Sharco Express, here after referred to as the "Company" is authorized to make such
investigations and inquiries of my personal, employment, financial or medical history 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 agree to furnish such additional
information and complete such examinations as may be required to complete my application
file.
Authorization to Verify Your Background
Sharco Express conducts its own pre-employment inquiries. We do not use a consumer
reporting agency or a third-party background-screening company to prepare reports about
you, so no consumer report or investigative consumer report is obtained in connection with
this application.
By my signature below, I authorize the Company and its authorized employees to contact
and obtain information about me directly from: my past and present employers; state
driver-licensing and motor vehicle records agencies; the FMCSA Drug and Alcohol
Clearinghouse; testing facilities and medical examiners; educational institutions; and the
references I have provided. I authorize each of those parties to release the requested
information to the Company.
The information that may be requested includes, without limitation: my employment dates,
position and reason for leaving; my safety performance history, including accidents and any
drug or alcohol testing records required to be released under 49 CFR Part 40 and Part 391;
my driving record and licence status; and verification of the training, certifications and
licences I have listed.
I understand that federal regulations require the Company to investigate my employment
record for the preceding three years, and that my previous DOT-regulated employers are
required to respond to those inquiries. I understand this authorization remains in effect
throughout my employment for inquiries the Company is required or permitted by law to make,
and that nothing in this form is an offer of employment.
By my signature below, I also certify that the information I provided on and in
connection with this form is true, accurate and complete, and I understand that a
misrepresentation or omission may disqualify me from consideration or, if discovered later,
result in termination. I agree that this form in original, faxed, photocopied or electronic
(including electronically signed) form is valid for the inquiries described above.
Important Disclosure Regarding Background Reports from the PSP Online Service
In connection with your application for employment with the Company, Sharco Express,
its employees, agents or contractors may obtain one or more reports regarding your driving,
and safety inspection history from the Federal Motor Carrier Safety Administration
(FMCSA).
When the application for employment is submitted in person, if the Company uses any
information it obtains from FMCSA in a decision to not hire you or to make any other
adverse employment decision regarding you, the Company will provide you with a copy of the
report upon which its decision was based and a written summary of your rights under the
Fair Credit Reporting Act before taking any final adverse action. If any final adverse
action is taken against you based upon your driving history or safety report, the Company
will notify you that the action has been taken and that the action was based in part or in
whole on this report.
When the application for employment is submitted by mail, telephone, computer, or other
similar means, if the Company uses any information it obtains from FMCSA in a decision to
not hire you or to make any other adverse employment decision regarding you, the Company
must provide you within three business days of taking adverse action oral, written or
electronic notification: that adverse action has been taken based in whole or in part on
information obtained from FMCSA; the name, address, and the toll free telephone number of
FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable
to provide you the specific reasons why the adverse action was taken; and that you may,
upon providing proper identification, request a free copy of the report and may dispute
with the FMCSA the accuracy or completeness of any information or report. If you request a
copy of a driver record from the Company who procured the report, then, within 3 business
days of receiving your request, together with proper identification, the Company must send
or provide to you a copy of your report and a summary of your rights under the Fair Credit
Reporting Act.
Neither the Company nor the FMCSA contractor supplying the crash and safety information
has the capability to correct any safety data that appears to be incorrect. You may
challenge the accuracy of the data by submitting a request to
https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by
a State, FMCSA cannot change or correct this data. Your request will be forwarded by the
DataQs system to the appropriate State for adjudication.
Any crash or inspection in which you were involved will display on your PSP report.
Since the PSP report does not report, or assign, or imply fault, it will include all
Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those
crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or
without violations, appear on the PSP report. State citations associated with Federal Motor
Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law
will also appear, and remain, on a PSP report.
The Company cannot obtain background reports from FMCSA without your authorization.
I have read the above Notice Regarding Background Reports provided to me by the Company
and I understand that if I sign this consent form, the Company may obtain a report of my
crash and inspection history. I hereby authorize the Company and its employees, authorized
agents, and/or affiliates to obtain the information authorized above.
By submitting, you confirm the information you provided is true,
accurate and complete.