Full Name (Please Print)                                                                                  

I certify that I personally completed this application and that all of the information is true and correct.  I authorize Harris Quality Inc., to do a complete background investigation in accordance with state and federal laws.  I authorize my previous employers to release any information requested by Harris Quality Inc., and hold them harmless of all liability from the release of said information.

    Signature:__________________________________________ XX SIGN HERE

Driver Consent & Release Statement

A.
In connection with my application for employment with Harris Quality Inc., I understand that consumer reports may contain public record information that may be requested from DAC Services of Tulsa Oklahoma.  These reports may include the following types of information:  names, dates of previous employers, reason for termination of employment, work experience, accidents, etc.
I authorize without reservation, any party or agency contacted by DAC to furnish such information.  I hereby authorize procurement of consumer report(s).  If hired, this authorization shall remain on file and shall serve as ongoing authorization for Harris Quality Inc., to procure consumer reports at any time during my employment period.

B.  Drug/Alcohol Testing
In accordance with FMCSR's regulations we are therefore, providing you with the driver's written authorization directing your company to provide Harris Quality Inc., with the following information:
1)  All positive/negative drug results during the past three (3) years;
2)  All alcohol test results 0.04 or greater during the past three (3) years;
3)  All instances which a driver refused to submit to a DOT drug and/or alcohol test during the past three (3)  years;
4)  Rehab completed under the direction of SAP/MRO

C.  Work History
The above named driver has applied for a driving position with Harris Quality Inc., in a Safety-Sensitive position:

Statement of Release.

I herby certify that I personally completed this form, and that the information is true, correct, and complete to the best of my knowledge. In accordance with Section 391.23 of the Federal Motor Carrier Safety Regulations I authorize Harris Quality Inc. or their agent to obtain information relating to my past or present work history and to do a complete background investigation in accordance with state and federal laws. Furthermore, I give my express consent for any previous employer, their agent, or medical review officer or their agent to release information concerning any of my past controlled substance test and training records, by any former employers and hold them harmless of any liability from release of said information .

I understand that I have the right to review information provided by previous employers, have errors corrected by previous employer and resubmitted to Harris Quality Inc. and/or have a rebuttal statement attached to erroneous information if my previous employer(s) and I cannot agree on accuracy of information. I understand that I must request past employers information by Harris Quality Inc. in writing within thirty (30) days of my application.

Signature:                                                       Date:                                   X SIGN HERE