Information disclosure

I authorize you to make investigation and inquiries to my personal, employment, financial or medical history, public records (including driving and criminal), and 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. I understand that information I provide regarding current and/or previous employers may be used, and those employers will be contacted, for the purpose of investigating my safety performance history and 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 employer; and

*Have a rebuttal statement attached to the allieged erroneous information. If the previous employers and I cannot agree on the accuracy of the information.

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