CMV DRIVER DISCLOSURE & RELEASE REQUEST FOR DOT INFORMATION

In connection with your employment or application for employment (including contract for services), consumer reports may be requested from Patriot Testing Services ("PTS"). These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, motor vehicle accidents and incidents, professional credentials, and drugs/alcohol use. Such reports may contain public record information concerning your 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 PTS concerning previous driving record requests made by others from such state agencies and state provided driving records. 

You have the right to make a request to PTS, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the sources of information and the recipients of any reports on you that PTS has previously furnished within the two-year period preceding your request. Patriot Testing Services may be contacted by mail at P.O. Box 1203, Carver, Massachusetts, 02330, by phone at (877) 808-3117, or by email at admin@patriottesting.com. All requests will be processed within 5 business days. 

Under 49 CFR 391.23, you have the right to review any information provided by previous employers; the right to have errors in the information corrected by the previous employer and for that previous employer to resend the corrected information to the prospective employer; and the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information. 

I hereby fully release and discharge PTS, their respective affiliates, subsidiaries, directors, officers, employees, agents, and attorneys thereof, and each of them, and any individual, organization, entity, agency, or other source providing information to PTS from all claims and damages arising out of or relating to any investigation of my background for employment purposes. This release is valid for all federal, state, county and local agencies, authorities, previous employers, military services and educational institutions. I have been provided a copy of the summary of the rights of the consumer pursuant to the Fair Credit Reporting Act (FCRA). 

PTS is authorized to disclose all information obtained to the requesting entity for the purpose of making a determination as to my eligibility for employment, promotion or any other lawful purpose. I agree that such information which PTS has or obtains, and my employment history if I am hired, may be supplied by PTS to other companies that subscribe to PTS. If hired or contracted, this authorization shall remain on file and shall serve as ongoing authorization for the procurement of consumer reports at any time during my employment or contract period. 

I hereby authorize all previous employers to release the following information from my Department of Transportation Safety Performance History File for purposes of investigation required by 49 CFR Parts 391.23, 40.25 and 382.413 of the Federal Motor Carrier Safety Regulations. You are hereby released from any and all liability that may result from furnishing such information.

I provide consent, in accordance with 49 CFR Part 382.703, to conduct limited queries of the FMCSA CDL Drug & Alcohol Clearinghouse to determine whether drug and alcohol violation information about me exists in the Clearinghouse for the duration of my employment. I understand that if the limited query conducted indicates that drug or alcohol violation information about me exists, FMCSA will not disclose that information to employer without first obtaining additional specillc consent from me. I further understand that if I refuse to provide consent for the employer to conduct a limited query, I will be prohibited from performing safety-sensitive functions, including driving a CMV, as required by FMCSA's drug and alcohol regulations.