It is agreed and understood that Company or its agents may investigate Driver’s background to ascertain any
and all information of concern to Driver’s record, including but not limited to criminal conviction history, whether same is on record or not, and Driver releases employers, carrier lessees, and persons named herein from all liability for any damages on account of furnishing such information.
Upon receipt of an offer of a lease opportunity, Driver agrees to furnish additional information that may be
required by federal, state, or local law upon the Company’s request and to complete examinations such as a
physical and/or blood and/or urine tests to determine the presence of controlled substances, or to determine
compliance with all applicable requirements under Department of Transportation Rules found at 49 C.F.R.
Driver understands that nothing contained in this information sheet or in the granting of an interview is intended
to create an employment relationship between Company and Driver.
This certifies that this form was completed by me, and that all entries on it and information in it are true
and complete to the best of my knowledge. It is agreed and understood that any misrepresentations of any
information, and/or any false statements herein submitted shall constitute an act of dishonesty which shall
constitute sufficient grounds for rejection or termination of the lease, without regard to time lapsed before
discovery of such act of dishonesty.
I understand that I have the right to: (1) review any of this information obtained by former employers and
lessees; (2) have errors in the information corrected by former employers and have the corrected information re-sent; and (3) attach a written rebuttal statement to any information which I perceive to be inaccurate and which
is the subject of a disagreement between me and a former employer/lessees. I understand that if I desire lessee
to review information provided by a former employer/lessees, I must submit a written request to the former
employer at any time up to 30 days after being qualified or being notified of a denial of qualification. I
understand that if I have not arranged to pick up the requested records within 30 days of the records being made
available, I may have waived my right to review the records.