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Title United States Truck Driver
Target Location US-FL-Lake City
Email Available with paid plan
Phone Available with paid plan
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Candidate's Name , LLC.Street Address  E. Fourth St, Suite 340Santa Ana, CA Street Address
PHONE NUMBER AVAILABLEStreet Address -08-2023 5:14:35PM CSTIntelliAppThank you for your interest in Candidate's Name , LLC. 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.If due to a disability, I am unable to complete the application process, I agree to notify the Company so that we may discuss options for a reasonable accommodation. Active JobsJob Name NOV - 2192 - Hot Job - SGWS - Jacksonville, FL Job Title Local Class B CDL Box Truck DriverPersonal InformationReferral Code: jp_indeedName Ty CanadayResidence 3 years or longer (If No,previous addresses shown below)NoCurrent Address 310 Sw Lakeview AveCity, State/Province Zip/Postal Lake City, FL 32025 Country United StatesAddresses Over last 3 years Address 1310 Sw Lakeview AveLake City, FL 32025United States03-2022 to 11-2023Address 215805 sr 121 lot 3Macclenny, FL 32063United States04-1990 to 03-2022SSN/SIN 6376Date of BirthPrimary Phone PHONE NUMBER AVAILABLECell Phone PHONE NUMBER AVAILABLE1Preferred method of contact EmailBest time to contact you AnyEmail EMAIL AVAILABLECell Phone Provider PHONE NUMBER AVAILABLEYes, I agree to receive informationconcerning future opportunities orpromotions from Candidate's Name , LLC.by email or other commercial electroniccommunications.YesWould you like to receive communicationfrom Candidate's Name , LLC. via textmessage?By participating, you consent to receivetext messages sent by an automatictelephone dialing system, which maycontain recruiting/advertising messages.Consent to these terms is not a conditionof being hired, contracted, or leased. Youmay opt out at any time by texting STOP tounsubscribe. You also agree thatCandidate's Name , LLC.'s service providerreceives in real time and logs your textmessages with Candidate's Name , LLC..YesCompany QuestionsAd Number RecruiterGENERAL INFORMATIONWhat location are you applying for? FL, Jacksonville If hired, can you present evidence of yourright to work in the U.S.?YesAre you currently employed? NoWhat date did your last employment end? 11-03-2023 Are you able to perform the essentialfunctions of the job for which you areapplying, either with or without reasonableaccommodation?YesPlease describe the functions that cannotbe performed. (Note: We comply with theADA and consider reasonableaccommodation measures that may benecessary for eligibleapplicants/employees to perform essentialfunctions. Hire may be subject to passing amedical examination, and skill and/oragility tests.)2Have you ever worked for this companybefore?NoEnter start and end dates, location,position, and reason for leaving:Are you a veteran? YesDo you have a Hazmat Endorsement? NoDo you have a Tanker Endorsement? YesDo you have a Double Endorsement? YesDo you have a current TWIC card? NoExpiration date:Have you ever been known by any othername?NoEnter name:How did you hear about Centerline? Indeed.comIf you chose "Referral" or "Other", pleaseexplain:DRIVING EXPERIENCEFor 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 Since 1088Tractor and Semi-Trailer Since 1995Tractor - Two Trailers NoneOther Tanker/flatbed less than 6 monthsEDUCATIONList highest grade completed: College - 3List last school attended (name, city, andstate):FSCJEMERGENCY CONTACTName: Brandi HarveyPhone Number: PHONE NUMBER AVAILABLEGoogle Tracking3LicensesList all driver licenses that you have held in the past License Number 390Licensing Authority FLCountry United StatesLicense Class Class AOriginal Issue DateLicense Expiration Date 04-19-2028DOT Medical Card Expiration Date 04-30-2020Current License YesCommercial Driver License YesEndorsementsTanker Endorsement YesHAZMAT Endorsement NoX Endorsement NoDoubles Triples Endorsement YesOther Endorsement NoEmployment / UnemploymentEnvirowaste ServicesPLEASE DO NOT CONTACTCompany Envirowaste ServicesStart Date 11-2023End Date 11-2023AddressCity, State/Province Zip/Postal Orlando, FLCountry United StatesPhone PHONE NUMBER AVAILABLEFax PHONE NUMBER AVAILABLEPosition Held DriverReason for leaving? Need better paying jobWere you terminated/discharged/laid off? NoIs this your current employer? YesNo4May we contact this employer at this time?Did you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas Driven North FloridaMiles driven weekly 500-1000Most common truck driven Class B VehicleMost common trailer OtherTrailer length 31 feet or lessPettyonePLEASE DO NOT CONTACTCompany PettyoneStart Date 01-2023End Date 10-2023Address 900 canalCity, State/Province Zip/Postal Jacksonville, FL 32209 Country United StatesPhone PHONE NUMBER AVAILABLEPosition Held Linehaul driverReason for leaving? Transit time and lack of workWere you terminated/discharged/laid off? NoIs this your current employer? NoMay we contact this employer at this time? NoDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andYes5subject to drug and alcohol testing?Areas Driven Jacksonville to TampaMiles driven weekly 2000-2500Most common truck driven Tractor-TrailerMost common trailer VanTrailer length 53 feet or morePetty One