You are applying for a Non-DOT position (CDL Not Required)
Job Description
Personal Information
The Department of Transportation requires employers to have 3 years of residency information.
If you are applying for a driving position, please complete the following five items.

Education / Training

Military Status

Employment Record
Begin with your present employer and work backward in order, list all employment for at least 10 years.
ALL time must be accounted for including self employment, unemployment, and military service.
If you have no commercial driving experience only go back 5 years.

Personal Reference

A Summary of your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) is designed to promote accuracy, fairness, and privacy of information in the files of every "consumer reporting agency" (CRA). Most CRAs are credit bureaus that gather and sell information about you--creditors, employers, landlords, and other businesses. You can find the complete text of the FCRA, 15 U.S.C. 1681-1681u, at the Federal Trade Commissions web site ( The FCRA gives you specific rights, as outlined below. You may have additional rights under state law. You may contact a state or local consumer protection agency or a state attorney general to learn those rights.
Outdated information may not be reported. In most cases, a CRA may not report negative information that is more than seven years old; ten years for bankruptcies.
Access to your file is limited. A CRA may provide information about you only to people with a need recognized by the FCRA--usually to consider an application with a creditor, insurer, employer, landlord, or other business.
Your consent is required for reports that are provided to employers, or reports that contain medical information. A CRA may not give out information about you to your employer, or prospective employer, without your written consent. A CRA may not report medical information about you to creditors, insurers, or employers without your permission.
You must be told if information in your file has been used against you. Anyone who uses information from a CRA to take action against you--such as denying an application for credit insurance, or employment--must tell you, and give you the name, address, and phone number of the CRA that provided the consumer report.
You may choose to exclude your name form CRA lists for unsolicited credit and insurance offers. Creditors and insurers may use file information as the basis for sending you unsolicited offers of credit or insurance. Such offers must include a toll-free phone number for you to call if you want your name and address removed from future lists. If you call, you must be kept off the lists for two years. If you request, complete, and return the CRA form provided for this purpose, you must be taken off the lists indefinitely.
You can find out what is in your file. At your request, a CRA must giv eyou the informaiton in your file, and a list of everyone who has requested it recently. There is no charge for the report if the person has taken action against you because of information supplied by the CRA, if you request the report within 60 days of receiving notice of the action. You also are entitled to one free report every twelve months upon request if you certify that you (1) are unemployed and plan to seek employment withing 60 days, (2) you are on welfare, or (3) your report is inaccurate due to fraud. Otherwise, a CRA may charge you up to eight dollars.
You may seek damages from violators. If a CRA, a user or (in some cases) a provider of CRA data, violates the FCRA, you may sue them in state or federal court.
You can dispute inaccurate information with the CRA. If you tell a CRA that your file contains inaccurate information, the CRA must investigate the items (usually within 30 days) by presenting to its information source all relevant evidence you submit, unless your dispute is frivolous. The source must review your evidence and report its findings to the CRA. (The source also must advise national CRAs--to which it has provided the data--of any error.) The CRA must give you a written report of the investigation, and a copy of your report if the investigation results in any change. If the CRAs investigation does not resolve the dispute, you may add a brief statment to your file. The CRA must normally include a summary of your statement in the future reports. If an item is deleted or a dispute statement is filed, you may ask that anyone who has recently received your report be notified of the change.
The FCRA give several different federal agencies authority to enforce the FRCA:
For questions concerning or regarding:
Please Contact:
CRAs creditors and others not listed below
Federal Trade Commission Consumer Response Center Washington, DC 20580 202-326-3761 National banks, federal branches/agencies of foreign banks (word "National" or initials "N.A." appear in or after banks name)
Office of the Controller of the
Currency/Compliance Management
Mail Stop 6-6 Washington, DC 20218 Savings associations and federally chartered savings banks (word "Federal" or inistials "F.S.B" appreas in federal institutions name)
Office of Thrift Supervision
Consumer Programs Washington, DC 20552 Federal Reserve System member banks (except national banks, and federal branches/agencies of foreign banks)
State-chartered banks that are not members of the Federal Reserve System
Federal Deposit Insurance Corp.
Division of Compliance and Consumer Affairs
Washington, DC 20429 Federal Reserve Board Consumer and Community Affairs Washington, DC 20551
National Credit Union Administration
Federal credit unions (words "Federal Credit Union" appear in institutions name)
Inaccurate information must be corrected or deleted. A CRA must remove or correct inaccurate or unverified information from its files, usually within 30 days after you dispute it. However, the CRA is not required to remove accurate data from your file unless it is outdated (as described below) or cannot be verified. If your dispute results in any change to your report, the CRA cannot reinsert into your file a disputed item unless the information source verifies its accuracy and completeness. In addition, the CRA must give you a written notice telling you it has reinserted the item. The notice must include the name, address and phone number of the information source.
Air, surface, or rail common carriers regulated by former Civil Aeronautics Board or Interstate Commerce Commission
Department of Transportation
Office of Financial Management
Washington, DC 20590 1775 Duke Street
You can dispute inaccurate items with the source of the information. If you can tell anyone--such as a creditor who reports to a CRA--that you dispute an item, they may not then report the information to a CRA without including a notice of your dispute. In addition, once youve notified the source of the error in writing, it may not continue to report the information if it is, in fact, an error.
Alexandria, VA 22314
Washington, DC 20250

Authorization to Conduct Pre-Employment Reference and Background Checks. In exchange for considering my application for employment, I authorize A&A Tank Truck Co. to investigate my background and job qualifications by contacting any organization or individual I listed on my Application for Employment or resume or mentioned in interviews and obtain from them and from other organizations or individuals mentioned by or obtained from those I listed any relevant information about my background, qualifications, knowledge, experience, skills, abilities, performance, productivity, attitude, attendance, disciplinary action, reasons for termination, and other such information. I also authorize A&A to obtain information from various federal, state, and other agencies, including public and private sources which maintain records concerning my past activities relating to my driving record, credit history, criminal record, civil matters, previous employment, educational background, and other past experiences.
Authorization to Release Information to A&A Tank Truck Co. I consent to and authorize the release of any information about me held or known by my current or former employers, supervisors, and co-workers. I also consent to and authorize the release of information held or known by other organizations or individuals, including schools and educational institutions, professional or business associates, and friends and acquaintances A&A Tank Truck Co. might contact while investigating my background and suitability for employment.
Release of Liability and Waiver of Right to Take Legal Action. I release A&A Tank Truck Co. from any and all liability of any type or nature whatsoever arising out of or relating to its investigation or inquiries conducted pursuant to this Authorization and Release and agree not to file or pursue any complaints, claims, or legal actions of any kind against any organization or individual that provides information about me to A&A Tank Truck Co. or its agents in accordance with the terms and intent of this release. I also agree not to file or pursue any complaints, claims, or legal actions against A&A Tank Truck Co. or any of its employees, representatives, or agents arising out of or relating to their efforts to its investigation or inquiries conducted pursuant to this Authorization and Release.
A telephonic facsimile or photocopy of this Authorization and Release shall be as valid as the original.

Below you will be required to enter an Electronic Signature which WILL BE BINDING AS YOUR ACTUAL SIGNATURE. Your Electronic Signature below indicates your agreement with the following statements:
By typing my name in the following box I certify the above statements to be true and correct, to the best of my knowledge, and that this information can be used for the purpose of processing my employment application and information.