In connection with my application for employment (including contract for services) with you, I understand that consumer reports which may contian public record information may be requested from DAC services in Tulsa, Oklahoma. These reports may include the following types of information: names and dates of previous employers, reason for termination of employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, bankruptcy proceedings, criminal records, etc., from federal, state, and other agencies which maintian such records; as well as information from DAC concerning previous driving record requests made by opthers from such state agencies and state provided driving records. I also understand that a claims history report may be requested from Great West Casuality Company. This report may include the following information with regard to my driving history, accident dates, state of accident location, and a brief description of the accident.

I AUTHORIZE WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC OR GREAT WEST CASUALTY COMPANY TO FURNISH THE ABOVE MENTIONED INFORMATION.

I have the right to make a request to DAC, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC has previously furnished within the two year period preceding my request. I hereby consent to your obtaining the above information from DAC and I agree that such information which DAC has or abtains, and my employment history with you if I am hired, will be supplied by DAC to other companies which subscribe to DAC services. I also have the right to make a request to Great West Casualty Company, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request.

I hereby authorize procurement of consumer report(s). If hired (or contracted), this authorization shall remain on file and shall serve as ongoing authorization for you to procure consumer reports at any time during my employment (or contract) period.

______________________________________ Print Name	______________________________________ Social Security Number
______________________________________ Applicant's Signature	______________________________________ Date