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: wl / cpc / ~lsrfacebook ~lmdonlinead /

~lcpwl-cdlstudentconversion-fb / ~ladi~ltr7~lcalm~latvideo Name Charles A Banks

Residence 3 years or longer (If No,

previous addresses shown below)

Yes

Current Address 24 Garden Drive Apt 104

Address 2 Apt 104

City, State/Province Zip/Postal Martinsburg, WV 25404 Country United States

Residence 3 years or longer (If No,

previous addresses shown below)

Yes

SSN/SIN 2472

Date of Birth

Primary Phone 240-***-****

Cell Phone 304-***-****

Preferred method of contact Cell Phone

Best time to contact you Any

Email ***************@*****.***

How did you hear about us? Internet - Allie Knight - Youtube 1

Yes, I agree to receive information

concerning future opportunities or

promotions from Wilson Logistics by email

or other commercial electronic

communications.

Yes

Would you like to receive communication

from Wilson Logistics 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 Wilson

Logistics's service provider receives in real

time and logs your text messages with

Wilson Logistics.

Yes

Company Questions

GENERAL INFORMATION

Recruiter Routing- HIDDEN CQ

HIDDEN CQ: Worklist

HIDDEN CQ: Lead Data

Hidden CQ: Recruiting Pod

Have you spoken with a Wilson Logistics

recruiter?

Select the recruiter.

What position are you applying for? Company Driver If you are running a team, enter your team

member's name:

Are you legally eligible for employment in

the United States?

Yes

Do you read, write, and speak English? Yes

Have you ever worked for Wilson Logistics

before?

Enter start and end dates, location,

position, and reason for leaving:

Do you have a current TWIC card? No

Expiration date:

Have you ever been known by any other

name?

Enter name:

Were you referred by a current Wilson

Logistics driver?

Enter name:

In case of Emergency, notify:

First name: Unilateral Starkes

Last name: Banks

Phone Number: 240-***-****

Relationship: Wife

DRIVING EXPERIENCE

Do you have experience as a commercial

truck driver?

Yes

How many years? 1-3

Do you have Van experience? Yes

Do you have Reefer experience? Yes

Do you have recent heavy haul experience

with 53-foot trailers?

Yes

Do you have experience with a Drop Axle

Tractor (3 or 4 axle)?

Do you have experience with a Drop Axle

Trailer (3 or 4 axle)?

NON-RELATED PERSONAL REFERENCES

First Reference

First name: Mitchell

Last Name: Robinson

Phone Number: 301-***-****

Relationship: Pastor

Second Reference

First Name: Bradley

Last Name: Doves

Phone Number: 240-***-****

Relationship: Assn pastor

Licenses

License Number 845

State/Province WV

Country United States

License Class Class A

License Expiration Date 08-28-2024

Physical Expiration Date 09-23-2021

Current License Yes

Commercial Driver License Yes

Endorsements

Tanker Endorsement No

HAZMAT Endorsement No

X Endorsement No

Doubles Triples Endorsement No

Other Endorsement Yes

Employment / Unemployment

Unemployment

Start Date 03-2021

End Date 03-2021

Comment Laid off since pandemic

Unemployment

Start Date 02-2021

End Date 02-2021

Comment still unemployed

Unemployment

Start Date 12-2020

End Date 01-2021

Comment job ended

Lenox distribution cyr

Company Lenox distribution cyr

Start Date 06-2019

End Date 11-2020

Address 108378 oak ridge drive

City, State/Province Zip/Postal Hagerstown, MD 21742 Country United States

Phone 301-***-****

Position Held Operator

Reason for leaving? Lay off

Were you terminated/discharged/laid off? Yes

Termination Explanation Pandemic

Is this your current employer? No

May we contact this employer at this time? Yes

Did you operate a commercial motor

vehicle?

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 subject to drug and

alcohol testing?

Areas Driven

Miles driven weekly

Most common truck driven

Most common trailer

Trailer length

BH Trans INC

Company BH Trans INC

Start Date 02-2019

End Date 05-2019

Address 1425 W. Ray Street

City, State/Province Zip/Postal Indianapolis, IN 46221 Country United States

Phone 317-***-****

Position Held driver

Reason for leaving? no miles

Were you terminated/discharged/laid off? No

Is this your current employer? No

Yes

May we contact this employer at this time?

