IMPORTANT NOTICE
REGARDING BACKGROUND REPORTS
FROM THE PSP Online Service
In connection with your application for employment with Carthage Marine Transport or Gubser Trucking,
They may obtain one or more reports regarding your credit, driving, and/or criminal background history
from a consumer reporting agency and/or other sources. If the Prospective Employer uses any information
it obtains from a background report 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 a
background report, the Prospective Employer will notify you that the action has been taken and that the
background report was the reason for the action. The Prospective Employer cannot obtain background
reports from consumer reporting agencies or other sources regarding you unless you consent in writing. If
you agree that the Prospective Employer may obtain such background reports, please read the following
and sign below:
I authorize Carthage Marine Transport or Gubser Trucking to contact any organization or individual that I
have listed on my employment application or resume or mentioned in job interviews and obtain from them
any relevant information about my job qualifications, including my experience, skills, and abilities. 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, as well as any
reference-related information about me held or known by my former employers, supervisors, and
co-workers. In addition, I consent to the release of any information about my education, experience,
abilities, or work-related characteristics or traits held or known by other organizations or individuals,
including schools and educational institutions, professional or business associates, and friends and
acquaintances that Prospective Employer might contact in the course of conducting a reference check or
background investigation of my suitability for employment.
I understand and acknowledge that this release of information can involve my qualifications, performance,
credentials, or other characteristics or factors affecting my suitability for employment with Prospective
Employer. Specifically, I am authorizing the release of any information about my performance, experience,
capability, attitude, specific events, or other work-related characteristics that currently are in the
possession of the requested organizations or their managers or representatives.
In exchange for Prospective Employer's consideration of my employment application, I agree not to file or
pursue any complaints, claims, or legal actions of any kind against any organization or individual that
provides work-related information about me to Prospective Employer or its agents in accordance with the
terms and intent of this release. 1 also agree not to file or pursue any complaints, claims, or legal actions
against Prospective Employer or any of its employees, representatives, or agents arising out of their
efforts to obtain work-related information about me.
I have read the above Notice Regarding Background Reports provided to me by Prospective Employer
and I understand that if I sign this consent form, Prospective Employer and/or any entity it retains to obtain
such background reports may obtain reports of my credit, driving, and/or criminal background history in
addition to information regarding my background, references, education, specific events, and past
employment.
1 hereby authorize Carthage Marine Transport or Gubser Trucking and its employees, agents, and
affiliates to obtain the information authorized above.
Date:___________________
Signature ______________________________
Name (Please Print) ________________________________
NOTICE: The information contained herein is made available to monthly account holders by NICT solely
for use as an example of template content. NICT assumes no legal liability or responsibility for the
accuracy, completeness or currency of the information disclosed in this example. The intent of the
template example is to illustrate for a monthly account holder an example of a driver consent form, but all
monthly account holders and third party information providers should consult their own legal counsel with
respect to the proper format and content of this notice.