Pacific Shipping and Trucking Co
**** **** ****** ***** ***** 130
Highlands Ranch, CO 80129
**-**-**** *:11:37PM CST
IntelliApp
Personal Information
Referral Code: cdljobnow
Name Edward Li
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 25242 Sping Iris Ln
City, State/Province Zip/Postal Katy, TX 77494
Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 8528
Date of Birth
Primary Phone 281-***-****
Cell Phone 281-***-****
Email adtyrf@r.postjobfree.com
Yes, I agree to receive information
concerning future opportunities or
promotions from Pacific Shipping and
Trucking Co by email or other commercial
electronic communications.
Yes
Would you like to receive communication
from Pacific Shipping and Trucking Co 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 Pacific
Shipping and Trucking Co's service
provider receives in real time and logs your
text messages with Pacific Shipping and
Trucking Co.
Yes
1
Company Questions
GENERAL INFORMATION
What position are you applying for? Company Driver If you answered "Owner Operator" or
"Fleet Owner", select yes.
No
EQUIPMENT (OWNER/OPERATORS ONLY)
Equipment Description (Tractor):
Type:
Year:
Make:
Model:
Color:
VIN:
Weight
Mileage
Fifth Wheel Height
What location are you applying for? Texas
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 a current TWIC card? Yes
Expiration date: 07-11-2027
Please enter the names of any relatives
employed here:
none
Have you ever been known by any other
name?
No
Enter name:
How did you hear about us? Web
If "Driver Referral", please enter the
driver's name
If "Other", please explain
2
In case of Emergency, notify (list name,
address, and phone):
Angelica Li
25242 Spring Iris Ln
Katy, TX 77494
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 and Semi-Trailer 7 YEARS
600,000
Tractor - Two Trailers NONE
Other NONE
Which safe driving awards do you hold and
from whom?
EDUCATION
List highest grade completed: Grade 12
List last school attended (name, city, and
state):
hong kong
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship: First Reference: Andrew Li ( son )
25242 Spring Iris Ln
Katy, TX 77494
Second Reference: Diana LI ( Daughter )
25242 Spring Iris Ln
Katy, TX 77494
Licenses
License Number 348
Licensing Authority TX
Country US
License Class Class A
License Expiration Date 05-15-2023
Physical Expiration Date 07-25-2023
Current License Yes
Commercial Driver License Yes
3
Endorsements None
Employment / Unemployment
Sega Trucking Llc
Company Sega Trucking Llc
Start Date 10-2022
End Date 12-2022
Address 2955 Candle Falls Ln,
City, State/Province Zip/Postal Pearland, TX 77584 Country United States
Phone 346-***-****
Position Held driver
Reason for leaving? still working on Sega Trucking 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 2500-3000
Pay Range (cents/mile) 0.70
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Unemployment
Start Date 09-2022
End Date 10-2022
Comment
4
Unemployment
Start Date 07-2022
End Date 08-2022
Comment
LMD Logistic INC
Company LMD Logistic INC
Start Date 02-2022
End Date 06-2022
Address 4242 1st Ave,
City, State/Province Zip/Postal Lyons, IL 60534
Country United States
Phone 708-***-****
Position Held driver
Reason for leaving? Current
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 2500-3000
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
MORNINGSTAR YM TRUCKING LLC
Company MORNINGSTAR YM TRUCKING LLC
Start Date 10-2021
End Date 01-2022
5
Address 4108 FAIR MEADOWS DR.
City, State/Province Zip/Postal Plano, TX 75024
Country United States
Phone 214-***-****
Position Held driver
Reason for leaving? Truck broke down,no parts to fix. no other truck to cover.
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 Houston,Texas
Miles driven weekly 3000-3500
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
MC Express Inc.
Company MC Express Inc.
Start Date 09-2016
End Date 10-2021
Address P.O. Box17701
City, State/Province Zip/Postal Sugar Land, TX 77496 Country United States
Phone 415-***-****
Position Held driver
Reason for leaving? no job for me
Were you terminated/discharged/laid off? No
6
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 Houston,Texas
Miles driven weekly 1000-1500
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Container
Trailer length 32 to 44 feet
Uber Transport
PLEASE DO NOT CONTACT
Company Uber Transport
Start Date 12-2015
End Date 08-2016
Address
City, State/Province Zip/Postal Houston, TX 77081
Country United States
Phone 832-***-****
Position Held
Reason for leaving? current
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
7
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 Other
Most common trailer Other
Trailer length Other
Well Luck Inc,co.
