Driver
Resume:
TransAm Trucking Inc.
Olathe, KS 66062
**-**-**** **:51:21AM CDT
IntelliApp
Thank you for your interest in TransAm Trucking. 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: leadflex_neu_reg_ded_91895_houston_tx Name Michele Carey Wray
Current Address 21446 Cherry St
City, State/Province Zip/Postal New Caney, TX 77357 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 6098
Date of Birth
Primary Phone 832-***-****
Cell Phone 832-***-****
Email ado4a4@r.postjobfree.com
Yes, I agree to receive information
concerning future opportunities or
promotions from TransAm Trucking Inc. by
email or other commercial electronic
communications.
Yes
Would you like to receive communication
from TransAm Trucking Inc. 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 TransAm
Trucking Inc.'s service provider receives in
Yes
1
real time and logs your text messages with
TransAm Trucking Inc..
Company Questions
GENERAL INFORMATION
What position are you applying for? Company Driver Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? No
What date did your last employment end? 10-18-2021 Do you read, write, and speak English? Yes
Do you have a current TWIC card? No
Expiration date:
How did you hear about us? Web
If "Driver Referral", please enter the
driver's name
If "Other", please explain
DRIVING EXPERIENCE
For each class of equipment, select years of experience. If no experience in a class, select "None".
Straight Truck None
Tractor and Semi-Trailer 6-7 years
Tractor - Two Trailers None
Other
PHYSICAL ASSESSMENT
Get in and out of a truck? Yes
Get in and out of Trailer? Yes
Get under a unit to perform duties? Yes
Raise and lower hood of a conventional
tractor?
Yes
Raise and lower trailer dollies when under
load?
Yes
Apply enough pressure to release fifth
wheel pin?
Yes
Apply enough force to open and close
trailer doors?
Yes
Repeatedly lift and carry up to 70lbs? No
2
Sit in driver's seat for long periods of time? Yes Apply enough pressure to a trailer lever to
release?
Yes
Be on duty for the maximum D.O.T Hours? Yes
Are you willing to consent to a drug test? Yes
Licenses
License Number 104
State/Province TX
Country United States
License Class Class A
License Expiration Date 10-03-2021
Physical Expiration Date 06-07-2017
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
Bay & Bay
PLEASE DO NOT CONTACT
Company Bay & Bay
Start Date 09-2021
End Date 10-2021
Address
City, State/Province Zip/Postal Eagan, MN
Country United States
Phone 651-***-****
Position Held
Reason for leaving? Too low of miles and delays in pay 3
Were you terminated/discharged/laid off?
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?
Did you perform any safety sensitive
functions in this job subject to drug and
alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Taylor Truck Line
Company Taylor Truck Line
Start Date 06-2021
End Date 09-2021
Address
City, State/Province Zip/Postal Northfield, MN
Country United States
Phone 507-***-****
Fax 888-***-****
Position Held
Reason for leaving? Too little pay
Were you terminated/discharged/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
4
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
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Southern Mail Services
Company Southern Mail Services
Start Date 01-2020
End Date 06-2021
Address
City, State/Province Zip/Postal Houston, TX
Country United States
Phone 281-***-****
Position Held
Reason for leaving? Too little miles and no time off Were you terminated/discharged/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?
Did you perform any safety sensitive
functions in this job subject to drug and
alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
5
Most common trailer
Trailer length
USA Truck
Company USA Truck
Start Date 10-2018
End Date 12-2019
Address 3200 Industrial Park Road
City, State/Province Zip/Postal Van Buren, AR 72956 Country United States
Phone 479-***-****
Fax 479-***-****
Position Held Driver
Reason for leaving? Low 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 East of I35
Miles driven weekly 2000-2500
Pay Range (cents/mile) .52 cpm
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Unemployment
Start Date 01-2013
End Date 04-2016
Comment I took care of father dying of cancer
Unemployment
6
Start Date 09-2010
End Date 08-2011
Comment
Trucking School
Start Date 05-2016
End Date 06-2016
School C-1 Ft Worth
City, State/Province Ft Worth, TX
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?
No
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 40
Border Crossing No
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 No
7
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
•
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
8
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 3 years? No Violations
Criminal Record
Have you ever been convicted of a crime? No
Do you have any deferred prosecutions? No
Do you have criminal charges pending? No
Have you ever pled "guilty" to, been
convicted of, or pled "no contest" to a
felony?
No
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
Signature
Full Name Michele Carey Wray
IP Address 2607:fb90:4445:c
Signature Date/Time 10-21-2021 12:51 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: 10-21-2021 12:51 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)
Yes
9
agree to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
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
10
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
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
ado4a4@r.postjobfree.com.
Yes
11
DISCLOSURE FOR CONSUMER REPORTS
In connection with your employment or owner-operator (independent contractor) application, TransAm Trucking 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 (including but not limited to CDLIS Central Site, CDLIS Master Pointer Record data and your driver record from the jurisdiction identified in the CDLIS data, in accordance with applicable state law and the Driver Privacy Protection Act), former employers, public court records, and federal, state, and other government agencies that maintain such records. Printed Name:
michele CAREY wray
Social Security #:
6098
Signed Date: 10-21-2021
michele CAREY wray
21446 Cherry St
New Caney, TX 77357
Gender:
12
AUTHORIZATION FOR CONSUMER REPORTS
I authorize TransAm Trucking 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:
michele CAREY wray
Social Security #:
6098
Signed Date: 10-21-2021
michele CAREY wray
21446 Cherry St
New Caney, TX 77357
Gender:
13
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with TransAm Trucking Inc. ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).
