In order to process your application, please complete the form below.





Date of Birth:

Social Security Number:

Drivers License State:

Drivers License Number:

Driver Type:

MVR authorization

I hereby authorize Smith Transportation Inc and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or investigative consumer report to be generated for employment purposes. If hired, I understand that this authorization shall be in effect throughout my employment, authorizing Smith Transportation Inc to conduct comprehensive background checks at any time during my employment.

I hereby authorize Smith Transportation Inc to do a complete background investigation in accordance with state and federal laws. I authorize the release of any information, including all information related to my alcohol and controlled substances testing and training records conducted under the FHWA 49 CFR Parts 40,382 or 391, by any former employers and hold them harmless of any liability from the release of said information.

I herby authorize Smith Transportation Inc to conduct an investigation of my accident history for the past 3 years while employed in any position that is safety sensitive as defined by the DOT in the FMCSR Part 391,390 and 382. I also authorize Smith Transportation Inc to perform an inquiry into my driving record for every state in which I have held a vehicle operator’s license or permit in the last 3 years.

I understand that I have the right under FMCSR 390 and 391 to review information provided to Smith Transportation Inc by my previous employers. I also have the right to request that any errors in the provided information are corrected by my previous employer(s) and that the corrected information be re-sent to Smith Transportation Inc. I have the right to have a written rebuttal statement attached to any erroneous information if my previous employer and I cannot come to an agreement and the accuracy of any of the information provided.

I authorize the complete release of these records or data pertaining to me which any individual, company, firm, corporation or public agency may have. I understand that I must provide my date of birth to adequately complete said screening and acknowledge that my date of birth will not affect any hiring decisions.

PSP Authorization

In connection with your application for employment with Smith Transportation, Inc. (“Prospective Employer”), it may obtain one or more reports regarding your driving and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA). If the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. The Prospective Employer cannot obtain background reports from FMCSA unless you consent in writing. If you agree that the Prospective Employer may obtain such background reports, please read the following and mark the correct box below:

I authorize Smith Transportation, Inc. (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am consenting to the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.

I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to http://dataqs.fmcsa.dot.gov. If I am challenging crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forward by the Data Qs system to the appropriate State for adjudication.

I have read the above Notice Regarding Background Reports provided to me by Smith Transportation, Inc. and I understand that if I mark this box with “yes”, Smith Transportation, Inc. may obtain a report of my crash and inspection history. I hereby authorize Smith Transportation, Inc. and its employees, authorized agents, and/or affiliate to obtain the information authorized above.