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A Driver Postal

Location:
Katy, TX
Posted:
December 09, 2022

Contact this candidate

Resume:

Pacific Shipping and Trucking Co

**** **** ****** ***** ***** 130

Highlands Ranch, CO 80129

877-***-****

**-**-**** *: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

346-***-****

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

346-***-****

Second Reference: Diana LI ( Daughter )

25242 Spring Iris Ln

Katy, TX 77494

713-***-****

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

281-***-****

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

877-***-****

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

281-***-****

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



Contact this candidate