Company Well Luck Inc,co.
Start Date 06-2014
End Date 11-2015
Address 13888 Westfair E. Dr
City, State/Province Zip/Postal Houston, TX 77041
Country United States
Phone 832-***-****
Position Held Driver
Reason for leaving? need more home time
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 Texas,OK,AR,LA
Miles driven weekly 2000-2500
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer Reefer Trailer
8
Trailer length 45 to 52 feet
CR England Truckin Companyg
Company CR England Truckin Companyg
Start Date 03-2014
End Date 05-2014
Address 4701 W 2100 S
City, State/Province Zip/Postal Salt Lake City, UT 84120 Country United States
Phone 801-***-****
Position Held truck driver
Reason for leaving? close to my home
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 Utah,Wyoming,Iowa,california
Miles driven weekly 3500+
Pay Range (cents/mile)
Most common truck driven Straight Truck
Most common trailer Reefer Trailer
Trailer length 53 feet or more
Suzie Wong's world Restaurant
Company Suzie Wong's world Restaurant
Start Date 01-2014
End Date 02-2014
Address 5929 FM 1463 ste 140
City, State/Province Zip/Postal Katy, TX 77494
Country United States
9
Phone 281-***-****
Position Held waiter
Reason for leaving? move up to truck 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?
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 07-2013
End Date 12-2013
Comment
E-Tao Asian Restaurant
Company E-Tao Asian Restaurant
Start Date 11-2011
End Date 06-2013
Address 5135 W.Alabma St. #7295
City, State/Province Zip/Postal Houston, TX 77056 Country United States
Phone 713-***-****
Position Held Kitchen Manage
Reason for leaving? Change Job
Were you terminated/discharged/laid off? No
10
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
No
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Unemployment
Start Date 06-2011
End Date 10-2011
Comment unemployment
USA Truck,Inc.
Company USA Truck,Inc.
Start Date 03-2011
End Date 05-2011
Address
City, State/Province Zip/Postal Van Buren, AR 72956 Country United States
Phone
Position Held
Reason for leaving? not comfortable to leave home
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 No
11
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
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Unemployment
Start Date 05-2010
End Date 01-2011
Comment
Save-a-lot
PLEASE DO NOT CONTACT
Company Save-a-lot
Start Date 05-2004
End Date 04-2010
Address 11011 Bissonnet
City, State/Province Zip/Postal Houston, TX 77099
Country United States
Phone
Position Held Meat Market Manage
Reason for leaving? Store cloese
Were you terminated/discharged/laid off? Yes
Termination Explanation Store close, laid off
Is this your current employer? No
May we contact this employer at this time? No
Did you operate a commercial motor
vehicle?
No
12
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven
Most common trailer
Trailer length
Trucking School
Start Date 02-2011
End Date 03-2011
School C1 Professional Training Center
Address
Address 2
City, State/Province Ft.worth,tx., 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 130
Border Crossing No
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials No
13
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
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
•
No
14
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 11-2022
Hazmat Accident / Incident No
Was the vehicle towed away? Yes
City Pesotum
State/Province IL
Were you in a commercial vehicle? Yes
If yes, was this a Department of
Transportation recordable accident?
Yes
Were you at fault? No
Were you ticketed? No
Description Tire exploded while driving. When pulled over on the ramp to check, the tire caught
fire. I immediately used a fire extinguisher
to stop the fire. After the incident, I called
911 in case the fire restarted. I then
reported the events to DOT and the fire
department.
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
No
15
If you have any felony convictions, do you
currently hold a minister's permit to enter
or exit Canada?
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 Edward Li
IP Address 98.194.188.4
Signature Date/Time 12-05-2022 6:11 PM
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: 12-05-2022 6:11 PM
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
Yes
16
consent. An electronic signature is as
legally binding as an ink signature.
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
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.
Yes
17
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.
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 adtyrf@r.postjobfree.com.
