IMPORTANT DISCLOSURE REGARDING
                                    BACKGROUND REPORTS FROM THE PSP Online Service
                            
In connection with your application for employment with Emr Express, Inc. 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 (FMCSA).
   
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, or 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 or in 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 3 business days of receiving your 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 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 Carrier 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 below:    
 I authorize Emr Express, Inc. 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 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. I understand my 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 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 a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR 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 Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.

NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.LAST UPDATED 12/22/2015    

 This Disclosure & Release along with any pre-screening and applicant forms are being submitted solely for the purpose of consideration for employment with EMR EXPRESS, INC. (hereafter referred to as the company). It is agreed and understood that any misrepresentation of information given herein shall be considered an act of dishonesty, and be cause for disqualification or discharge.    

It is agreed and understood that the company or its agents LISTED BELOW (ALSO REFERRED TO AS AGENTS) including EMR EXPRESS, INC. may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is on record or not, and applicant releases employers and persons named herein from all liability for any damages on account of furnishing such information. It is agreed and understood that this is not a contract. The applicant agrees to furnish such additional information and complete such examinations as may be required to complete their file. It is agreed and understood that this application in no way obligates the company to hire the applicant. It is agreed and understood that if hired the applicant will be on a probationary period of 90 days during which time they may be discharged without recourse.    

I understand that any offer of hire is contingent on my ability to produce documentation to verify my identity and legal authorization to work in the U.S. as required by law. The company is an equal opportunity employer and a Drug Free Workplace. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete and correct to the best of my knowledge.    

Additionally I, having made application to the company as a commercial motor vehicle driver, and desiring that they may be informed by investigation of past records and reports for verification of facts, do hereby release employers and past employers, the agents, and all persons whomever, from any present or future liabilities of any type resulting from the provision of such information to the company. I understand that such records and reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc. I authorize without reservation, any party or agency contacted by the company, its agents to furnish the above mentioned information. I understand that if hired my duties will include all duties normally associated with being a professional truck driver and driving a commercial motor vehicle.    

It is understood that I have the right to request from the agents (upon proper identification) the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which the agents has previously furnished within the three year period preceding my request. I hereby consent to the company, its agents including EMR EXPRESS, INC., obtaining the above information from the agents or any other source. I understand and consent that my employment history with the company if hired will be supplied to one or more of the agents. I hereby authorize procurement of consumer reports. I acknowledge that I have been provided with the Summary of Rights form under the Fair Credit Reporting Act, provided by the Consumer Reporting Agent (s) listed below. If hired this authorization shall remain on file and shall serve as ongoing authorization for the company and its agents to procure consumer reports at any time during my employment period.    

 I hereby acknowledge that I have been properly notified that I must submit to DOT mandated alcohol and controlled substance tests (Federal Regulation, 49 CFR 382.113) and furthermore authorize designated MROs to release to the company and its agents my test results. In addition I consent to and authorize the company and its agents to obtain alcohol and controlled substances test results information from my past employers. I hereby authorize all of my former employer(s) (in accordance with 49 CFR 382.405 & 382.413) to release and forward all information on my alcohol and controlled substances test records to the company and its designated agents.

 INCLUDE YOUR CONTACT INFO IN THE EMAIL TO SPEED UP THE APPLICATION PROCEDURE.