Drug Screen Authorization and Consent
I hereby authorize and give full permission to have Truckers411.com,LLC.and/or there medical company physician send a specimen of my
urine and/or blood to a laboratory for screening test using S.A.M.H.S.A standards for the presence of illegal drugs.
I will hold all parties concerned harmless, meaning it will not sue or hold resposible for any alleged harm to me or interfering with
my obtaining a job or continuing my employment due to not submiting to the tests or as a result of the tests.This includes, but is not
limited to, possible clerical or laboratory error.
This policy and authorization have been explained to me in a language I understand and I have been told that if I have any question
they will be answered about the test.I understand this is legal binding document which is binding because Truckers411.com,LLC. is sending
me for the examination and paying for it
I UNDERSTAND Truckers411.com,LLC. WILL REQUIRE A DRUG SCREEN TEST WHENEVER AN ON-THE-JOB ACCIDENT AND INJURY IS REPORTEED IN
ACCORDANCE WITH Truckers411.com,LLC. POLICY. MY REFUSAL TO SUBMIT TO DRUG TESTING WILL BE GROUND FOR TERMINATION
FMCSA Notification of Driver Rights
1) In compliance with 49 CFR Part 40 $391.23 you have certain rights regarding the safety performance history information
that will be provided to prospective employers
- l) You have the right to review information provided by previous employers.
ll) You have the right to have errors in the information corrected by the previous employers for that
previous employer to resend the corrected information to prospective employers.
lll) You have the right to have a rebuttal statement attached to the alleged erroneous information,
if the previous employer and the driver cannot agree on the accuracy of the information.
2) Drivers who have previous DOT regulated employment history in the preceding three years and wish to review
previous employer provided investigative information must submit a written request to prospective empolyers.
This may be done at any time, including when applying, or as late as 30 days after being employed or being notified
of denial of employment. Prospective employers must provide this information within five business days of receiving
the written request. If prospective employers have not yet received the requested information from the previous
employers, then the five deadline will begin when the requested safety performance history information is received.
If you have not arranged to pick up or receive the requested records within 30 days of prospective employers making
them available, the prospective employers may consider you to have waived your request to review the record.
DISCLOSURE & AUTHORIZATION FOR RELEASE OF INFORMATION
As a part of our hiring, a background check and investigation will be conducted. We may ask FleetScreen, a consumer
reporting agency, to prepare a consumer report and an investigative consumer report prior to your being qualified in the
service of Truckers411.com LLC. The consumer investigative report may consist of contacting all listed prior
employers to verify your employment history, job performance and drug/alcohol testing data. It may also include a consumer
report to include a check of applicable criminal police or court records. Under the provisions of the Fair Credit Reporting
Act (15 USC at 1681-1681u) as amended, before we can seek such a report from FleetScreen, we must have your written
permission for FleetScreen to obtain the information and to provide the information to us as part of our analysis of your
application for employment with our company
Below you will find an authorization and release for FleetScreen to prepare a consumer report, and for our company to receive,
a copy of that report. If you do not wish to execute this release, please return all of the application materials to the person
from whom you obtained them.
AUTHORIZATION & RELEASE TO OBTAIN CONSUMER REPORT
Under the provision of the Fair Credit Reporting Act, 15 USC, Section 1681 et. Seq., the Americans with Disability Act and all
applicable federal, state and local laws, I hereby authorize and permit Truckers411.com LLC. to obtain from
FleetScreen, a consumer report and investigative consumer report which may include the following:
- 1. My employment records.
- 2. Records concerning any driving, criminal history, credit history, and civil records.
3. For Truck Drivers Only- In accordance with the Department of Transportation Motor Carrier Safety Regulations,
Section 382,413, information concerning alcohol and controlled substances use for the past three (3) years.
- 4. Verification of my academic and/or professional credentials; and information and/or copies of documents from any military service.
I understand that the above items, which may constitute "investigative consumer reports", may include information as to my
character, general reputation, personal characteristics, and mode of living which may be obtained by interviews with individuals
with whom I am acquainted or who may have knowledge concerning any such items of information.
I agree that a copy of the authorization has the same effect as an original.
I hereby release and hold harmless any person, firm or entity that discloses matters in accordance with this authorization, as
well as Truckers411.com LLC. and FleetScreen from liability that might otherwise result from the request for use of
and/or disclosure of any or all of the foregoing information
I understand and acknowledge that under provisions of the Fair Credit Reporting Act, I may request a copy of the consumer report
or consumer investigative report from FleetScreen, the consumer reporting agency that compiled the report, after I have provided
FleetScreen with proper identification. I also understand that before any adverse action is taken based, in whole or in part, on
the information in the consumer report, I will be provided a copy of the report, the name, address and telephone number of
Fleetscreen, and a summary of my rights under the Fair Credit Reporting Act.
I hereby authorize FleetScreen to obtain and prepare an investigative consumer report as set forth above and to provide that
report to Truckers411.com LLC. as part of its investigation of my employment application.