TO BE READ AND SIGNED BY APPLICANT


This certifies that this application was completed by me, and that all entries on it and the information in it are true and complete to the best of my knowledge.  


I authorize MNH Truck Leasing Co., LLC to make such investigations and inquiries of my personal, employment and financial or medical history, and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended.)  


I hereby release employers, schools, healthcare providers and other persons from all liability in responding to inquires and releasing information in connection with my application.  


In the even 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 MNH Truck Leasing Co., LLC.


FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT.


In accordance with the provisions of Section 604(b) (2) (A) of the Fair Credit Reporting Act, Public Law 91-509, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying you previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes.  These reports are required by Sections 382.413, 391.23, and 391.225 of the Federal Motor Carrier Safety Regulations.  


MNH Truck Leasing Co., LLC reserves the right to run any and all of the above reports at random throughout the course if your employment.


THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS

IMPORTANT DISCLOSURE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

In connection with your application for employment with MNH Truck Leasing Co., LLC ("Prospective Employer''), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the  Federal Motor Carrier Safety Administration (VMCSA).

When the application for employment is submitted in person, if the prospective Employer uses any information it obtains from FMCSA in a decision to not  hire you or to make any other  adverse employment  decision regarding you, the Prospective Employer 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 Employer will notify  you that the action  has been taken and that the action was based in part or in whole on this report.

When the application for employment is submitted by mail, telephone, computer, ot other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you,  the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification; that adverse action has been taken based in whole o rin part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report.  If you request a copy of a driver record from the Prospective Employer who procured the report, then, within three business days of receiving you request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.

Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect.  You may challenge the accuracy of the data by submitting a request to   https://dataqs.fmcsa.dot.gov.  If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data.  Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or a co-driver and where those crashes were reported to FMCSA, regardless of fault, similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Vehicle Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a  PSP report.
The Prospective Employer cannot obtain background reports from FMCSA without your authorization.


AUTHORIZATION

If you agree that the Prospective Employer may obtain such background reports, please read the following and sign above:

I authorize MNH Truck Leasing Co., LLC (“Prospective Employer”) to access the FMCSA Pre Employment Screening Program (PSP) system to see 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 further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect.  I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov.  If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data.  Your request will be forwarded by the DataQs system to the appropriate State for adjudication.

I understand that any crash or inspection in which I was involved in will display on my PSP report.  Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was the driver or Co-driver and where those crashes were reported to FMCSA, regardless or fault.  Similarly, I understand all inspections, with or without violations will appear on my PSP report, and State citations associated with FMCSA violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.  I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employers and I understand that if I sign this Disclosure and Authorization, Perspective Employer may obtain a report of my crash and inspection history.  I hereby authorize Perspective Employer, authorized agents, and/or affiliates to obtain the information authorized above. 

11480 W Township Rd 116, Fostoria, OH, 44830 United States

MNH Truck Leasing Co., LLC

A Transportation and Logistics Company

419.894.6170     MNHDISPATCH@mnhtruck.com