Employment Application

FAIR CREDIT REPORTING ACT DISCLOSURE & AUTHORIZATION FORM

As an applicant for employment or a current employee of Miller Expedited Freight Co. you are a consumer with rights under the Fair Credit Reporting Act. In the event any of the following circumstances exist, Miller Expedited Freight LLC or an Affiliated Company may choose to obtain and use information contained in either a consumer report or an investigative consumer report from a consumer reporting agency about you when: (1) considering your application for employment, (2) making a decision whether to offer you employment, (3) deciding whether to continue your employment (if you are hired), or (4) making any other employment-related decisions directly affecting you.

A consumer reporting agency is any person, which, for monetary fees, dues, or on a cooperative nonprofit basis, regularly assembles or evaluates consumer credit information or other information on consumers for the purpose of furnishing consumer reports to others, such as Miller Expedited Freight Co.

A consumer report means any written, oral, or other communication of any information by a consumer reporting agency bearing on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living which is used or expected to be used or collected in whole or in part for the purpose of serving as a factor in establishing your eligibility for employment purposes.

An investigative consumer report means a consumer report or portion thereof in which information on your credit worthiness, credit standing, credit capacity, character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with your neighbors, friends, or associates reported on or with others with whom you are acquainted or who may have knowledge concerning any such items of information.

In the event an investigative consumer report is prepared, you may request additional disclosures regarding the nature and scope of the investigaion requested as well as a written summary of your rights under the Fair Credit Reporting Act.

AUTHORIZATION

By providing an electronic signature at the end of this applicaiton, you hereby voluntarily authorize Miller Expedited Freight Co. to obtain either a consumer report or an investigative consumer report about you from a consumer reporting agency and to consider this information when making decisions regarding your employment at Miller Expedited Freight Co.  You understand that you have rights under the Fair Credit Reporting Act, including the rights discussed above. This report may be delivered in either written or electronic form.

You voluntarily authorize all persons, including current and former employees and supervisors, credit reporting agencies, educational institutions, law enforcement agencies, motor vehicle departments, and municipal state, and federal courts to release information they may have about you to Miller Expedited Freight Co.

You also understand that if you are employed by Miller Expedited Freight Co, this authorization shall remain in effect throughout your employment.

FMCSA Disclosure & Acknowledgement

THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service
In connection with your application for employment with Miller Expedited Freight (“Prospective Employer”), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).
When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address,
and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a
driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.
Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.
Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign,or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.
The Prospective Employer cannot obtain background reports from FMCSA without your authorization.
 

AUTHORIZATION

By providing an electronic signature at the end of this applicaiton, you agree that the Prospective Employer may obtain such background reports.

You further authorize Miller Expedited Freight (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding your commercial driving safety record and information regarding your safety inspection history.

your electronic signature also signifies that you understand that you are authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. You understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding your suitability as an employee.

You further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You understand you may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. You understand your request will be forwarded by the DataQs system to the appropriate State for adjudication. You understand that any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, you acknowledge it will include all CMV crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, you understand all inspections, with or without violations, will appear on your PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on your PSP report.

You acknowledge that you have read the above Disclosure Regarding Background Reports provided to you by Prospective Employer and understand that if you sign this Disclosure and Authorization via electronic signature at the end of this applicaiton, Prospective Employer may obtain a report of your crash and inspection history. You hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

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.L

General Consent for Limited Queries of the Federal Motor Carrier Safety
Administration (FMCSA) Drug and Alcohol Clearinghouse

By providing your electronic signature at the end of this applicaiton, you further hereby provide consent to Miller Expedited Freight, INC.,( MEFI) to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. You understand that if the limited query conducted by MEFI indicates that drug or alcohol violation information about you exists in the Clearinghouse, FMCSA will not disclose that information to MEFI without first obtaining additional specific consent from you. You further understand that if you refuse to provide consent for MEFI to conduct a limited query of the Clearinghouse, MEFI, must prohibit you from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.

By providing your electronic signature at the end of this application, you authorize and request Brands Insurance or any other approved 3rd party vendor to request a copy of your driving record so that you can be considered for employment by Miller Expedited Freight.

You further authorize Brands Insurance to forward a copy of your driving abstract to the insurance company that underwrites the coverage for your potential employer.