Starting with your current/last employer, please list each job held, including part time, summer or temporary employment and military service (include rank and date of discharge). Even if you are submitting a resume is attached, you will still need to complete this section. Note: If you have driven a commercial vehicle* in intrastate or interstate commerce you must provide 10 years of employment information on those employers for you operated such vehicle.
This release is in accordance with regulation FMCSA Part 391.23, Investigation and Inquiries. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests durign the past three years:
I, the undersigned, herby consent and authorize Southeast Food Distribution, its affiliated companies and/or its agents (collectively herein after referred to as "the Company") to obtain information about me from a consumer reporting agency for employment purposes. I understand that this means that a "consumer report" and/or an "investigative consumer report" may be requested which may include information regarding my character, general reputation, personal characteristics and mode of living, whichever are applicable. The report may also contain information relating to my criminal history, credit history, motor vehicle records such as a driving records, social security verification, verification of education or employment history or other background checks. This may involve personal interviews with sources such as neighbors, friends or associates. These reports may be obtained at any time after receipt of my authorization, and if I am hired, throughout my employment. I understand I have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report to e-Verifile, 900 Circle 76 Parkway, Suite 1550, Atlanta, GA 30339 - 770-859-9899. For information about e-Verifile's privacy practices see www.e-verifile.com. The scope of this notice and authorization is not limited to the present and, if hired, will coninue to allow the Company to conduct future screenings for retention, promotion or reassignment unless revoked by me in writing. The Company also reserves the right to share background investigation results with any third-party companies for whom I will be placed to work with as a representative of the Company. My information will only be used and/or disclosed as permitted by law and as required for creation of any report(s).
I HEREBY CERTIFY THAT THIS FORM WAS COMPLETED BY ME, THAT THE INFORMATION PROVIDED IS TRUE AND CORRECT AS OF THE DATE HEREOF AND I AUTHORIZE E-VERIFILE TO OBTAIN A CONSUMER REPORT AND/OR INVESTIGATIVE CONSUMER REPORT ON ME, AS APPLICABLE. I acknowledge that the Company has provided with a copy of A Summary of Your Rights Under the Fair Credit Reporting Act.
New York applicants or employees onlyYou have the right to inspect and receive a copy of any investigative consumer report requested by the Company by contacting e-Verifile directly. You also acknolowedge receipt of a copy of Article 23-A of the New York Correction Law by signing above.
CA, MN, OK applicants or employees onlyI understand that if the Company requests a copy of my consumer report for employment purposes, I have the right under California, Minnesota and Oklahoma law to receive a copy of that consumer report from the Company free of charge. I understand that by checking "yes" below, a copy will be provided to me at the address I provide above.
*Note: Date of Birth and Gender information are required for identification purposes only, and are in no manner used as qualifying for joining the Company.