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VA Code 46.2-208 classifies driver abstracts as privileged records and limits the release of an abstract of a driver's record to only an employer, potential employer, or authorized agent who has been authorized in writing by such driver to obtain the driver's record.
THE UNDERSIGNED DOES HEREBY ACKNOWLEDGE AND CERTIFY AS FOLLOWS:
l understand that if offered a job, it may be conditioned on the results of a physical examination, drug test, and/or motor vehicle record. l understand that I will be required, prior to hire, to provide proof of eligibility to work in the United States and information on any relevant criminal convictions. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. I understand, also, that I am required to abide by all rules and regulations of the company.
I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification; to the extent such investigation includes information bearing on my character, general reputation, personal characteristics or mode of living.
This notice serves to full-fill the requirements of 49CFR, part 391.23(1), Each motor carrier must notify each driver, who is regulated by the Department of Transportation, of their rights regarding investigative information that will be provided to a prospective employer. I understand I have the right to:
By signing below,
* Failure to sign will end the application process.
These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.
I further understand that, if I refuse to provide consent for H & T Transitx LLC to conduct a limited query of the Clearinghouse, H & T Transitz LLC must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
I understand that, if a limited query reveals that the Clearinghouse contains information about me, I must grant electronic consent within 24 hours via the Clearinghouse website for H &. T Transit, LLC to obtain my full query. Refusal to provide consent will result in my removal from safety-sensitive duties.
* This consent form must be retained until 3 years after the date of the last limited query
When conducting an annual inquiry, H & T Transit, LLC has the right to request a “Limited” report that only indicates, if the Clearinghouse has any information about you. It does not release any violations or testing information. In order for the company to request a limited report, we must have your written authorization per 382.70 1 (b).
If a limited query conducted by H & T Transit, LLC indicates that drug or alcohol violation information about you exists in the Clearinghouse, FMCSA will not disclose that information to H & T Transit, LLC . You will be required to log in to the Clearinghouse website within 24 hours to grant electronic consent for to obtain my full Clearinghouse record.
I authorize you to make sure investigations and inquiries to 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 a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquires and releasing information in connection with my application.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand 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 employer(s) 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:
As a prospective driver employee, you have the right to review information provided by previous employers. You have the right to have errors in the information corrected by the previous employer(s) and for that previous employer(s) to re-send the information, if the previous employer and the driver cannot agree on the accuracy of the information.
Driver employees who have previous Department of Transportation {DOT) regulated employment history in the preceding three years, and wish to review the information provided by the previous employer(s), must submit a written request to the prospective employer. This may be done at anytime, including when applying for the position, up to thirty days after being employed or when notified of denial of employment.
The prospective employer must provide this information to the applicant within five business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five business day deadlines will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived their request to review the records.
