Safety Performance History Records Request

Section 1: To be completed by prospective employee

Hereby authorize:

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 date of employment application.

Prospective Employer: RD EXPEDITED
Street: 500 W. Plainfield Rd, Suite #300,
City, State, Zip: Countryside, IL 60525
Phone : 708-350-4808

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.

After Signig this document you will redirect to “Declaration of Employment Status” document
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