EW Wylie
West Fargo, ND *****
**-**-**** **:29:54PM CDT
IntelliApp
Thank you for your interest in EW Wylie. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted. In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.
Personal Information
Referral Code: leadflexppc
Name Johnny M Shelly, Sr.
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Address 326 Longhill Dr
City, State/Province Zip/Postal Fayetteille, NC 28311 Country United States
SSN/SIN 0880
Date of Birth
Primary Phone 910-***-****
Cell Phone 910-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email ad3d0t@r.postjobfree.com
Company Questions
GENERAL INFORMATION
What position are you applying for? Lease Purchase What location are you applying for? Sanford, NC
Are you a U.S. citizen? Yes
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? No
1
What date did your last employment end? july 2012
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:
Do you have a current TWIC card? No
Expiration date:
Do you have a current Passport/Pass
card?
No
Expiration date:
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 EW Wylie? Internet
How did you hear about EW Wylie? Internet
How did you hear about EW Wylie? Internet
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 van 200*-****-**,000
Tractor and Semi-Trailer reefer,van, flatbed 200*-****-***,000 Tractor - Two Trailers none
Other Special Military Hauling
Which safe driving awards do you hold and
from whom?
3 year safety driver award Marten
Transport
EQUIPMENT (OWNER/OPERATORS ONLY)
Equipment Description (Tractor):
Type:
Year:
Make:
Model:
Color:
VIN:
2
Weight
Mileage
Fifth Wheel Height
EDUCATION
List highest grade completed: Grade 12
List last school attended (name, city, and
state):
Pine Forest Fayetteille,NC
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship: First Reference: Vinny Elliott 419 Slocomb Rd Fayetteville NC 717-***-**** Friend
Second Reference: Craige Mitchell 210 Spring Lake NC 910-***-**** Friend
Licenses
License Number 578
State/Province NC
Country United States
License Class Class A
License Expiration Date 12-04-2016
Physical Expiration Date 03-04-2014
Current License Yes
Commercial Driver License Yes
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement Yes
Hazmat Expiration Date 03-04-2014
X Endorsement Yes
Doubles Triples Endorsement No
Other Endorsement No
3
Employment / Unemployment
Unemployment
Start Date 07-2012
End Date 08-2013
Comment still collecting
Covenant Transport
Company Covenant Transport
Start Date 01-2012
End Date 07-2012
Address 400 Birmingham
City, State/Province Zip/Postal Chattanooga, TN 37419 Phone 423-***-****
Fax 423-***-****
Position Held O/O company driver
Reason for leaving? had bad team driver
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 3000-3500
Pay Range (cents/mile) 46
Most common truck driven Conventional Tractor
Most common trailer Reefer Trailer
Trailer length 53 feet or more
Heartland Express
Company Heartland Express
Start Date 08-2010
4
End Date 12-2011
Address 2777 HEARTLAND DRIVE
City, State/Province Zip/Postal Coralville, IA 52241-9908 Phone 800-***-****
Fax 319-***-****
Position Held driver
Reason for leaving? work with O/O
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 2500-3000
Pay Range (cents/mile) 46
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 53 feet or more
Marten Transport, Ltd
Company Marten Transport, Ltd
Start Date 05-2007
End Date 08-2010
Address 129 Marten Street
City, State/Province Zip/Postal Mondovi, WI 54755
Phone 800-***-****
Fax 800-***-****
Position Held driver
Reason for leaving? regional job
Were you terminated/discharged/laid off? No
5
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 3000-3500
Pay Range (cents/mile) 42
Most common truck driven Conventional Tractor
Most common trailer Reefer Trailer
Trailer length 53 feet or more
deBoer Transportation, Inc
Company deBoer Transportation, Inc
Start Date 09-2006
End Date 05-2007
Address 8814 County Road F
City, State/Province Zip/Postal Blenker, WI 54415
Phone 715-***-****
Fax 888-***-****
Position Held driver
Reason for leaving? forced per diem
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
Yes
6
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven 48 states
Miles driven weekly 2500-3000
Pay Range (cents/mile) 40
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 53 feet or more
KLLM Transport Services, LLC
Company KLLM Transport Services, LLC
Start Date 03-2006
End Date 08-2006
Address 135 Riverview Dr.
