I authorize you to make sure investigation and inquiries to my person, employment, financial or medical history and all other related matters as may be necessary in
arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been
extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in
connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I
am required to abide by all rules and regulations of the Company.
“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 current/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
- Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the