LLCPLEASE DO NOT CONTACTCompany Petty One LLCStart Date 08-2020End Date 12-2022Address 900 Canal StreetCity, State/Province Zip/Postal Jacksonville, FL 32209 Country United StatesPhone PHONE NUMBER AVAILABLEPosition Held Linehaul driverReason for leaving? Looking for better pay job with benefits Were you terminated/discharged/laid off? NoIs this your current employer? YesMay we contact this employer at this time? NoDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas Driven FloridaMiles driven weekly 2000-2500Most common truck driven Tractor-TrailerMost common trailer VanTrailer length 53 feet or morePritchett Trucking Inc.Company Pritchett Trucking Inc.6Start Date 07-2020End Date 08-2020Address 1050 SE 6th StreetCity, State/Province Zip/Postal Lake Butler, FL 32054 Country United StatesPhone PHONE NUMBER AVAILABLEFax PHONE NUMBER AVAILABLEPosition Held DriverReason for leaving? Looking for better payWere you terminated/discharged/laid off? NoIs this your current employer? YesMay we contact this employer at this time? YesDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas DrivenMiles driven weekly 1500-2000Most common truck driven Tractor-TrailerMost common trailer OtherTrailer length 53 feet or morePritchett Trucking Inc.Company Pritchett Trucking Inc.Start Date 07-2020End Date 07-2020Address 1050 SE 6th StreetCity, State/Province Zip/Postal Lake Butler, FL 32054 Country United StatesPhone PHONE NUMBER AVAILABLEFax PHONE NUMBER AVAILABLEPosition Held7Reason for leaving? Looking for something with different hours Were you terminated/discharged/laid off? NoIs this your current employer? YesMay we contact this employer at this time? YesDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas DrivenMiles driven weekly 1500-2000Most common truck driven Tractor-TrailerMost common trailer OtherTrailer length 53 feet or moreMPW Industrial ServicesCompany MPW Industrial ServicesStart Date 06-2020End Date 06-2020Address 9711 Lancaster Rd SECity, State/Province Zip/Postal Hebron, OH 43025Country United StatesPhone PHONE NUMBER AVAILABLEFax PHONE NUMBER AVAILABLEPosition Held DriverReason for leaving? Looking for full time driving position Were you terminated/discharged/laid off? NoIs this your current employer? YesMay we contact this employer at this time? YesDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyYes8Regulations while employed/contracted bythis employer/contractor?Did you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas DrivenMiles driven weeklyMost common truck driven Tractor-TrailerMost common trailer OtherTrailer length 53 feet or moreUnemploymentStart Date 05-2020End Date 05-2020Comment Had surgeryUnemploymentStart Date 02-2020End Date 04-2020Comment Had to have surgery before I resigned myposition.Baker SalvageCompany Baker SalvageStart Date 01-2014End Date 02-2020Address 7182 E. Mt. Vernon St.City, State/Province Zip/Postal Glen St.mary, FL 32063 Country United StatesPhone PHONE NUMBER AVAILABLEPosition Held DriverReason for leaving? DownsizingWere you terminated/discharged/laid off? NoIs this your current employer? NoMay we contact this employer at this time? YesDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyYes9Regulations while employed/contracted bythis employer/contractor?Did you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas DrivenMiles driven weekly 2000-2500Most common truck driven Tractor-TrailerMost common trailer VanTrailer length 53 feet or moreTransForce, Inc.Company TransForce, Inc.Start Date 03-2012End Date 01-2014Address Blanding Blvd Orange Park FlCity, State/Province Zip/Postal Alexandria, VACountry United StatesPhonePosition Held DriverReason for leaving? Took job closer to homeWere you terminated/discharged/laid off? NoIs this your current employer? NoMay we contact this employer at this time? YesDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas DrivenMiles driven weekly 2000-2500Most common truck driven Tractor-TrailerMost common trailer VanTrailer length 53 feet or more10Crews LogisticsCompany Crews LogisticsStart Date 01-2009End Date 02-2012Address North Lowder StreetCity, State/Province Zip/Postal Macclenny, FL 32063 Country United StatesPhone PHONE NUMBER AVAILABLEPosition Held DriverReason for leaving? Company went underWere you terminated/discharged/laid off? NoIs this your current employer? NoMay we contact this employer at this time? YesDid you operate a commercial motorvehicle?YesWere you subject to the Federal MotorCarrier or Transport Canada SafetyRegulations while employed/contracted bythis employer/contractor?YesDid you perform any safety sensitivefunctions in this job, regulated by DOT, andsubject to drug and alcohol testing?YesAreas DrivenMiles driven weekly 2000-2500Most common truck driven Tractor-TrailerMost common trailer VanTrailer length 53 feet or moreFMCSRUnder FMCSR 391.15, are you currentlydisqualified from driving a commercialmotor vehicle? [49 CFR 391.15]NoHas your license, permit or privilege todrive ever been suspended or revoked forany reason? [49 CFR 391.21(b)(9)]YesPlease provide additional detail, including the dates of the suspension(s)/revocation(s): Dot physical not attached was unaware11Have you ever been denied a license,permit, or privilege to operate a motorvehicle?