• Image-1
  • If less than three years at current address please provide address

  •  - -
  •  -

  • CDL License Info

  •  - -




  • Traffic Accidents

  • Traffic Accident 1

  • Traffic Accident 2

  • Traffic Convictions

  • Traffic Conviction 1

  • Traffic Conviction 2

  • Background

  • Employment Information

    Start with your most current Employer.

  • Employment History

    Driver applicants operating in the interstate commerce must provide the following information on all employers during the previous 3 years. Enter the information for your previous employer proving as much detail as possible. Failure to provide adequate or required detail will inhibit the ability to obtain the necessary background information.

    CDL holders are required to list additional 7 years previous employer information for a total of 10 years listed on their application. Account for any breaks in employment by indication any time not working as a result of lay off, personal leave, unemployment, medical leave, etc. Note: Self Employment may require tax records to verify your employment for the period of time indicated as self-employed.

  • Employer 1

  •  -
  • Employer 2

  •  -
  • Employer 3

  •  -
  • Employer 4

  •  -
  • Employer 5

  •  -
  • I understand my employer Heads Up Racing Inc. may request for lawful purposes, background information about me from a consumer reporting agency in connection with my employment and/or insurance application as applicable. These background reports may be obtained at any time after receipt of this authorization and, if hired or engaged by the company, throughout my employment of contract period.

    The types of information that may be obtained include, but are not limited to: social security number verification; address history; criminal records and history; public court records; driving records; accident history; prior drug and alcohol history; worker’s compensation claims; educations history verification (e.g. dates of attendance, degrees obtained); employment history verifications (e.g. dates of employment, reasons for termination, etc.); professional and/or personal reference checks; professional licensing and certification checks; drug/alcohol testing results, drug/alcohol history in violations of law and/or company policy; other information bearing my character, general reputation, personal characteristics, mode of living and credit standing.

    This information may be obtained from private, public record sources, appropriate government agencies, educational institutions, former employers, and other information sources.

    I know I may request more information about the nature and scope of any investigative consumer reports by contacting the Company. My signature below certifies my receipt of my summary of rights under the fair credit reporting act.

  • References:

    Federal Motor Carrier Safety Regulations: Sections 382.413, 391.23, and 391.25

    Fair Credit Reporting Act: Sections 604 (b) (A) and 607, Public Law 91-508, as amended by the Consumer Reporting Act of 1996 (Title ll, Subtitle D, Chapter 1, of Public Law 104-208)

  •  
  • Should be Empty: