I give my permission for a complete check of my driving record, including any state where I presently have or have had a driver’s license or permit. This inquiry is required by 49CFR, Part 391.25, and will be made annually or as Stillwater Transportation, LLC deems necessary during the course of my employment.

In compliance with the Fair Credit Reporting Act, which provides consumers with rights regarding consumer reports, I know that I may obtain a copy of this report from my employer and have the opportunity to dispute information if I believe it is incorrect before any adverse action is taken. 391.25 Annual inquiry and review of driving record.

(a) Except as provided in subpart G of this part, each motor carrier shall, at least once every 12 months, make an inquiry into the driving record of each driver it employs, covering at least the preceding 12 months, to the appropriate agency of every State in which the driver held a commercial motor vehicle operator’s license or permit during the time period.

(b) Except as provided in subpart G of this part, each motor carrier shall, and least once every 12 months, review the driving record of each driver it employs to determine whether that driver meets minimum requirements for safe driving or is disqualified to drive a commercial motor vehicle pursuant to 391.15. (1) The motor carrier must consider any evidence that the driver has violated any applicable Federal Motor Carrier Safety Regulations in this subchapter or Hazardous Materials Regulations (49 CFR chapter I, subchapter C). (2) The motor carrier must consider the driver’s accident record and any evidence that the driver has violated laws governing the operation of motor vehicles, and must give great weight to violations, such as speeding, reckless driving, and operating while under the influence of alcohol or drugs, that indicate that the driver has exhibited a disregard for the safety of the public.

(c) Recordkeeping. (1) A copy of the response from each State agency to the inquiry required by paragraph (a) of this section shall be maintained in the driver’s qualification file.

(c)(2) A note, including the name of the person who performed the review of the driving record required by paragraph (b) of this section and the date of such review, shall be maintained in the driver’s qualification file.

I hereby give consent to Stillwater Transportation, LLC to conduct a query of the FMCSA Commercial Drivers’ License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. This consent includes all queries Stillwater Transportation, LLC wishes to conduct for pre-employment and for the duration of my employment.

I understand that if a limited query conducted by Stillwater Transportation, LLC indicates that a violation exists in the Clearinghouse, that information will not be disclosed without first obtaining additional specific consent from me. If I refuse to provide consent for Stillwater Transportation, LLC to conduct a query of the Clearinghouse when requested, Stillwater Transportation LLC cannot employ me in a Safety Sensitive Position (as a driver). Violations reported to the Clearinghouse are:

1. A verified positive, adulterated, or substituted drug test result
2. A breath alcohol test with a confirmed result of .04 or greater
3. A refusal to submit to any test required by the employer
4. An employer’s report of actual knowledge (see 49CFR, Part 382.107)
a. On duty alcohol use (see 49CFR, Part 382.205)
b. Pre duty alcohol use (see 49CFR, Part 382.207)
c. Alcohol use following an accident (see 49CFR, Part 382.209)
d. Controlled substance use (see 49CFR, Part 382.213)
5. A substance abuse professional (SAP) report of successful completion of the Return-to-Duty Process.
6. A negative Return-to-Duty test.
7. An employer’s report of completion of required Follow-up testing program.

I have received, read, and understood all provisions outlined in the Stillwater Transportation, LLC Substance Abuse Policy. I understand I can obtain upon request, a hard copy of educational materials concerning the effects of alcohol and controlled substance use on an individual’s health, work, and personal life; signs and symptoms of an alcohol or controlled substances problem; and available methods of intervening when a problem is suspected or identified.

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty. It is agreed and understood that the motor carrier or his agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his furnishing such information. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigating Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my application file. It is agreed and understood that this Application for Qualification in no way obligates the motor carrier to employ or hire the applicant. It is agreed and understood that if qualified and hired, I may be on a probationary period during which time I may be disqualified without recourse. 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.