To Be Read By Applicant

As a condition of my employment, I hereby certify that all the information I have provided on this application is true and correct.  If at any time after employment has been established it is discovered that I misrepresented or falsely prepared this application or related documents, I understand that it shall be considered an act of dishonesty, a possible DOT/FMCSR violation and subject me to immediate dismissal.  I further agree, as a condition of employment, to correctly furnish additional information and complete such documents and examinations, inclusive of medical examinations, that the company from time to time may require.  I also agree and understand that being allowed to make application for employment in no way obligates the company to employ me. 

I hereby authorize the company, or their agents, to investigate my complete background regardless of subject, in order to ascertain that all information given by me is correct and further, I release any and all past employers, persons, organizations from all liability for any damages on account of furnishing any information and agree to indemnify and hold harmless all such persons and organizations who furnish any such information. (Note: If there is anything in the statements you don’t understand, ask the person accepting your application for clarification and meaning.)

THIS RELEASE INCLUDES AUTHORIZATION OF ALL PREVIOUS EMPLOYERS TO RELEASE MY SAFETY HISTORY, DRIVING EXPERIENCE AND DRUG AND ALCOHOL TEST RESULTS AS REQUIRED BY FMCSR’S PARTS 382 THRU 391.

I understand that if the company hires me, my consent will apply and the company may obtain background reports of any kind throughout my employment.

In connection with my application for employment, I authorize Duncan & Son Lines, Inc. to obtain one or more reports regarding my driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA) and HireRight (formally DAC Services).  If Duncan & Son Lines, Inc. uses any information from these two agencies in a decision to not hire me or makes any adverse employment decision regarding me, Duncan & Son Lines, Inc. will provide me with a copy of the report upon which its decision was based and a written summary of my rights under the Fair Credit Reporting Act before taking any final adverse action.  If any final adverse action is taken against me based upon my driving history or safety report, Duncan & Son Lines, Inc. will notify me that the action has been taken and that the action was based in part or in whole on this report.  Duncan & Son Lines, Inc. cannot obtain background reports from FMCSA or HireRight without my written consent.  If you agree that Duncan & Son Lines, Inc. may obtain such background reports, please read the following and sign below.

I authorize Duncan & Son Lines, Inc. to access the FMCSA Pre-Employment Screening Program (PSP), HireRight, and all previous employers, to seek information regarding my commercial driving safety record, employment history, social security number verification, criminal history, state driving records and drug and alcohol test results.  I understand that I am consenting to the release of safety performance information including crash data from the previous five ( 5) years and inspection history from the previous three (3) years from PSP.  HireRight and previous employers may furnish information beyond five (5) years, but only drug and alcohol history from three (3) years.  I understand and acknowledge that this release of information may assist Duncan & Son Lines, Inc. to make a determination regarding my suitability as an employee.

I further understand that neither Duncan & Son Lines, Inc., FMSCA, nor HireRight supplying the information has the capability to correct any safety data that appears to be incorrect.  I understand I may challenge the accuracy of data from FMCSA by submitting a request to https://dataqs.fmcsa.dot.gov.  If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data.  I understand my request will be forwarded by the DataQ system to the appropriate State for adjudication.  I may challenge the accuracy of data from HireRight by contacting 800- 400-2761.  I understand that I may obtain more information about my privacy at www.hireright.com/privacy-policy.aspx.

For a complete “Summary of Your Rights Under the Fair Credit Reporting Act” you may visit: http://www.consumer.ftc.gov/sites/default/files/articles/pdf/pdf-0096-fair-credit-reporting-act.pdf (Click on the link or copy and paste into your browser.  Be sure to open another web window so you do not  interrupt your application process and lose information )

I have read this notice regarding background reports and I understand that if I sign this consent form, Duncan & Son Lines, Inc. may obtain any and all information mentioned herein.  I hereby authorize Duncan & Son Lines, Inc. and it’s employees, authorized agents, and/or affiliates to obtain the information outlined above.

 

 
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Adam Kline
06/27/2022

 

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