I hereby authorize the release of all records of employment including assessments of job performance, ability and character, work habits, traffic offenses, accident history, credit, experience and reason for termination.  Additionally, pursuant to FMCSR Part 382, I authorize the release of all records regarding prior controlled substance and/or alcohol tests.  This includes any refusals to be tested from any company for which I performed a safety sensitive function or for which I took a pre-employment controlled substance and/or alcohol test during the preceding five (5) years, and any other information that is contained in the records of DAC Services (USIS), Tulsa, OK.  I hereby release Opies Transport, Inc., my previous employers, and DAC Services (USIS) from any liability that might arise from the release of the aforementioned information.

 I understand that I have the right to review information provided by previous employers, have errors corrected by previous employer and resubmitted to Opies Transport Inc. and/or have a rebuttal statement attached to erroneous information if my previous employer and I cannot agree on the accuracy of the information.  I understand that I must request past employer information obtained by Opies Transport Inc. in writing within 30-days of employment or denial of employment.

Applicant Signature: X                                                                           Date:___/__/___               

Applicant Name:_________________________________________SS#____________________________________

 Applicant please print, sign and fax to:  573-392-2284  Attn: Corby