A Driver Local
Resume:
AAA Cooper Transportation
Dothan, AL 36303
800-***-**** x3182
**-**-**** *:20:59AM CST
IntelliApp
Thank you for your interest in AAA Cooper Transportation. To apply for a 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.
Position City State/Province
Dedicated Local Driver -
DRA
Baton Rouge LA
Personal Information
Referral Code: ACT_Website_Dedicated_Local_Driver_Baton_Rouge_LA Name Michael Dupuy
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 14491 Whispering Oaks Dr
City, State/Province Zip/Postal Gonzales, LA 70737 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 4415
Date of Birth
Primary Phone 225-***-****
Cell Phone 225-***-****
Email adu7x1@r.postjobfree.com
Yes, I agree to receive information
concerning future opportunities or
promotions from AAA Cooper
Transportation by email or other
commercial electronic communications.
Yes
Would you like to receive communication
from AAA Cooper Transportation via text
message?
By participating, you consent to receive
text messages sent by an automatic
Yes
1
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 AAA
Cooper Transportation's service provider
receives in real time and logs your text
messages with AAA Cooper
Transportation.
Company Questions
Worklist
Recruiter
GENERAL INFORMATION
I certify that I have read the job description
which set forth the essential functions of
the job which I am applying and that I may
be required to undergo a physical
assessment to determine my ability to
perform these functions.
I Agree
Are you legally eligible for employment in
the United States?
Yes
What county do you reside in? US
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: 9/11/2026
Please enter the names of any relatives
employed here:
Have you ever been known by any other
name?
No
Enter name:
What is your preferred name or nickname?
How did you hear about us? Indeed
Who referred you?
2
Have you ever served in the Military? No
Please select which branch
Start Date
End Date
Can you provide your DD214?
In case of Emergency, notify (list name,
address, and phone):
Elaine cloud 225-***-****
DRIVING EXPERIENCE
For each class of equipment, enter type of equipment (van, reefer, tank, etc.), select the total amount of experience.
Straight Truck 10+ years
Tractor and Semi-Trailer 3 years
Tractor - Two Trailers None
Other Na
Which safe driving awards do you hold
and from whom?
Driver of the month twice CRST
EXPERIENCE AND QUALIFICATIONS - PLATFORM
LIst types of platform experience and
years of each
Forklift 3yrs
List platform equipment you can operate
(lift truck, etc.)
Show courses of training in platform work
EDUCATION
List highest grade completed: Some College
If you completed College, what type of
degree did you earn?
List last school attended (name, city, and
state):
Gulf coast junior college perkinston MS
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship (please do not include relatives):
First Reference:
Name Clint desouge
Phone Number 225-***-****
Relationship Friend
Second Reference:
Name Curtis Buker
3
Phone Number 225-***-****
Relationship Friend
Third Reference
Name Brian Dupuy
Phone Number 225-***-****
Relationship Brother
Licenses
License Number 570
Licensing Authority LA
Country US
License Class Class A
License Expiration Date 11-10-2023
Physical Expiration Date 10-12-2023
Current License Yes
Commercial Driver License Yes
Endorsements None
Employment / Unemployment
Network Transport, LLC
Company Network Transport, LLC
Start Date 02-2023
End Date 02-2023
Address 735 Broad Street
Address 2 Suite 1001
City, State/Province Zip/Postal Chattanooga, TN 37401 Country United States
Phone 423-***-****
Position Held
Reason for leaving? None
Were you terminated/discharged/laid off? No
Is this your current employer? Yes
May we contact this employer at this time? Yes
4
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 Southeast
Miles driven weekly 2000-2500
Pay Range (cents/mile) .65
Most common truck driven Tractor-Trailer
Most common trailer Van
Trailer length 53 feet or more
Network Transport, LLC
Company Network Transport, LLC
Start Date 11-2022
End Date 01-2023
Address 735 Broad Street
Address 2 Suite 1001
City, State/Province Zip/Postal Chattanooga, TN 37401 Country United States
Phone 423-***-****
Position Held Class A
Reason for leaving? Currently working
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
5
Areas Driven
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Arnold Transportation Services
Company Arnold Transportation Services
Start Date 08-2022
End Date 10-2022
Address 3375 High Prairie Road
City, State/Province Zip/Postal Grand Prairie, TX 75050 Country United States
Phone 800-***-****
Fax 972-***-****
Position Held Class A
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Unemployment
6
Start Date 10-2021
End Date 07-2022
Comment
deBoer Transportation, Inc
Company deBoer Transportation, Inc
Start Date 01-2021
End Date 09-2021
Address 8814 County Road F
City, State/Province Zip/Postal Blenker, WI 54415
Country United States
Phone 920-***-****
Fax 888-***-****
Position Held Class A
Reason for leaving? Company got brought out
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Unemployment
Start Date 09-2020
End Date 12-2020
Comment
7
Us Exppess
Company Us Exppess
Start Date 01-2020
End Date 08-2020
Address
Address 2 4080 Jenkins Rd
City, State/Province Zip/Postal Chattanooga Tn, TN Country United States
Phone 423-***-****
Position Held Class A
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
CRST
Company CRST
Start Date 11-2017
End Date 12-2019
Address
City, State/Province Zip/Postal Cedar Rapids, IA
Country United States
8
Phone
Fax 319-***-****
Position Held
Reason for leaving? Regional 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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Tractor-Trailer
Most common trailer
Trailer length
Unemployment
Start Date 07-2017
End Date 09-2017
Comment
Hotshot
Company Hotshot
Start Date 07-1997
End Date 06-2017
Address 14491 Whispering oaks
City, State/Province Zip/Postal Gonzales, LA 70737 Country United States
Phone
Position Held Class c hotshot
Reason for leaving? Class A
9
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
Miles driven weekly
Pay Range (cents/mile)
Most common truck driven Straight Truck
Most common trailer
Trailer length
Trucking School
Start Date 10-2017
End Date 11-2017
School CRST
Address
Address 2
City, State/Province Cedar Rapids, IA
Country US
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 4.0
10
Hours of Instruction 50
Border Crossing No
Log Books Yes
Federal Motor Carrier Regulations Yes
Hazardous Materials Yes
Motor Vehicle Record
1. Has any license, permit or privilege ever
been denied, suspended or revoked for
any reason?
