Rd Expedited Hiring

Safety Performance History Records Request


Safety Performance History Records Request

Section 1: To be completed by prospective employee

I (Print Name)
 
First, M.I., Last
Social Security Number
Date of Birth

Hereby authorize:

Previous Employer:
 
Telephone:
 
Street:
 
Fax No.:
 
City, State, Zip:
 

To release and forward the information requested by section 3 of this document concerning my Alcohol and

Controlled Substance Testing records within the previous 3 years from
 
to
 
 
(date of employment application)

Attn:
 
Phone:
 

Prospective Employer: RD EXPEDITED INC
Street: P.O. BOX 328
City, State, Zip: Lyons, IL, 60534
Fax : (708)496-6500

In compliance with §40.25(g) and 391.23(h), release of this information must be made in a written form that ensures confidentiality , such as fax, letter or e-mail.

Leave this empty:

Rd Expedited Hiring http://rdexpedited.net/hiring
Signature Certificate
Document name: Safety Performance History Records Request
Unique Document ID: 279f34f16bb0246c6bca84e02969a72fd64f7c29
Timestamp Audit
2016-08-13 08:18:25 CSTSafety Performance History Records Request Uploaded by Radomir Dobrasinovic - recruiting@rdexpedited.net IP 178.149.250.135