To Be Read and Signed by Applicant
I affirm that the information I have provided in this application is true to the best of my knowledge, information and belief, and I
have not knowingly withheld any information requested. I understand that withholding or misstating any information requested in
this application is grounds for rejection of my application, and that providing false or misleading information in this application is
grounds for discharge.
I authorize the company to verify my record of employment and any other information I have provided. Unless otherwise noted, I
authorize the references I have listed to disclose any information related to my work record and my professional experiences with
them, without giving me prior notice of such disclosure. In addition, I release the company, my former employers and all other
persons and entities, from any and all claims, demands or liabilities arising out of or in any way related to such inquiry or disclosure.
Nebraska is an “Employment at Will” state meaning any employee can be dismissed at any time for any reason.
Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor
Carrier Safety Regulations.