I certify that I personally completed this application and that all of the information is true and correct.
In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 1-508, as
amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are
being informed that reports verifying your previous employment, previous drug and alcohol test results, and your
driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23,
and 391.25 of the Federal Motor Carrier Safety Regulations.
Having completed this application for employment at Point Dedicated Services, I request that their representative be
informed as to my previous record. I hereby authorize the investigation of my past record to ascertain any and all information
which may concern my past employment, credit history, criminal record, and driving record (MVR), whether same is of record
or not. If applicable, this authorization includes the release of information under 382.413 concerning previous alcohol and
controlled substance testing records and refusal to submit to such testing for the past two (2) years. You and your company
are hereby released from any and all liability, which may result from furnishing such information.
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