Carriage House Plans: Fmcsr

Saturday 8 December 2012

Fmcsr

In connection with you application for a leased contractor with Clark Transfer, Inc. (“Prospective Lessee”), it

may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). If the Prospective Lessee uses any information it obtains from FMCSA in a decision to not offer you a lease or make any other adverse leasing decision regarding you, the Prospective Lessee 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 Lessee will notify you that the action has been taken and that the action was based in part or in whole on this report. The Prospective Lessee cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Lessee may obtain such background reports, please read the following and sign below:

I authorize Clark Transfer, Inc (“Prospective Lessee”) 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 consenting to 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 Lessee to make a

determination regarding my suitability as a Leased Operator.