MAG CARRIERS, LLC APPLICATION FORM
TO BE READ AND SIGNED BY APPLICANT
I authorize MAG Carriers, LLC to make such investigations and inquiries of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be make only if and after a conditional offer of independent contractor’s lease or employment has been extended.) I hereby release employers, schools, health care providers and other persons for all liability in responding to inquiries and releasing information in connection with my application. In the event of obtaining an independent contractor’s lease or employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company and FMCSRs (Federal Motor Carrier Safety Regulations). I understand that information I provide regarding current and/or previous employment may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand I have the right to:
➢ Review information provided by previous employers.
➢ Have errors in the information corrected by previous employers to re-send the corrected information to the prospective employers; and
➢ Have a rebuttal statement to the alleged erroneous information if the previous employer(s) and I cannot agree on the accuracy of the information.
PAST FIVE YEAR RESIDENCY