SAFETY RECORD REQUEST
Request for General and Safety Performance History Records from
By filling out this form you release the following information to H&H Express Inc. and its ASSIGNEES for the purpose of investigations as required by Parts 390, 391, 382, and 40 of the Federal Motor Carrier Safety Regulations. This includes the release of all safety performance history information, as well as specific information requested below in reference to drug and alcohol testing within the last three years, including information you may have from previous employers. You are released from any and all liability, which may result from furnishing such information. Thank you for your cooperation.
TO BE COMPLETED BY APPLICANT
TO BE COMPLETED BY PREVIOUS EMPLOYER
* If answering the Drug and Alcohol History questions, include any required DOT drug and alcohol testing information obtained from previous employers in the previous 3 years prior to the application date.
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