DISCLOSURE AND RELEASE

This Disclosure & Release along with any pre-screening and applicant forms are being submitted solely for the purpose of consideration for employment with Cadence Premier Global (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 the agents) including Cadence Premier Logistics 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 Cadence Premier Logistics, 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.

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Name
Date *
Date
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Agents