First Name*
Last Name*
Date of birth*
Last 4 of SSN#*
Phone*
Email*
Experience*
CDL#*
CDL State*
Current Address*
Have you ever been convicted of a felony or DUI?* YesNo
How Did you hear about our company?* FacebookInternetEmailReferenceOther
Have you ever tested positive for a pre-employment or Random Drug or Alcohol test in the past two years?* YesNo
I hereby authorize LEMBERG GROUP INC (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am 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. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.
I hereby authorize LEMBERG GROUP INC (“Prospective Employer”) to obtain reports verifying your previous employment, previous drug and alcohol test results, and your Driving Motor Vehicle Report (“MVR”). These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations. Prior to taking any adverse action based in whole or in part on the report(s), you will be provided a copy of the report(s) and a description of your rights under Section 606 of the Federal Fair Credit Reporting Act, 15 USC § 1681d.
