Cdl A Regional
Resume:
Indian River Transport
Corporate Office
Winter Haven, FL 33884
**-**-**** *:58:01AM CST
IntelliApp
Thank you for your interest in Indian River Transport. 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.
Active Jobs
Job Name East Central Regional CDL-A Tanker Driver Job Title East Central Regional CDL-A Tanker Drive Personal Information
Referral Code: jp_driver_pulse
Name Roosevelt Washington, Jr.
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 1224 Evergreen Ave
Address 2 1334 Meadow Lane Apt F
City, State/Province Zip/Postal Waterloo, IA 50701 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 6121
Date of Birth
Primary Phone 319-***-****
Cell Phone 319-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email ad06ar@r.postjobfree.com
Yes, I agree to receive information
concerning future opportunities or
promotions from Indian River Transport by
email or other commercial electronic
Yes
1
communications.
Would you like to receive communication
from Indian River Transport 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 Indian
River Transport's service provider receives
in real time and logs your text messages
with Indian River Transport.
Yes
Company Questions
GENERAL INFORMATION
What position are you applying for? OTR
What location are you applying for? Cedar Rapids, IA Are you legally eligible for employment in
the United States?
Yes
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, and reason for leaving:
Do you have Tanker experience (not
required)?
Yes
Do you have a current Tanker
Endorsement (required for employment)?
Yes
Do you have a current TWIC card (not
required for employment)?
In Process
If you answered "yes", please provide the
expiration date:
Do you have your Hazmat Endorsement
(not required for employment)?
No
Do you have a current Passport (not
required for employment)?
No
If you selected "yes", please provide the
expiration date:
2
Please enter the names of any relatives
employed here:
Have you ever been known by any other
name?
No
Enter name:
How did you hear about us? Tenstreet Pulse Match
Specify
Please list drivers name if referral
In case of Emergency, notify (list name,
address, and phone):
Effie Washington 1224 evergreen Ave
JOB REQUIREMENTS / DUTIES
By selecting "Yes" to the Job Requirements/Duties listed below, I certify that I can complete the required job duties as described and understand that my ability to not perform these requirements will result in a withdraw of my pre-employment offer with Indian River Transport.
Sitting / driving for long periods of time Yes
Climb ladder to inspect seals on top of
tank / in and out of tractor
Yes
Lift approx. 45lbs - hoses Yes
Squatting for short periods of time to check
connections
Yes
Pass DOT physical 1 year Yes
Fulfill pre-trip inspection requirements Yes
Use of electronic logs - manage hours of
service
Yes
Meet delivery times Yes
Maintain equipment and customer
relationships in a professional manner
Yes
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 None
Tractor Trailer Van reefer lowboy beaver tail 2001 Other None
Which safe driving awards do you hold and
from whom?
EDUCATION
List highest grade completed: GED
3
List last school attended (name, city, and
state):
Hawkeye community college Waterloo Ia
Recruiter
Licenses
License Number 933
Licensing Authority IA
Country US
License Class Class A
License Expiration Date 07-13-2029
DOT Medical Card Expiration Date 10-23-2023
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
Lazer Spot, Inc.
Company Lazer Spot, Inc.
Start Date 10-2023
End Date 11-2023
Address 6525 Shiloh Rd.
Address 2 SUite 900
City, State/Province Zip/Postal Alpharetta, GA 30005 Country United States
Phone 678-***-****
Fax 678-***-****
Position Held Driver
Reason for leaving? Co workers problem
Were you terminated/discharged/laid off? No
4
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 Local
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Yard Horse
Most common trailer Reefer Trailer
Trailer length 53 feet or more
EMCO Transportation LLC
PLEASE DO NOT CONTACT
Company EMCO Transportation LLC
Start Date 08-2023
End Date 09-2023
Address 874 Lynkaylee Dr
City, State/Province Zip/Postal Waterloo, IA 50701 Country United States
Phone 319-***-****
Position Held Driving
Reason for leaving? Pay wasn't good
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
5
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Midwest
Miles driven weekly 2000-2500
Pay Range (cents/mile) Percentage
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 53 feet or more
Unemployment
Start Date 03-2023
End Date 07-2023
Did you receive unemployment
compensation?
