EMPLOYMENT

• The right to review information provided by previous employers;
• The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer;
• The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.

• Law enforcement and all other federal, state and local agencies;
• Learning institutions (including public and private schools, colleges and universities);
• Testing agencies;
• Information service bureaus;
• Credit bureaus;
• Record/data repositories;
• Courts (federal, state, and local);
• Motor vehicle records agencies;
• My past or present employers;
• The military; and
• All other individuals and sources with any information about or concerning me.

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.

NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49 C.F.R. 383.5.

LAST UPDATED 12/22/2015