City, State/Province Zip/Postal Jackson, MS 39218
Phone 601-***-****
Fax 601-***-****
Position Held driver
Reason for leaving? terminated
Were you terminated/discharged/laid off? Yes
Termination Explanation later determined wrongful termination 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 at first
Miles driven weekly 3000-3500
Pay Range (cents/mile)
Most common truck driven Conventional Tractor
Most common trailer Reefer Trailer
7
Trailer length 53 feet or more
atlas vanlines
Company atlas vanlines
Start Date 10-2004
End Date 03-2006
Address 3715 ramsey st
City, State/Province Zip/Postal Fayetteille, NC 28301 Phone 910-***-****
Position Held driver
Reason for leaving? to run multi states
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 3-4 states
Miles driven weekly 1000-1500
Pay Range (cents/mile) hourly
Most common truck driven Conventional Tractor
Most common trailer Van
Trailer length 45 to 52 feet
Central Refrigerated Services
Company Central Refrigerated Services
Start Date 04-2004
End Date 10-2004
Address 5175 West 2100 South
City, State/Province Zip/Postal W Valley City, UT 84120 Phone 800-***-****
Position Held driver
8
Reason for leaving? reginal job(family related)
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 2500-3000
Pay Range (cents/mile) 36
Most common truck driven Conventional Tractor
Most common trailer Reefer Trailer
Trailer length 53 feet or more
Military
Branch of Service Army
Start Date 02-1985
End Date 01-1987
Can you obtain your DD214? Yes
Rank at discharge E-3
Did you receive an honorable discharge? Yes
Trucking School
Start Date 04-1985
End Date 06-1985
School US Army
City, State/Province Ft Leonardwood, MO
Country United States
Phone
9
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
Hours of Instruction 200
Border Crossing Yes
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
Trucking School
Start Date 03-2004
End Date 04-2004
School CTA
City, State/Province Princeton, 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
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 160
Border Crossing Yes
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
10
Motor Vehicle Record
1. Has any license, permit or privilege ever
been denied, suspended or revoked for
any reason?
Yes
Date 07-2012
Comment 30 day civil(reversed)
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 a 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
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
11
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 ministers 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
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 ad3d0t@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
12
Signature
Full Name Johnny M Shelly, Sr.
Social Security Number 0880
Date of Birth
IP Address 75.178.18.55
Signature Date/Time 08-23-2013 12:29 PM
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.
Signed Date: 08-23-2013 12:29 PM
Signed:
13
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) through EW Wylie, consumer reports (Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services). These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well as information from HireRight concerning previous driving record requests made by others from such state agencies and state provided driving records.
We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA"). You have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that HireRight has previously furnished within the past two year period preceding your request (3 years in California). HireRight may be contacted by mail at P.O. Box 33181, Tulsa, OK 74153 or by telephone at 800-***-****. You may also bring a third party with you to view the information at the HireRight offices if this person provides proper identification. Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx.
I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY HIRERIGHT TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I.
I hereby consent to your obtaining the above information from HireRight, and I agree that such information which HireRight has or obtains in my employment history (not DOT drug and alcohol information without a specific consent by me) with you if I am hired, will be supplied by HireRight to other companies which subscribe to HireRight. I hereby authorize procurement of consumer reports as set forth above. If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you to procure consumer reports at any time during my employment or contract period. I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs System at: https://dataqs.fmcsa.dot.gov.
Printed Name:
johnny m shelly, Sr.
Social Security #:
0880
Signed Date: 08-23-2013
johnny m shelly, Sr.
326 Longhill Dr
Fayetteille, NC 28311
Gender:
14
IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
1. In connection with your application for employment with EW Wylie ("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 EW Wylie ("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:
johnny m shelly, Sr.
Social Security #:
0880
Signed Date: 08-23-2013
johnny m shelly, Sr.
326 Longhill Dr
Fayetteille, NC 28311
Gender:
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 08-23-2013
Date
X 0880
Social Security Number
johnny m shelly, Sr.
326 Longhill Dr
Fayetteille, NC 28311
Gender:
X johnny m shelly, Sr.
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Heartland Express To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to EW Wylie
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 EW Wylie, or to HireRight for the sole purpose of transmitting such records to EW Wylie. 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 EW Wylie or HireRight to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes EW Wylie 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 08-23-2013
Date
X 0880
Social Security Number
johnny m shelly, Sr.
326 Longhill Dr
Fayetteille, NC 28311
Gender:
X johnny m shelly, Sr.
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Covenant Transport To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to EW Wylie
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 EW Wylie, or to HireRight for the sole purpose of transmitting such records to EW Wylie. 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 EW Wylie or HireRight to review involves tests required by DOT. If any carrier
(company/school) listed above furnishes EW Wylie 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
DISCLOSURE AND RELEASE
In connection with your employment or application for employment (including contract for services) through EW Wylie, consumer reports (Investigative Consumer Reports in California) may be requested from HireRight (formerly USIS Commercial Services). These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well as information from HireRight concerning previous driving record requests made by others from such state agencies and state provided driving records.
We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA"). You have the right to make a request to HireRight, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that HireRight has previously furnished within the past two year period preceding your request (3 years in California). HireRight may be contacted by mail at P.O. Box 33181, Tulsa, OK 74153 or by telephone at 800-***-****. You may also bring a third party with you to view the information at the HireRight offices if this person provides proper identification. Information about HireRight's privacy practices is available at www.hireright.com/Privacy-Policy.aspx.
I AUTHORIZE, WITHOUT RESERVATION, HIRERIGHT, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY HIRERIGHT TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I.
I hereby consent to your obtaining the above information from HireRight, and I agree that such information which HireRight has or obtains in my employment history (not DOT drug and alcohol information without a specific consent by me) with you if I am hired, will be supplied by HireRight to other companies which subscribe to HireRight. I hereby authorize procurement of consumer reports as set forth above. If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you to procure consumer reports at any time during my employment or contract period. I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs System at: https://dataqs.fmcsa.dot.gov.
Employer / Contractor / Educational Institution:
atlas vanlines
Printed Name:
johnny m shelly, Sr.
Social Security