Yes
18
DISCLOSURE FOR CONSUMER REPORTS
In connection with my application for employment (including contract) with Pacific Shipping and Trucking Co, I understand consumer reports will be requested by Pacific Shipping and Trucking Co ("Company"). These reports may include, as allowed by law, the following types of information, as applicable: names and dates of previous employers, reason for termination of employment, work experience, education, accidents, licensure, credit, etc. I further understand that such reports may contain public record information such as, but not limited to: my driving record, CDLIS, workers' compensation claims, judgments, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies that maintain such records. In addition, investigative consumer reports (gathered from personal interviews, as applicable, with former employers or landlords, past or current neighbors and associates of mine, etc.) to gather information regarding my work or tenant performance, character, general reputation and personal characteristics, and mode of living (lifestyle) may be obtained. If I am hired (or contracted), I understand that Company can use this disclosure and authorization to continue to obtain such consumer reports throughout my employment or contract period. Printed Name:
Edward Li
Social Security #:
8528
Signed Date: 12-05-2022
Edward Li
25242 Sping Iris Ln
Katy, TX 77494
Gender:
19
AUTHORIZATION FOR CONSUMER REPORTS
I hereby authorize procurement of consumer report(s) and investigative consumer report(s) by Company. If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for Company to procure such reports at any time during my employment or contract period. I authorize without reservation, any person, business or agency contacted by any consumer reporting agency retained by Company to furnish the above-mentioned information. This authorization is conditioned upon the following representations of my rights: I understand that I have the right to make a request to any consumer reporting agency ("Agency") that supplied the report to the Company upon proper identification, to obtain copies of any reports furnished to Company by the Agency and to request the nature and substance of all information in its files on me at the time of my request, including the sources of information, and the Agency, on Company's behalf, will provide a complete and accurate disclosure of the nature and scope of the investigation covered by any investigative consumer report(s). The Agency will also disclose the recipients of any such reports on me which the Agency has previously furnished within the two year period for employment requests, and one year for other purposes preceding my request
(California three years). I hereby consent to Company obtaining the above information from such Agencies. I understand that I can dispute, at any time, any information that is inaccurate in any type of report with the Agency by contacting the Agency directly. I may view the Agency's privacy policy at their website. I understand that I can also contact the Company at 3900 S. Wadsworth Blvd. Suite 550, Lakewood, CO, 877-***-**** to request information about the nature of any consumer reports or investigative consumer reports supplied by an Agency.
Agency Contact Information:
HireRight, LLC
Attn: Consumers Department
14002 E. 21st Street
Suite 1200
Tulsa, OK 74134
Phone: 866-***-****
Fax: 918-***-****
Email: adtyrf@r.postjobfree.com
http://www.hireright.com/applicants
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
adtyrf@r.postjobfree.com
https://www.tenstreet.com/privacy-policy/
As a California applicant, I understand that I have the right under Section 1786.22 of the California Civil Code to contact the Agency during reasonable hours (9:00 a.m. to 5:00 p.m. (CTZ) Monday through Friday) to obtain all information in Agency's file for my review. I may obtain such information as follows: 1) In person at the Agency's offices, which address is listed above or, if not listed above, obtained by contacting Tenstreet by phone. I can have someone accompany me to the Agency's offices. Agency may require this third party to present reasonable identification. I may be required at the time of such visit to sign an authorization for the Agency to disclose to or discuss Agency's information with this third party; 2) By certified mail, if I have previously provided identification in a written request that my file be sent to me or to a third party identified by me; 3) By telephone, if I have previously provided proper identification in writing to Agency; and 4) Agency has trained personnel to explain any information in my file to me and if the file contains any information that is coded, such will be explained to me. I understand that if the report is provided to an employer in the State of Washington, that I can contact the following office for more information regarding my rights under Washington state law in regard to these reports: State of Washington Attorney General, Consumer Protection Division, 800 5th Ave, Ste. 2000, Seattle, Washington 98104-3188, 206-***-****. 20
Printed Name:
Edward Li
Social Security #:
8528
Signed Date: 12-05-2022
Edward Li
25242 Sping Iris Ln
Katy, TX 77494
Gender:
21
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Pacific Shipping and Trucking Co ("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 Pacific Shipping and Trucking Co ("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