report is needed in the future. Printed Name:

Daniel James Mclaughlin, Sr.

Social Security #:

6631

Signed Date: 04-04-2016

Daniel James Mclaughlin, Sr.

707 Hidden Creek Cir

Salisbury, NC 28147

704-***-****

Gender:

IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Cardinal / Greatwide Logistics ("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 Cardinal / Greatwide Logistics ("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:

Daniel James Mclaughlin, Sr.

Signed Date: 04-04-2016

TO BE READ AND SIGNED BY APPLICANT

I understand that the information in this application will be used and that prior employers will be contacted for purposes of investigation as required by 391.23 of the Motor Carrier Safety Regulations. The Civil Rights Act of 1964 prohibits discrimination in employment because of race, color, religion, sex or national origin. Federal law also prohibits discrimination on the basis of age with respect to certain individuals as well as some additional types



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