Applicant / Employee Permission to Acquire Personal Information

In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91‐
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 testing results, and your driving records may be obtained for employment purposes. Your
employer or prospective employer may obtain this information from Accufax, Equifax, Transunion, Experion, or other vendors of such information services.

You should also be aware that, as a condition of your application for employment or continued
employment, your employer or prospective employer may acquire your criminal background records by
means of employing a service that specialized in obtaining such records via electronic interface with local,
state, and federal municipalities, law enforcement agencies, bureaus, or other sources of such criminal
and court records.

Lastly, you should be aware that your employer or prospective employer may utilize the FMCSA’s Pre‐
Employment Screening (PSP) system in order to obtain your previous DOT roadside inspection and crash
records for review.

Your signature on this form constitutes your acknowledgement of full understanding of the information
presented above, and the granting of your permission for your employer or perspective employer to
obtain any and all such records as are referred to within the information presented above.