Authorization for the Release of Information from Past Employers
AUTHORIZATION FOR THE RELEASE OF INFORMATION FROM PAST EMPLOYERS
Requesting Company:
Sparhawk Trucking Inc. Contact Person: Mike Saramandich
421 25th Ave North Phone: (715) 423-0380
Wisconsin Rapids, WI 54495 Fax: (715) 423-0313
TO BE READ AND SIGNED BY THE APPLICANT
According to law established by the Department of Transportation, Sparhawk Trucking is required to conduct a background check on each applicant. By signing this release, you are allowing Sparhawk Trucking to conduct the background check.
It is understood that the information in this application will be used and that prior employers will be contacted for purposes of investigation as required by 391.23 of the Motor Carrier Safety Regulations.
It is agreed and understood that Sparhawk Trucking Inc. or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether some is of record or not, and applicant releases employers and persons named herein form all liability for any damages on account of his furnishings such information.
It is agreed and understood that if hired, the employee may be on a probationary period during which time he may be discharged without recourse.
It is further understood an investigative report may be made whereby information is obtained through personal interviews with third parties, such as family members, business associates, financial sources, friends, neighbors, others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living, whichever may be applicable. You have the right to make a written request within a reasonable period of time for a complete and accurate disclosure of additional information concerning the nature and scope of any investigative consumer reports requested by us.
It is understood that the applicant, by presenting the application for employment represents that the statements given by the applicant to the information requested in this application are true, correct and complete, and that any false, misleading or incomplete statement of the information requested in the application shall be sufficient grounds for discharge from employment.
RELEASE FOR DRUG AND ALCHOL INFORMATION
In accordance with 49 CFR 382.405 (f) and 382.413 (b), you are hereby authorized and requested to furnish to Sparhawk Trucking Inc. any and all information in your possession concerning my participation in your drug and alcohol testing program under 49 CFR Part 382. I specifically authorize you to release information on any alcohol tests with a concentration results of .04 or greater, positive controlled substance test results and/or refusals to be tested within two years preceding the date of this request. I further authorize and request you to release any information in your possession concerning my evaluation by a substance abuse professional, the identity of that substance abuse professional, my participation in any treatment or rehabilitation recommended by the substance abuse professional and the results of any return-to-duty drug or alcohol test within two years preceding this request. A photocopy of this release shall be as valid as the original. This authorization shall be valid for one year from the date of signing hereof.