[49 CFR 391.21(b)(9)]NoWithin the past two years, have you testedpositive, or refused to test, on apre-employment drug or alcohol test by anemployer to whom you applied, but did notobtain, safety-sensitive transportation workcovered by DOT agency drug and alcoholtesting rules? [49 CFR 40.25(j)]NoIn the past three(3) years, have you everbeen convicted of any of the followingoffenses: [49 CFR 391.15]:Driving a commercial motor vehiclewith a blood alcohol concentration("BAC") of .04 percent or moreDriving under the influence ofalcohol, as prescribed by state lawRefusal to undergo drug andalcohol testing as required by anyjurisdiction for the enforcement ofFederal Motor Carrier Safety ActregulationsDriving a commercial motor vehicleunder the influence of any 21C.F.R. 1308.11 Schedule Iidentified controlled substance, anamphetamine, a narcotic drug, aformulation of an amphetamine, ora derivative of a narcotic drugTransportation, possession, orunlawful use of a 21 C.F.R.1308.11 Schedule I identifiedcontrolled substance,amphetamines, narcotic drugs,formulations of an amphetamine, orderivatives of narcotic drugs whileyou were on duty driving for amotor carrierLeaving the scene of an accidentwhile operating a commercial motorvehicleOr any other felony involving theuse of a commercial motor vehicleNo12Vehicle Accident RecordWere you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?Type of Accident / Incident Non-InjuryDate of Accident / Incident 12-2015Hazmat Accident / Incident NoWas the vehicle towed away? NoCityState/Province NCWere you in a commercial vehicle? YesIf yes, was this a Department ofTransportation recordable accident?YesWere you at fault? YesWere you ticketed? YesDescription slow speed coming to a stop at stop sign behind a vehicle lightly rearended as driverstopped short.Traffic Convictions \ ViolationsHave you had any moving violations or traffic convictions in the past 3 years? Violation Date 12-2015Charge / Description OtherViolation State/Province NCIn Commercial Vehicle YesFined? YesLicense Suspended?License Revoked?Perform Community Service?Other Penalty?Fine Amount (if any): 100 - $199Comments: Had fender bender unsurecwhat ticket said no injuries13SignatureFull Name Ty CanadayIP Address 2601:343:c200:45Signature Date/Time 11-08-2023 5:14 PMBy 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. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: Review information provided by previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; andHave a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.Signed Date: 11-08-2023 5:14 PMSigned:Federal FCRA Summary of Rights AcknowledgmentBy checking this box, I (a) acknowledgethat I have read and understand thefederal FCRA Summary of Rights andhave been given the opportunity tocopy/print the Summary of Rights and (b)agree to use an electronic signature todemonstrate my consent. An electronicsignature is as legally binding as an inksignature.YesCALIFORNIA DISCLOSURE REGARDING BACKGROUND CHECKS DOCUMENT By checking the box, I 1) agree to use anelectronic signature to demonstrate myconsent, 2) agree that an electronicsignature is as legally binding as an inksignature, and 3) acknowledge that I haveYes14read and understood this CaliforniaDisclosure Regarding Background Checksdocument.Massachusetts Criminal Policy and Record Correction Acknowledgment By checking the box, I (a) acknowledgethat I have read and understand theCompany's Massachusetts CriminalRecord Policy and Information Concerningthe Process in Correcting a Criminalrecord and have also been given theopportunity copy/print both, and (b) agreeto use an electronic signature todemonstrate my consent. An electronicsignature is as legally binding as an inksignature.YesNew Jersey Summary of Rights AcknowledgmentBy checking the box, I (a) acknowledgethat I have read and understand theSummary of Rights Under New Jersey'sFair Credit Reporting Act and also havebeen given the opportunity to copy/printthe Summary of Rights, and (b) agree touse an electronic signature to demonstratemy acknowledgment. An electronicsignature is as legally binding as an inksignature.YesNew York State Article 23-A NoticeBy checking the box, I (a) acknowledgethat I have read and understand the NewYork State Correction Law Article 23-A andhave been given the opportunity tocopy/print it and (b) agree to use anelectronic signature to demonstrate myacknowledgment. An electronic signatureis as legally binding as an ink signature.YesWashington Summary of Rights AcknowledgmentBy checking the box, I (a) acknowledgethat I have read and understand theSummary of Rights Under Washington'sFair Credit Reporting Act and have beengiven the opportunity to copy/print theSummary of Rights and (b) agree to useYes15an electronic signature to demonstrate myacknowledgment. An electronic signatureis as legally binding as an ink signature.PSP Disclosure and AuthorizationBy checking the box, I (a) acknowledgethat I have read and understand the PSPDisclosure and Authorization and alsohave been given the opportunity tocopy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesFCRA DisclosureBy checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesFCRA AuthorizationBy checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesEmployment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.YesClearinghouse ReleaseYes16By