DRIVER'S APPLICATION FOR EMPLOYMENT

TO BE READ AND SIGNED BY APPLICANT

l authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary for 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.l I hereby release employers, schools, health care providers and other persons from ill tiaUitny 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 l am required to abide by all rules and regulations of the Company.

I understand that information provided regarding current and/or previous employers may be used, and those employee(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 previous employers;
• Have errors in the information corrected by previous employers corrected information to the prospective employer; and
• Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and cannot agree on the accuracy of the information.

EMPLOYMENT HISTORY

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE

EXPERIENCE AND QUALIFICATIONS - DRIVER

DRIVING EXPERIENCE

EXPERIENCE & QUALIFICATIONS - OTHER

Employment Screening Policy

Edwards Transportation Co. requires, as a condition of employment, and/or continued employment that all applicants consent to and authorize a verification of the information submitted on their application or resume. Please read this statement carefully.

This release and authorization acknowledge that Edwards Transportation Co., may now, or at any time while I am employed, conduct a verification of my education, employment history, credit history, and motor vehicle records including accident history. ln addition understand that an investigative Consumer Report may be requested and I understand that this report may include information as to my character, general reputation, personal characteristics, mode of living, work habits, performance, and experience, along with the reasons for termination of past employment, whichever are applicable, obtained through personal interviews with associates and personal references who have knowledge concerning such items of information. In addition, Edwards Transportation Co. may require that I provide a urine specimen to be tested for the presence of drugs or alcohol, and may request and receive any record of criminal history or other relevant information pertaining to me which may be in the files or any Federal, State or Local criminal justice agency, and/or other information as deemed necessary to fulfill the job requirements.I have read and understand this release and consent and authorize the background verification. I authorize persons, schools, current and former employers, and other organizations and agencies providing such information from any and all claims of damages in connection

I have read and understand this release and consent and authorize the background verification. I authorize persons, schools, current and former employers, and other organizations and agencies providing such information from any and all claims of damages in connection to their release of any requested information. I agree that any copy of this document is as valid as the original.

I do hereby agree to forever release and discharge Edwards Transportation co., its agents, Hire Right and/or iix, its agents as well as any and all agencies providing such information to the full extent permitted by the law from any claims, damages, losses, liabilities, cost and expenses, or any other charge or complaint filed with any agency arising from the retrieving and reporting information. According to the Federal Fair Credit Reporting Act, I am entitled to know if employment was denied based on information obtained by my prospective employer, and to a disclosure of the public record information and of the nature and scope of the investigative report.

I, the undersigned applicant, do hereby certify that the information provided by me for the purpose of employment is true and complete to the best of my knowledge. I understand that if I am employed, any false statements will be considered as cause for possible dismissal. I also acknowledge that any employment with Edwards Transportation Co. is at will employment and either the company of the employee can terminate the employment relationship at any time, with or without cause, with or without notice.

Please provide all requested information below.

Previous Pre-employment Employee Alcohol and Drug Test Statement

If "yes" to question 1, retain this form and documentation provided for 5 years.

If "no" to question 1, discard after employment terminated but not less than 2 years from date of statement.

CERTIFICATION OF COMPLIANCE WITH DRIVER LICENSE REQUIREMENTS

Fair credit Reporting Act Disclosure

Authorization Disclosure As an applicant for employment or a current employee of (Edwards Transportation Company), you are a consumer with rights under’the Fair credit reporting e[t. when any of the following circumstances exist, (Edwards Transportation Company) may choose to obtain and use information contained in either a consumer report or an investigative consumer report from a consumer reporting agency about you when: 1; considering your application for employment, 2) making a decision whether to offer you employment, 3) deciding whether to continue your employment (if you are hired), or 4) making other employment-related decisions directly affecting you.

For explanation purposes, a ‘consumer reporting agency” is a person or business which, for monetary fees, dues, or on a cooperative non-profit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing consumer reports to others, such as (Edwards Transportation Company).

A “consumer report” means any written, oral, or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living!, which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment purposes.

An “investigative consumer report” means a consumer report or portion thereof in which information on your character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates reported on or with others with whom you are acquainted or who may have knowledge concerning any such items of information.

In the event an investigative consumer report is prepared, you may request additional disclosures regarding the nature and scope of the investigation requested, as well as a written summary of your rights under the Fair Credit Reporting Act.

AUTHORIZATION

By filing your electronic signature below, I hereby voluntarily authorize (Edwards Transportation company) to obtain either a consumer report or an investigative consumer report about me from a consumer- reporting agency and to consider this information when making decisions regarding my employment at (Edwards Transportation company). I understand that I have rights under the Fair Credit Reporting Act, including the rights discussed above.

SAFETY PERFORMANCE HISTORY RECORDS REQUEST

HIRERIGHT TRUCKING INDUSTRY: DOT D/A Disclosure and Authorization

PART I - DISCLOSURE AND AUTHORIZATION FOR RELEASE OF INFORMATION FOR EMPLOYMENT PURPOSES - 49 CFR PART 39I.23. DOT DRUG AND ALCOHOL TESTING 

In accordance with OOT Regulation 49 CFR Part 391.23. I hereby authorize release of my DoT-regulated drug and alcohol testing records by the DoT-regulated employer(s) listed below to HheRight for the purpose of HireRight transmitting such records to the HireRight customer listed above. I understand that information/documents released pursuant to this Part I is limited to the following OOT-regulated testing items, including pre-employment leading results, occurring during the previous three (31years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including adulterated and/or substituted tests); (iv) other violations of DOT drug and alcohol testing regulations (i.e., violations of 49 CFR 382 Subpart B); (v) information obtained from previous employers of a drug and alcohol rule violation: and (vi) any documentation of completion of the return-to-duty process following a rule violation. If any company listed below furnishes HireRight with information concerning items (i) through (vi) above, I also authorize such company to furnish the following information to HireRight, if applicable: (i) dates of my negative drug and/or alcohol tests and/or less with results below 0.04 during the previous three (3) years; and (ii) the name and phone number of any substance abuse professional who evaluated me during the previous three (3) years. List all DoT-regulated employers you have applied with and/or worked for in a safety-sensitive function during the previous three (3) years. If necessary, attach additional pages, including the date, your name, social security number and signature.

Part 2 - FMCSA Notification of Driver Rights

DRIVER NOTIFICATION AND RELEASE