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

Most common truck driven Tractor-Trailer

Most common trailer Van

Trailer length 53 feet or more

Western Express

Company Western Express

Start Date 12-2018

End Date 01-2019

Address 2925 schronersville rd

City, State/Province Zip/Postal Bethlehem, PA

Country United States

Phone 615-***-****

Position Held Company driver

Reason for leaving? Better 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 Otr

Miles driven weekly 2000-2500

Most common truck driven Tractor-Trailer

Most common trailer Van

Trailer length 53 feet or more

Western Express

Company Western Express

Start Date 05-2018

End Date 11-2018

Address N/a

City, State/Province Zip/Postal Nashville, TN

Country United States

Phone 615-***-****

Position Held lease driver

Reason for leaving? went to co.

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 Otr

Miles driven weekly 2000-2500

Most common truck driven Tractor-Trailer

Most common trailer Van

Trailer length 53 feet or more

Schilli Specialized Flatbeds

Company Schilli Specialized Flatbeds

Start Date 02-2018

End Date 04-2018

Address 6358 US 24 W

City, State/Province Zip/Postal Remington, IN 47977 Country United States

Phone 219-***-****

Fax 219-***-****

Position Held Company driver

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 2000-2500

Most common truck driven Tractor-Trailer

Most common trailer Van

Trailer length 53 feet or more

Vanwyk trucking

Company Vanwyk trucking

Start Date 05-2017

End Date 01-2018

Address 200 w 12th St

City, State/Province Zip/Postal Waynesboro, VA 22934 Country United States

Phone

Position Held Company driver

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 2500-3000

Most common truck driven Tractor-Trailer

Most common trailer Reefer Trailer

Trailer length 53 feet or more

DMBowman

Company DMBowman

Start Date 11-2016

End Date 04-2017

Address Governor lane

City, State/Province Zip/Postal Williamsport, MD 21743 Country United States

Phone

Position Held Company driver

Reason for leaving? Change 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 Otr

Miles driven weekly 2500-3000

Most common truck driven Tractor-Trailer

Most common trailer Van

Trailer length 53 feet or more

Celadon Trucking Services

Company Celadon Trucking Services

Start Date 09-2016

End Date 10-2016

Address 9503 E 33rd Street

City, State/Province Zip/Postal Indianapolis, IN 46235 Country United States

Phone 317-***-****

Fax 317-***-****

Position Held Truck Driver

Reason for leaving? Quit

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

Most common truck driven Tractor-Trailer

Most common trailer Reefer Trailer

Trailer length 53 feet or more

Quad graphics

Company Quad graphics

Start Date 10-2015

End Date 07-2016

Address 100 n Miller's st

City, State/Province Zip/Postal Fairfield, PA

Country United States

Phone 402-***-****

Position Held Machine operator

Reason for leaving? Change career

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?

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

Most common truck driven

Most common trailer

Trailer length

Unemployment

Start Date 04-2015

End Date 10-2015

Comment Looking for work

Aeroteck

Company Aeroteck

Start Date 01-2015

End Date 04-2015

Address

City, State/Province Zip/Postal Hagerstown, MD

Country United States

Phone

Position Held Picker

Reason for leaving? Assignment Ended

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?

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

Most common truck driven

Most common trailer

Trailer length

Axiom Staffing

Company Axiom Staffing

Start Date 11-2013

End Date 01-2015

Address 2715 Ramsey Rd

City, State/Province Zip/Postal Gainesville, GA 30501 Country United States

Phone 770-***-****

Fax 678-***-****

Position Held Temp Agency

Reason for leaving? Assignment Ended

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?

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

Most common truck driven

Most common trailer

Trailer length

ManPower Staffing

Company ManPower Staffing

Start Date 08-2012

End Date 11-2013

Address

City, State/Province Zip/Postal Hagerstown, MD

Country United States

Phone

Position Held Temp Agency

Reason for leaving? Assignment Ended

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?

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

Most common truck driven

Most common trailer

Trailer length

Charleston Country Schools

Company Charleston Country Schools

Start Date 09-2010

End Date 08-2012

Address

City, State/Province Zip/Postal Charleston County, SC Country United States

Phone

Position Held Janitor for School System

Reason for leaving? Moved to Maryland

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?

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

Most common truck driven

Most common trailer

Trailer length

Dorchester County Schools

Company Dorchester County Schools

Start Date 04-2008

End Date 09-2010

Address

City, State/Province Zip/Postal Dorchester County, SC Country United States

Phone

Position Held Janitor for School System

Reason for leaving? Moved

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?

