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By clicking the “submit” button I hereby authorize company authorized individuals to investigate and compile history of my former employment, and or customers, together with any and all information concerning my business practices, ability, personal character, credit, arrest record, etc. I hereby release this company and its authorized individuals from any and all liability for damages whatsoever that may result to me upon completion of above defined investigation.
Further, I hereby authorize the present and past customers/employers listed herein to furnish my previous service/employment record with them, with reasons for termination of services, or separation of employment and any and all information which said company may have concerning me or my business to the company’s investigation agency. I also release present and past customers and employers listed herein, and their authorized individuals from any and all liability for damages whatsoever as a result of furnishing my past service records, employment records, including alcohol and controlled substances information per Department of Transportation Regulation 49 CFR 40.25.
Further, I authorize any local, county, state, or federal law enforcement agency to furnish any and all information regarding any arrest, conviction, or information listed under my name that might be on file to the company’s investigative agencies. I hereby release said law enforcement agency from any and all liability for damages whatsoever which may result for furnishing any information concerning my business or me.
By completion of this data sheet I confirm that I am representing myself as an Independent Contractor and understand that the investigative report is being created in order to fulfill the DOT requirements as to background investigations. I acknowledge I am not applying for, nor am I being offered employee status by this data sheet. I have read and understand the above.
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