391.23 Investigation, Inquiries and Employment History Authorization
I authorize Simon’s Trucking, Inc to investigate my previous experience and qualifications and hereby release any parties furnishing such information from any resulting liabilities for damage. I hereby give Simon’s Trucking, Inc written authorization to obtain the results of all DOT required drug and/or alcohol records and a Pre-Employment Screen program record. This release is in accordance with FMCSA Part 391.23, Investigation and Inquiries. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: Alcohol tests with a result of 0.04 or higher alcohol concentration, Verified positive drug tests, Refusals to be tested, Other violations of DOT agency drug and alcohol testing regulations, documentation (if any) of completion of the return-to-duty process following a rule violation, and information obtained from previous employers of a drug and alcohol rule violation. You have a right to make a written request within a reasonable period of time for the complete and accurate disclosure of additional information concerning the nature and scope of the investigation.
I authorize Simon’s Trucking, Inc to contact any organization or individual that I have listed, or not listed but have employed me, on my employment/contract application or resume and obtain from them relevant information about my job qualifications, including my experience, skills, and abilities. I understand that I am consenting to the release of education, experience, abilities, or work-related information about me held or known by my former employers, supervisors, co-workers, educational institutions, professional or business associates, and friends and acquaintances that Simon’s Trucking, Inc might contact in the course of conduction of a reference check or background investigation of my suitability for employment/contract.
I give permission to obtain all DOT required drug and/or alcohol test results, consumer information including employment and driving records as well as background reports from the PSP Online Service. I agree not to file or pursue any complaints against Simon’s Trucking, Inc and/or any employees, representatives, or agents arising out of their respective efforts to obtain work-related, driving history, or criminal background information about me.
I declare the foregoing information to be a truthful and complete statement of the facts with the understanding that if found false, it may prevent my being hired or may cause my dismissal if hired. I also understand that, if hired, I can voluntarily terminate my employment or be terminated at any time, with or without cause.
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 have read and agree to the above release.