Employment Driver History Supply

EMPLOYMENT DRIVER HISTORY SUPPLY

This form is required for applicants and employees who will operate motor vehicles in the course of employment. The information supplied herein will be used to evaluate driving qualifications, to obtain motor vehicle records, and to verify prior employment and driving history. All answers must be complete and accurate to the best of your knowledge.

Personal Information

Position Information

Full-Time    Part-Time    Temporary

Driver License Information

Driving Experience

Years of driving experience (non-commercial): — Years of commercial driving experience:

Accidents and Violations

Have you been involved in any motor vehicle accidents in the last 3 years?    Yes    No

Have you had any traffic citations, moving violations, license suspensions, revocations, or disqualifications in the past 10 years?    Yes    No

Have you ever refused, failed, or tested positive on a drug or alcohol test required for commercial driving?    Yes    No

Previous Driving-Related Employment (Most Recent First)

Education

References (Professional)

Legal Disclosures

At-Will Employment: I understand that, if employed, my employment is at-will and may be terminated by either party at any time with or without cause or notice, unless a written agreement signed by an authorized representative of the employer provides otherwise.

Equal Opportunity: The employer provides equal employment opportunity to all applicants and employees without regard to race, color, religion, sex, national origin, age, disability, or other protected characteristic as required by applicable law.

Applicant Certification and Authorizations

I certify that the information provided on this form is true, complete, and correct. I authorize the employer, its agents, and designated third parties to obtain and review my motor vehicle records, driving history, and to contact prior employers, references, licensing authorities, and any other persons or organizations necessary to verify information provided. This authorization includes obtaining copies of my current and past motor vehicle records and accident reports, and any records relating to prior drug or alcohol testing required for commercial driving.

I release from liability all persons, employers, organizations, and the employer for gathering and providing such information. I understand that adverse findings in my driving record, falsification of information, or failure to disclose required information may disqualify me from employment or be cause for immediate termination.

I further acknowledge that I have been informed that the employer may obtain a copy of my motor vehicle record and will provide any required notice in writing prior to procurement where required by law.

Consent to Obtain Records: I expressly consent to the release of motor vehicle records, driving history, accident reports, and any driver qualification files to the employer and its agents for employment purposes. I understand this consent shall remain in effect during my employment or until revoked in writing.

Background and Testing Authorization: I authorize background checks and drug/alcohol testing as a condition of employment where required for safety-sensitive driving positions. I agree to comply with testing procedures and to provide any information necessary for verification of prior testing results or refusals.

Applicant Affirmation: I certify under penalty of perjury that all statements made on this form are true and complete. I understand that falsification, omission, or misleading statements may result in denial of employment or termination.

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