Work History: Please list current, or most recent employment first
Official Disclosure Statement:
I certify that I personally completed this application and that all of the information is true and correct to the best of my knowledge.
Authorization to Release Records
I authorize the carrier subscribers including Steven Sullivan & Associates to do a complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by these carrier subscribers and hold them harmless of all liability from the release of said information.
I authorize the carrier subscribers including Steven Sullivan & Associates to run a motor vehicle record (MVR) and pre-employment screening program (PSP) report, and to hold them harmelss of all liability from the release of said information.
I hereby request and authorize to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed this application of my own free will and hold harmless of all liability all companies, agents and associated parties for the use of this application.
To Be Read and Signed by Applicant:
This is to notify you, your signature below authorizes Big Boy Ranch Transportation or their designee the approval to conduct a background investigation, contact previous employers to determine my previous safety performance history required by 49 CFR 391.23 and to request a copy of my driving record from my state licensing agency. As an applicant, you have due process of rights as specified in 49 CFR 391.23 (i) regarding information received as a result of these investigations.
This certifies that 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.