Owner Operator Application

Official Disclosure Statement:

I certify that I personally completed this application and that all the information is true and correct to the best of my knowledge

Authorization to Release Records:

I authorize the carrier subscribers indicated on this application to do a
complete background investigation in accordance with state and federal laws. I authorize my previous employers to release any information requested by these carrier subscribers and hold them harmless of all liability from the release of said information. I hereby request and authorize to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to
my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of information. I have completed
this application of my own free will and hold harmless of all liability all companies, agents, and associated parties for the use of this application.

PSP Release Consent

I authorize Mid Group Transportation Inc (“Prospective Employer”) 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.

Fair Credit Reporting Act Disclosure Statement

I hereby authorize the prospective employer listed below, in connection with my application for employment, or my continuing employment, to obtain the reports verifying my previous employment, previous drug and alcohol test results and my driving records.

MVR Release Consent

In conjunction with my potential employment at Mid Group Transportation Inc (“The Company”), I consent the release of my Motor Vehicle Records (MVR) to the company. I understand the company will use these records to evaluate my suitability to fulfill driving duties that may be related to the position for which I am applying. I also consent to the review evaluation, and other use of any MVR I may have provided to the company.