This certifies that this application was completed by me, and that all entries on it and information in it are true and
complete to the best of my knowledge.
In the event of employment, I understand that false or misleading information given in my applications or
interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the
Company.
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 as required by 49 CFR 391.23
(d) and (e). I understand that I have the right to:
- Review information provided by the 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 alleged erroneous information, if the previous employer(s) and I cannot
agree on the accuracy of the information.