In connection with my application for employment (including contract for services) with DAYS CORPORATION.
I understand that consumer reports which may contain public record information may be requested by DAYS CORPORATION. These reports may include the following types of information; Names and dates of precious employers, reason for termination of employment, work experience, accidents, safety performance, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation history, credit, bankruptcy proceedings, criminal records, etc. from federal, state, and other agencies which maintain such records. I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAYS CORPORATION TO FURNISH THE ABOVE MENTIONED INFORMATION TO THE EXTENT AUTHORIZED BY THE STATE AND FEDERAL LAW.
I have the right make request to DAYS CORPORATION, upon proper identification, to request the nature and substance of all information into the files on me at the time of my request, to have incorrect information corrected and to have a rebuttal statement included if necessary. In conformity with 49 C.F.R. Part 40, I hereby authorize motor carries (company/school) listed on my application to furnish to DAYS CORPORATION the following information concerning drug and alcohol tests, DOT drug and alcohol testing violations including pre-employment tests during the past three years (I) the dates on which I tested positive for drugs and the drugs involved; (II) the dates on which I tested .04 or greater for alcohol and the test result levels; (III) the dates on which I refused to be tested for drugs and/or alcohol; (IV) any failure to undertake or complete a rehabilitation program prescribed by a Substance Abuse Professional; (V) other violations of DOT drug and alcohol testing regulations; and (VI) any information the carriers have received regarding violations of drug/alcohol testing regulations from my previous employers observed by DOT.
I fully understand that the information I authorize DAYS CORPORATION to receive involves tests which are required by the Department of Transportation (DOT). If any carrier (company/school) listed on my application furnishes DAYS CORPORATION with information concerning items (I) through (V) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the names and phone numbers of any substance abuse professional who evaluated me during the past three years.
In compliance with Federal and Sate equal opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job disability, or any other group protected status.
I certify that the information presented on 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.