checking the box, I (a) acknowledgethat I have read and understand the aboveand also have been given the opportunityto copy/print it, and (b) agree to use anelectronic signature to demonstrate myconsent. An electronic signature is aslegally binding as an ink signature.Summary of Rights Under 15 U.S.C. Section 1681m(a) By checking this box, I represent that Iunderstand and agree to the abovelanguage.YesNYC AuthorizationBy checking this box, I represent that Iunderstand and agree to the abovelanguage.YesNV Background Disclosure-AuthorizationBy checking this box, I represent that Iunderstand and agree to the abovelanguage.YesMD Background Disclosure-AuthorizationBy checking this box, I represent that Iunderstand and agree to the abovelanguage.YesNH Background Disclosure-AuthorizationBy checking this box, I represent that Iunderstand and agree to the abovelanguage.YesUser Requested CopyUser requested a copy to be sent to thisemail address tycanaday6@gmail.com.Yes17Centerline (the "Company") may request, for lawful employment purposes, background information about you from a consumer reporting agency in connection with your employment or application for employment (including independent contractor assignments, as applicable). This background information may be obtained in the form of consumer reports and/or investigative consumer reports (commonly known as "background reports"). An "investigative consumer report" is a background report that includes information from personal interviews (except in California, where that term includes background reports with or without information obtained from personal interviews), the most common form of which is checking personal or professional references. These background reports may be obtained at any time after receipt of your authorization and, if you are hired or engaged by the Company, throughout your employment or your contract period, as allowed by law.The background report may contain information concerning your character, general reputation, personal characteristics, and mode of living. The types of information that may be obtained include, but are not limited to: employment history(e.g., dates of employment, final salary information, performance-related information, reasons for departure, etc.); personal and professional reference checks; and other information bearing on your character, general reputation, personal characteristics, and mode of living.This information may be obtained from private and public record sources, including, as appropriate: government agencies and courthouses; educational institutions; former employers; and, for investigative consumer reports, personal interviews with sources such as neighbors, friends, former employers and associates; and other information sources provided as references. The Company is not intending to collect, and will not be requesting, any information bearing on your credit worthiness, credit standing, or credit capacity, unless it otherwise notifies you prior thereto in writing. You may request more information about the nature and scope of an investigative consumer report, if any, by contacting the Company.A summary of your rights under the Fair Credit Reporting Act is also being provided to you. Printed Name:Ty CanadaySocial Security #:6376Signed Date: 11-08-2023Ty Canaday310 Sw Lakeview AveLake City, FL 32025PHONE NUMBER AVAILABLEGender:DISCLOSURE REGARDING BACKGROUND INVESTIGATION 18ACKNOWLEDGMENT AND AUTHORIZATIONI have carefully read and understand the Disclosure Regarding Background Investigation and the attached summary of rights under the Fair Credit Reporting Act. By my signature below, I consent to preparation of background reports by a consumer reporting agency such as Asurint and/or HireRight, and to the release of such background reports to the Company and its designated representatives and agents, for the purpose of assisting the Company in making a determination as to my eligibility for employment, promotion, retention or for other lawful employment purposes. I understand that if the Company hires me, my consent will apply, and the Company may, as allowed by law, obtain additional background reports pertaining to me, without asking for my authorization again, throughout my employment or contract period from Asurint, HireRight and/or other consumer reporting agencies. I also understand that nothing herein shall be construed as an offer of employment. By my signature below, I certify the information I provided on and in connection with this form is true, accurate, and complete. I agree that this form in original, faxed, photocopied or electronic (including electronically signed) form, will be valid for any background reports that may be requested by or on behalf of the Company. Printed Name:Ty CanadaySocial Security #:6376Signed Date: 11-08-2023Ty Canaday310 Sw Lakeview AveLake City, FL 32025PHONE NUMBER AVAILABLEGender:DISCLOSURE REGARDING BACKGROUND INVESTIGATION 19IMPORTANT DISCLOSUREREGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with Candidate's Name , LLC. ("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. AUTHORIZATIONIf you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize Candidate's Name , LLC. ("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

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