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

Most common truck driven

Most common trailer

Trailer length

U.S. Military

Branch of Service Army National Guard

Start Date 10-1987

End Date 06-1995

Can you obtain your DD214? Yes

Rank at discharge E3

Trucking School

Start Date 06-2016

End Date 08-2016

School Celadon Driving Academy

City, State/Province Indianapolis, IN

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

FMCSR

Under FMCSR 391.15, are you currently

disqualified from driving a commercial

motor vehicle? [49 CFR 391.15]

Has your license, permit or privilege to

drive ever been suspended or revoked for

any reason? [49 CFR 391.21(b)(9)]

Have you ever been denied a license,

permit, or privilege to operate a motor

vehicle?[49 CFR 391.21(b)(9)]

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)]

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

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 5 years (even if not at fault)?

Type of Accident / Incident Non-Injury

Date of Accident / Incident 09-2012

Hazmat Accident / Incident No

Was the vehicle towed away? No

City Hagerstown

State/Province MD

Were you in a commercial vehicle? No

If yes, was this a Department of

Transportation recordable accident?

Were you at fault? Yes

Were you ticketed? Yes

Description Failure to stop at stopped traffic

Traffic Convictions \ Violations

Have you had any moving violations or traffic convictions in the past 3 years? Violation Date 08-2018

Charge / Description Other

Violation State/Province VA

In Commercial Vehicle Yes

Fined? Yes

License Suspended?

License Revoked?

Perform Community Service?

Other Penalty?

Fine Amount (if any): $500+

Comments: Citation for being in the wrong toll lane,and driving while disqualified to drive through

Signature

Full Name Charles A Banks

IP Address 2601:140:40c:343

Signature Date/Time 03-07-2021 7:15 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: 03-07-2021 7:15 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

Yes

signature.

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

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

Yes

to copy/print it, and (b) agree to use an

electronic signature to demonstrate my

consent. An electronic signature is as

legally binding as an ink signature.

Summary of Rights Under 15 U.S.C. Section 1681m(a) By checking the box, I (a) acknowledge

that I have read and understand the

Summary of Rights Under 15 U.S.C.

Section 1681m(a) and have been given

the opportunity to copy/print the 1681m

Summary of Rights and (b) agree to use

an electronic signature to demonstrate my

consent. An electronic signature is as

legally binding as an ink signature.

Yes

INVESTIGATIVE CONSUMER REPORT DISCLOSURE

By checking this box, I represent that I

understand and agree to the above

Investigative Consumer Report

Disclosure.

Yes

User Requested Copy

User requested a copy to be sent to this

email address

***************@*****.***.

Yes

DISCLOSURE FOR CONSUMER REPORTS

In connection with your employment or owner-operator (independent contractor) application, Wilson Logistics WT may order one or more consumer report(s) (commonly known as "background reports" or "background checks") about you from one or more consumer reporting agencies. If you are hired or engaged as an owner-operator (independent contractor), additional consumer reports may be obtained in connection with and throughout your employment for employment purposes or for the legitimate business purpose of evaluating you as an owner-operator.

To the extent allowed by law, the consumer reports may include information concerning your character, general reputation, personal characteristics, mode of living, drug and alcohol test results, motor vehicle records, driving records, criminal history, public court records, employment history (including names and dates of previous employers, reason for termination of employment, work experience, and accidents), social security number validation, education, licensure, or verification of other information supplied by you. Such reports may be obtained from private and public record sources, including sanctions databases, CDLIS, former employers, public court records, and federal, state, and other government agencies that maintain such records. Printed Name:

Charles A Banks

Social Security #:

2472

Signed Date: 03-07-2021

Charles A Banks

24 Garden Drive Apt 104

Apt 104

Martinsburg, WV 25404

240-***-****

Gender:

AUTHORIZATION FOR CONSUMER REPORTS

I authorize Wilson Logistics WT to obtain one or more consumer report(s) or investigative consumer report(s) about me. If hired or engaged as an owner-operator (independent contractor), I understand this authorization shall remain on file and shall serve as ongoing authorization for additional consumer reports or investigative consumer reports to be obtained from any consumer reporting agency at any time during my employment or contract period without asking me for authorization again. Printed Name:

Charles A Banks

Social Security #:

2472

Signed Date: 03-07-2021

Charles A Banks

24 Garden Drive Apt 104

Apt 104

Martinsburg, WV 25404

240-***-****

Gender:

IMPORTANT DISCLOSURE

REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Jim Palmer Trucking, Wil-Trans, O&S Trucking, and their partners, agents or affiliates

("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 Jim Palmer Trucking, Wil-Trans, O&S Trucking, and their partners, agents or affiliates ("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

Contact this candidate