No
Comment
Unemployment
Start Date 03-2023
End Date 06-2023
Did you receive unemployment
compensation?
No
Comment
Nutriject
Company Nutriject
Start Date 06-2022
End Date 02-2023
Address
City, State/Province Zip/Postal Hudson, IA
Country United States
Phone 319-***-****
Fax 319-***-****
Position Held
Reason for leaving? Hours
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?
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
Unemployment
Start Date 02-2022
End Date 06-2022
Did you receive unemployment
compensation?
No
Comment
POLO TRANSPORT SERVICES
Company POLO TRANSPORT SERVICES
Start Date 01-2020
End Date 02-2022
Address 3556 TURNBERRY DR
City, State/Province Zip/Postal Waterloo, IA 50701 Country United States
Phone 319-***-****
Fax 319-***-****
Position Held OTR Driver
Reason for leaving? Termination
Were you terminated/discharged/laid off? Yes
Termination Explanation Random
Is this your current employer? No
May we contact this employer at this time? Yes
7
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 Midwest southeast
Miles driven weekly 3000-3500
Pay Range (cents/mile) .52
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 53 feet or more
MWR
Company MWR
Start Date 07-2018
End Date 01-2020
Address 209 n railroad
City, State/Province Zip/Postal Wyoming, IA
Country United States
Phone
Position Held
Reason for leaving? Pay
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 California
8
Miles driven weekly 3500+
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Reefer Trailer
Trailer length 53 feet or more
N&M Trucking
Company N&M Trucking
Start Date 10-2016
End Date 06-2018
Address
City, State/Province Zip/Postal Waterloo, IA
Country United States
Phone
Position Held
Reason for leaving? More pay
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Dedic8ed Express LLC
Company Dedic8ed Express LLC
Start Date 06-2015
9
End Date 09-2016
Address
City, State/Province Zip/Postal Waterloo, IA
Country United States
Phone
Position Held
Reason for leaving? Went out of business
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)
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Gray Transportation, Inc
Company Gray Transportation, Inc
Start Date 09-2006
End Date 05-2015
Address 2459 Gt Drive
City, State/Province Zip/Postal Waterloo, IA 50704 Country United States
Phone 319-***-****
Fax 319-***-****
Position Held Driving
Reason for leaving? Quit
10
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 Midwest
Miles driven weekly 2000-2500
Pay Range (cents/mile) 45
Most common truck driven Tractor-Trailer
Most common trailer Reefer Trailer
Trailer length 53 feet or more
Trucking School
Start Date 02-2001
End Date 06-2001
School Hawkeye Community College
Address
Address 2
City, State/Province Waterloo, IA
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
Did you perform any safety sensitive
functions at this truck school, regulated by
DOT, and subject to drug and alcohol
testing?
Yes
GPA
11
Hours of Instruction
Border Crossing Yes
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
FMCSR
Under FMCSR 391.15, are you currently
disqualified from driving a commercial
motor vehicle? [49 CFR 391.15]
No
Has your license, permit or privilege to
drive ever been suspended or revoked for
any reason? [49 CFR 391.21(b)(9)]
No
Have you ever been denied a license,
permit, or privilege to operate a motor
vehicle?[49 CFR 391.21(b)(9)]
No
Within the past two years, have you 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? [49 CFR 40.25(j)]
No
In the past three(3) years, have you ever
been convicted of any of the following
offenses: [49 CFR 391.15]:
Driving a commercial motor vehicle
with a blood alcohol concentration
("BAC") of .04 percent or more
·
Driving under the influence of
alcohol, as prescribed by state law
·
Refusal to undergo drug and
alcohol testing as required by any
jurisdiction for the enforcement of
Federal Motor Carrier Safety Act
regulations
·
Driving a commercial motor vehicle
under the influence of any 21
C.F.R. 1308.11 Schedule I
identified controlled substance, an
amphetamine, a narcotic drug, a
formulation of an amphetamine, or
a derivative of a narcotic drug
·
Transportation, possession, or
unlawful use of a 21 C.F.R.
1308.11 Schedule I identified
·
No
12
controlled substance,
amphetamines, narcotic drugs,
formulations of an amphetamine, or
derivatives of narcotic drugs while
you were on duty driving for a
motor carrier
Leaving the scene of an accident
while operating a commercial motor
vehicle
·
Or any other felony involving the
use of a commercial motor vehicle
·
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?
