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I authorize you to make such investigations and inquireis of my personal, employment, financial or medial history and other related matters as may be necessary in arriving at an employmnet decision. (Generally, inquireis regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other personal from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that information I provide regbarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

* Review informatioun provided by previous employers;

* Have errors in the information corrected by previouse employers and for those previouse employers to re-send the corrected informatioun to the prospective employer; and

* Have a rebuttal statement attached to the alleged erroneous informatioun, if the previous employer(s) and I cannnot agree on the accuracy of the information.