I certify that I personally completed this
application and that all of the information is true and correct. I hereby request and
authorize Taylor Truck Line Inc. to cause to be conducted, at any time, an investigation
of my background for employment purpose, which may include, but is not limited to, any
information relating to my character, general reputation,
personal characteristics, criminal history, past work experience, educational background,
alcohol or drug test results, or failure to submit to an alcohol or drug test, or any
other information about me which may reflect upon my potential for employment gathered
from any individual organization, entity, agency, or other source which may have knowledge
concerning any such items of information. I have completed this application of my own free
will and hold Taylor Truck Link, Inc. harmless of all liability for providing this
application for my use.
In connection with my application for certification (including contract for services)
with you, I understand that consumer reports which may contain public record information
may be requested from DAC Services, Tulsa, Oklahoma. These reports may include the
following type of information: names and dates of previous employers, reason for
termination of employment, work experience, accidents, etc. I further understand that such
reports may contain public record information concerning my driving record, workers
compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal,
state and other agencies which maintain such records; as well as information from DAC
concerning previous driving record requests made by other from such state agencies, and
state providing driving records.
I AUTHORIZE WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC
TO FURNISH THE ABOVE MENTIONED INFORMATION.
I have the right to make a request to DAC, upon proper identification, to request the
nature and substance of all information in its files on me at the time of my request,
including the sources of information; and the recipients of any reports on me which DAC
has previously furnished within the two year period preceding my request. I hereby consent
to your obtaining the above information which DAC has or obtains, and my employment
history with you if I am hired, will be supplied by DAC to other companies which subscribe
to DAC Services.
I hereby authorize procurement of consumer report(s). If hired (or contracted), this
authorization shall remain on file and shall serve as ongoing authorization for you to
procure consumer reports at any time during my employment (or contract) period.
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