No
2. Have you ever been convicted of driving
during license suspension or revocation, or
driving without a valid license or an expired
license, or are any charges pending?
No
3. Have you ever been convicted for any
alcohol or controlled substance related
offense while operating a motor vehicle, or
are any charges pending?
No
4. Have you ever been convicted for
possession, sale or transfer of an illegal
substance (including but not limited to,
marijuana, amphetamines, or derivatives
thereof) while on duty, or are any charges
pending?
No
5. Have you ever been convicted of
reckless driving, careless driving or
careless operation of a motor vehicle, or
are any charges pending?
No
6. Have you ever tested positive, or
refused to test on a pre-employment drug
or alcohol test by an employer to whom
you applied, but did not obtain
safety-sensitive transportation work
covered by DOT agency drug and alcohol
testing rules in past three years, or have
you ever tested positive or refused to test
on any DOT-mandated drug or alcohol
test?
No
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 5 years (even if not at fault)?
No Accidents
11
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 Michael Dupuy
IP Address 2600:387:f:818:a
Signature Date/Time 02-06-2023 8:20 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: 02-06-2023 8:20 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
12
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
Additional Consent or Certification
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 Disclosure and 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
13
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
User Requested Copy
User requested a copy to be sent to this
email address adu7x1@r.postjobfree.com.
Yes
14
DISCLOSURE AND RELEASE
In connection with your employment or application of employment through AAA Cooper Transportation, consumer reports (Investigative Consumer Reports in California) may be requested from Asurint. These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well as information from Asurint concerning previous driving record requests made by others from such state agencies and state provided driving records. We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA"). You have the right to make a request to Asurint, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that Asurint has previously furnished within the past two year period preceding your request (3 years in California). Asurint may be contacted by mail at Asurint, P.O. Box 14730, Cleveland, OH 44114, 800-***-****, www.asurint.com. I AUTHORIZE, WITHOUT RESERVATION, ASURINT, FMCSA AND ANY OTHER PARTY OR AGENCY CONTACTED BY ASURINT TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I.
I hereby consent to your obtaining the above information from Asurint, and I agree that such information which Asurint has or obtains in my employment history (not DOT drug and alcohol information without a specific consent by me) with you if I am hired, will be supplied by Asurint to other companies which subscribe to Asurint I hereby authorize procurement of consumer reports as set forth above. If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you to procure consumer reports at any time during my employment or contract period. I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs System at: https://dataqs.fmcsa.dot.gov.
Printed Name:
Michael Dupuy
Social Security #:
4415
Signed Date: 02-06-2023
Michael Dupuy
14491 Whispering Oaks Dr
Gonzales, LA 70737
Gender:
15
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with AAA Cooper Transportation ("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 AAA Cooper Transportation ("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:
Michael Dupuy
Signed Date: 02-06-2023
16
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent for AAA Cooper Transportation 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 AAA Cooper Transportation to conduct annual limited queries of the Clearinghouse at any time during my employment without asking me for additional consent.
I understand that if I refuse to provide consent for AAA Cooper Transportation to conduct a limited query of the Clearinghouse, AAA Cooper Transportation 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 AAA Cooper Transportation indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to AAA Cooper Transportation unless I give additional specific consent within the Clearinghouse. However, I understand that AAA Cooper Transportation 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.
02-06-2023
Michael Dupuy Date
17
TO BE READ AND SIGNED BY APPLICANT
This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge.
Printed Name: Michael Dupuy
Social Security #: 4415
Signed Date: 02-06-2023
Signed:
18
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 02-06-2023
Date
X 4415
Social Security Number
Michael Dupuy
14491 Whispering Oaks Dr
Gonzales, LA 70737
Gender:
X Michael Dupuy
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Network Transport, LLC To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to AAA Cooper Transportation DISCLOSURE AND RELEASE
In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed above to AAA Cooper Transportation and/or Asurint for the sole purpose of transmitting such records to AAA Cooper Transportation. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers
(company/school) listed above to release information about names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and other information. The information that I have authorized AAA Cooper Transportation and/or Asurint to review involves tests required by DOT. If any carrier (company/school) listed above furnishes AAA Cooper Transportation and/or Asurint with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years. 19
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 02-06-2023
Date
X 4415
Social Security Number
Michael Dupuy
14491 Whispering Oaks Dr
Gonzales, LA 70737
Gender:
X Michael Dupuy
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize Network Transport, LLC To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to AAA Cooper Transportation DISCLOSURE AND RELEASE
In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my
Contact this candidate