READ AND SIGN THE STATEMENT BELOW
BY MY SIGNATURE BELOW, l AUTHORIZE YOU TO CONDUCT SUCH INVESTIGATIONS AND INQUIRY OF MY PERSONAL EMPLOYMENT, MEDICAL, DRIVING, ACCIDENT/INJURY, AND SUBSTANCE ABUSE TESTING REPORTS FROM MY CURRENT (IF CHECKED ABOVE) AND PREVIOUS EMPLOYERS AS MAY BE NECESSARY TO ARRIVE AT A QUALIFICATION DECISION. I UNDERSTAND THAT ANY OMISSSION OF INFORMATION OR MAKING FALSE A STATEMENT ON THIS OR ANY OTHER HIRING DOCUMENT CAN AND WILL LIKELY MEAN THAT I WILL NOT BE ALLOWED TO CONTINUE THE PROCESS. l ALSO UNDERSTAND THAT SHOULD I BE ALREADY WORKING UNDER THE DIRECTION OF CALCASIEU RENTALS WHEN SUCH OMISSION OR FALSE STATEMENT IS UNCOVERED, l MAY BE TERMINATED IMMEDIATELY, FOR CAUSE.
Employment Record
List employers, starting with the most recent, working backwards. LEAVE NOTHING BLANK. The employer is the company who paid you and issued a w-2 or 1099 at the end of the year. If you did not work between employers, list those gaps in time by filling out a section with the word “unemployed” for Company Name. CDL drivers must list all driving history for previous 10 years.
Accident Dates, Location, Name of Accident: (Such as Fatalities, Injuries, Violation)
Date of violation, Location Type of Violation: (If no violations enter none and do not list parking violations.)
Certification & Release
BY MY SIGNATURE BELOW, l AUTHORIZE YOU TO CONDUCT SUCH INVESTIGATIONS AND INQUIRY OF MY PERSONAL EMPLOYMENT, MEDICAL, DRIVING, ACCIDENT/INJURY, AND SUBSTANCE ABUSE TESTING REPORTS FROM MY CURRENT (IF CHECKED ABOVE) AND PREVIOUS EMPLOYERS AS MAY BE NECESSARY TO ARRIVE AT A QUALIFICATION DECISION. I UNDERSTAND THAT ANY OMISSSION OF INFORMATION OR MAKING FALSE A STATEMENT ON THIS OR ANY OTHER HIRING DOCUMENT CAN AND WILL LIKELY MEAN THAT I WILL NOT BE ALLOWED TO CONTINUE THE PROCESS. l ALSO UNDERSTAND THAT SHOULD I BE ALREADY WORKING UNDER THE DIRECTION OF CALCASIEU RENTALS WHEN SUCH OMISSION OR FALSE STATEMENT IS UNCOVERED, l MAY BE TERMINATED IMMEDIATELY, FOR CAUSE.