Type of Accident / Incident Injury
Date of Accident / Incident 08-2021
Hazmat Accident / Incident No
Was the vehicle towed away? No
City Waterloo
State/Province IA
Were you in a commercial vehicle? No
If yes, was this a Department of
Transportation recordable accident?
Were you at fault? No
Were you ticketed? No
Description Guy hit me
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 3 years? Violation Date 04-2019
Charge / Description Improper Lane Change
Violation State/Province CA
In Commercial Vehicle Yes
Fined? Yes
License Suspended?
License Revoked?
Perform Community Service?
13
Other Penalty?
Fine Amount (if any): $200 - $299
Comments:
Signature
Full Name Roosevelt Washington, Jr.
IP Address 173.17.235.36
Signature Date/Time 11-12-2023 8:58 AM
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. 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: 11-12-2023 8:58 AM
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 checking the box, I (a) acknowledge
that I have read and understand the PSP
Disclosure and Authorization 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 Disclosure
14
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 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
Clearinghouse Release
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
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
15
User Requested Copy
User requested a copy to be sent to this
email address ad06ar@r.postjobfree.com.
Yes
16
FCRA Disclosure
DISCLOSURE REGARDING BACKGROUND INVESTIGATION
Indian River Transport (the "Company") and/or Asurint may obtain information about you for employment purposes from a third-party consumer reporting agency. Thus, you may be the subject of a "consumer report" and/or "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying. You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your employment history and/or education conducted by the Company, HireRight, LLC 3349 Michelson Drive, Suite 150 Irvine, CA 92612,DriverIQ,4500 S 129th E Ave, Suite 127, Tulsa, OK 74134, or Asurint, P.O. Box 14730, Cleveland, OH 44114, 800-***-****, www.asurint.com, or another outside organization acting on behalf of the Company. The scope of this notice and authorization is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.
New York and Maine applicants and employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by Indian River Transport by contacting the consumer reporting agency identified above directly. You may also contact the Company to request the name, address, and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries, which the Company shall provide within 5 days.
New York applicants and employees only: Upon request, you will be informed whether or not a consumer report was requested by Indian River Transport, and if such report was requested, informed of the name and address of the consumer reporting agency that furnished the report. By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Oregon applicants and employees only: Information describing your rights under federal and Oregon law regarding consumer identity theft protection, the storage and disposal of your credit information, and remedies available should you suspect or find that Indian River Transport has not maintained secured records is available to you upon request. Washington State applicants and employees only: You also have the right to request form the consumer reporting agency a written summary of your rights under the Washington Fair Credit Reporting Act. 17
Printed Name:
Roosevelt Washington, Jr.
Social Security #:
6121
Signed Date: 11-12-2023
Roosevelt Washington, Jr.
1224 Evergreen Ave
1334 Meadow Lane Apt F
Waterloo, IA 50701
Gender:
18
ACKNOWLEDGMENT AND AUTHORIZATION
I acknowledge receipt of the separate document entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and a copy of A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" by Indian River Transport (the "Company") at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by the Company,, HireRight, LLC 3349 Michelson Drive, Suite 150 Irvine, CA 92612,DriverIQ,4500 S 129th E Ave, Suite 127, Tulsa, OK 74134,
or Asurint, P.O. Box 14730, Cleveland, OH 44114, 800-***-****, www.asurint.com or another outside organization acting on behalf of the Company. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.
New York applicants and employees only: By signing below, you also acknowledge receipt of Article 23-A of the New York Correction Law.
Minnesota and Oklahoma applicants and employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by Indian River Transport California applicants and employees only: By signing below, you also acknowledge receipt of the Summary of the Provisions Under the California Investigative Consumer Reporting Agencies Act (ICRAA). Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by Indian River Transport whenever you have a right to receive such under California law. Printed Name:
Roosevelt Washington, Jr.
Social Security #:
6121
Signed Date: 11-12-2023
Roosevelt Washington, Jr.
1224 Evergreen Ave
1334 Meadow Lane Apt F
Waterloo, IA 50701
Gender:
19
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Indian River Transport ("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 Indian River Transport ("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, 20
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,
Contact this candidate