To:___________________________________________________________________________________
        (Former Employer - Name, City, State)                                                                    (Date, Time)

I hereby authorize this company to release all records of employment, including assessments of my job performance, ability, and fitness (including dates of any and all alcohol or drug tests, those confirmed results and/or my refusal to submit to any alcohol or drug tests and any rehabilitation completion under direction of SAP/MRO) to each and every company (or their authorized agent) which may request such information in connection with my application for employment with said company. I hereby release this company, and its employees, offices, directors, and agents from any and all liability of any type as a result of providing the following information to the below mentioned person and/or company.

__________________________________________ (Applicant's signature, date)

__________________________________________ (Witness's signature, date)

Dear Personnel Manager:
The person named herein has applied to this company for employment in a safety-sensitive position. Your firm is listed by the applicant as a past employer. Will you kindly reply to this inquiry respecting this applicant. As you will note from the waiver statement above, all liability to you and your company has been released by the applicant. PLEASE BE FACTUAL. You may reply by fax to the number listed above. If this form was mailed to you, we have enclosed a self-addressed, stamped envelope for your convenience in replying by return mail.

Name of Applicant:_____________________________     Social Security Number: _______________________
Job Applying for: ___________________________________________
Did the applicant work for you as a _________________________   From ________   To ________  YES or NO
If no, please explain________________________________________________________
If employed as a driver, please answer the following:
    Company Driver?_____, Owner/Operator?______, Other?____________________
    Type of tractor operated________________________   Type of trailer pulled_____________________________
    Other Equipment___________________________   Commodities transported____________________________
    General area of operation__________________________  Accidents? YES or NO   If yes, dates and descriptions     ______________________________________________________________________________________
    Traffic Violations YES or NO     If yes, list all date and types ________________________________________
    License suspended? YES or NO     If yes, list dates of suspension____________________________
    Type of driver license______________ State_____ No________________
    Any problems with bonding? YES or NO     If yes, please explain _________________________________________     Why did this employee leave your company? __________________________________________
    Would you re-employ this person? YES or NO  If no, please explain _____________________________________
DATES OF DRUG AND ALCOHOL TEST PREVIOUS 2 YEARS
    1. Resulting in a confirmed positive result- Drug_________ Alcohol___________
    2. Applicant Driver refused to submit to testing- Drug_________ Alcohol___________
    3. Alcohol tests with a result of .04 or greater alcohol concentration____________
Additional Comments (Any problems with customer relations, supervision, or abuse of equipment?) _________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Name/Title (Person providing information)__________________________________________ Date _________