When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. 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 TransAm Trucking Inc. ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am 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:
michele CAREY wray
Signed Date: 10-21-2021
14
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to TransAm Trucking Inc. to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for TransAm Trucking Inc. to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent. I understand that if I refuse to provide consent for TransAm Trucking Inc. to conduct a limited query of the Clearinghouse, TransAm Trucking Inc. is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle. I understand that if the limited query conducted by TransAm Trucking Inc. indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to TransAm Trucking Inc. unless I give additional specific consent within the Clearinghouse. However, I understand that TransAm Trucking Inc. will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle.
10-21-2021
michele CAREY wray Date
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 10-21-2021
Date
X 6098
Social Security Number
michele CAREY wray
21446 Cherry St
New Caney, TX 77357
Gender:
X michele CAREY wray
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Bay & Bay To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to TransAm Trucking Inc.
DISCLOSURE AND AUTHORIZATION UNDER 49 C.F.R. PART 391.23 INCLUDING DOT DRUG AND ALCOHOL INFORMATION
For purposes of an investigation in accordance with 49 C.F.R. Part 391.23, I authorize my previous employers, contractors (if owner-operator), and trucking schools, as applicable, to release and forward to TransAm Trucking ("Company") the following information for the past three (3) years:
1. DOT alcohol and controlled substance information in accordance with Parts 382 and 40 of the Federal Motor Carrier Safety Regulations (49 CFR Part 382 and 49 CFR Part 40, Section 40.25) limited to the following DOT regulated testing items, including pre-employment testing results: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested;
(iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation. 2. Safety performance history information in accordance with 49 CFR Part 391.23, which includes: employment dates, work history
(which may include position held, reason for leaving, any termination information, whether subject to the Federal Motor Carrier Safety Administration regulations, equipment experience, area driven, and other information as applicable) and accident information
(including accident date, nature of accident, whether it was preventable, whether there were injuries, fatalities, or hazardous materials involved, and copies of any accident report).
Pursuant to Section 391.23(i) of the Federal Motor Carrier Safety Regulations, you have the following rights with regard to the information released:
1. You have the right to make a written request at any time to review the information provided by previous employers, contractors (if owner-operator), or trucking schools, as applicable. 2. You have the right to have errors in the information corrected by the previous employer, contractor (if owner-operator), or trucking school, as applicable and for that employer, contractor (if owner-operator), or trucking school to re-send the corrected information. 3. You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer, contractor (if owner-operator), or trucking school and you cannot agree on the accuracy of the information. 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 10-21-2021
Date
X 6098
Social Security Number
michele CAREY wray
21446 Cherry St
New Caney, TX 77357
Gender:
X michele CAREY wray
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Taylor Truck Line To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to TransAm Trucking Inc.
DISCLOSURE AND AUTHORIZATION UNDER 49 C.F.R. PART 391.23 INCLUDING DOT DRUG AND ALCOHOL INFORMATION
For purposes of an investigation in accordance with 49 C.F.R. Part 391.23, I authorize my previous employers, contractors (if owner-operator), and trucking schools, as applicable, to release and forward to TransAm Trucking ("Company") the following information for the past three (3) years:
1. DOT alcohol and controlled substance information in accordance with Parts 382 and 40 of the Federal Motor Carrier Safety Regulations (49 CFR Part 382 and 49 CFR Part 40, Section 40.25) limited to the following DOT regulated testing items, including pre-employment testing results: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested;
(iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation. 2. Safety performance history information in accordance with 49 CFR Part 391.23, which includes: employment dates, work history
(which may include position held, reason for leaving, any termination information, whether subject to the Federal Motor Carrier Safety Administration regulations, equipment experience, area driven, and other information as applicable) and accident information
(including accident date, nature of accident, whether it was preventable, whether there were injuries, fatalities, or hazardous materials involved, and copies of any accident report).
Pursuant to Section 391.23(i) of the Federal Motor Carrier Safety Regulations, you have the following rights with regard to the information released:
1. You have the right to make a written request at any time to review the information provided by previous employers, contractors (if owner-operator), or trucking schools, as applicable. 2. You have the right to have errors in the information corrected by the previous employer, contractor (if owner-operator), or trucking school, as applicable and for that employer, contractor (if owner-operator), or trucking school to re-send the corrected information. 3. You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer, contractor (if owner-operator), or trucking school and you cannot agree on the accuracy of the information. 17
Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing Records
And changes in Parts 390 and 391 of the FMCSA
X 10-21-2021
Date
X 6098
Social Security Number
michele CAREY wray
21446 Cherry St
New Caney, TX 77357
Gender:
X michele CAREY wray
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Southern Mail Services To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to TransAm Trucking Inc.
DISCLOSURE AND AUTHORIZATION UNDER 49 C.F.R. PART 391.23 INCLUDING DOT DRUG AND ALCOHOL INFORMATION
For purposes of an investigation in accordance with 49 C.F.R. Part 391.23, I authorize my previous employers, contractors (if owner-operator), and
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