In conjunction with my potential employment at City Haul Inc. (“the company”), I (applicant) consent to the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review, evaluation, and other use of any MVR I may have provided to the company. This consent is given in satisfaction of Public Law 18 USC 2721 et. Seq., “Federal Drivers Privacy Protection Act”, and is intended to constitute “written consent” as required by this Act. Please enter your full Legal Name below.

By entering my name below, provide consent to City Haul Inc to conduct a multiple limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. A full query will be conducted prior to employment. Once every year a limited query will be conducted while employed. I understand that if the limited query conducted by City Haul Inc indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to City Haul Inc without first obtaining additional specific consent from me. I further understand that if I refuse to provide consent for City Haul Inc to conduct a limited query of the Clearinghouse, City Haul Inc must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

The Age Discrimination of Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.

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