DISCLOSURE FOR CONSUMER REPORTS
In connection with your employment or owner-operator (independent contractor) application, iStanDrive Recruiting Service may order one or more consumer report(s) (commonly known as "background reports" or "background checks") about you from one or more consumer reporting agencies. If you are hired or engaged as an owner-operator (independent contractor), additional consumer reports may be obtained in connection with and throughout your employment for employment purposes or for the legitimate business purpose of evaluating you as an owner-operator.
To the extent allowed by law, the consumer reports may include information concerning your character, general reputation, personal characteristics, mode of living, drug and alcohol test results, motor vehicle records, driving records, criminal history, public court records, employment history (including names and dates of previous employers, reason for termination of employment, work experience, and accidents), social security number validation, education, licensure, or verification of other information supplied by you. Such reports may be obtained from private and public record sources, including sanctions databases, CDLIS (including but not limited to CDLIS Central Site, CDLIS Master Pointer Record data and your driver record from the jurisdiction identified in the CDLIS data, in accordance with applicable state law and the Driver Privacy Protection Act), former employers, public court records, and federal, state, and other government agencies that maintain such records.
AUTHORIZATION FOR CONSUMER REPORTS
I authorize iStanDrive Recruiting Service to obtain one or more consumer report(s) or investigative consumer report(s) about me. If hired or engaged as an owner-operator (independent contractor), I understand this authorization shall remain on file and shall serve as ongoing authorization for additional consumer reports or investigative consumer reports to be obtained from any consumer reporting agency at any time during my employment or contract period without asking me for authorization again.
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DISCLOSURE AND AUTHORIZATION UNDER 49 C.F.R. PART 391.23 INCLUDING DOT DRUG AND ALCOHOL INFORMATION
For purposes of an investigation in accordance with 49 C.F.R. Part 391.23, I authorize my previous employers, contractors (if owner-operator), and trucking schools, as applicable, to release and forward to iStanDrive Recruiting and transportation services the following information for the past three (3) years:
1. DOT alcohol and controlled substance information in accordance with Parts 382 and 40 of the Federal Motor Carrier Safety Regulations (49 CFR Part 382 and 49 CFR Part 40, Section 40.25) limited to the following DOT regulated testing items, including pre-employment testing results: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested; (iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation.
2. Safety performance history information in accordance with 49 CFR Part 391.23, which includes: employment dates, work history (which may include position held, reason for leaving, any termination information, whether subject to the Federal Motor Carrier Safety Administration regulations, equipment experience, area driven, and other information as applicable) and accident information (including accident date, nature of accident, whether it was preventable, whether there were injuries, fatalities, or hazardous materials involved, and copies of any accident report).
Pursuant to Section 391.23(i) of the Federal Motor Carrier Safety Regulations, you have the following rights with regard to the information released:
1. You have the right to make a written request at any time to review the information provided by previous employers, contractors (if owner-operator), or trucking schools, as applicable.
2. You have the right to have errors in the information corrected by the previous employer, contractor (if owner-operator), or trucking school, as applicable and for that employer, contractor (if owner-operator), or trucking school to re-send the corrected information.
3. You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer, contractor (if owner-operator), or trucking school and you cannot agree on the accuracy of the information.
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Driving Record
Release of Interest
Employers, prospective employers, volunteer organizations, or their agent can get driving records for an employee, prospective employee, or volunteer when authorized. Use this form to get their authorization.
- Complete the Company section.
- Give this form to your employee, prospective employee, or volunteer to complete their section.
- For audit purposes, keep this completed form in your files for at least five years. Do not mail it to the Department of Licensing.
Sealed juvenile records. Information contained in a driving record related to a sealed juvenile record may not be used for any purpose unless required by federal law. The employee or prospective employee may furnish a copy of the court order sealing the juvenile record to the employer, prospective employer, or their agent.
Company - To be completed by the company or the agent of the company
PRINT or TYPE Company Name
iStanDrive Recruiting and transportation services
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Agent company name (if applicable)
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Company/Agent company address
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Authorized representative name
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Title
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Certification
I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.
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| Date and place signed |
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Authorized representative signature |
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Employee, prospective employee, or volunteer - Complete this section and return the form to the company
RCW 46.52.130
DSC-425-020 (R/5/19)WA
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Robert L. Quinn
Commissioner of Safety
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State of New Hampshire
DEPARTMENT OF SAFETY
DIVISION OF MOTOR VEHICLES
STEPHEN E. MERRILL BUILDING
23 HAZEN DRIVE, CONCORD, NH 03305
Telephone: (603)227-4000 TDD Access Relay NH 7-1-1
RELEASE OF MOTOR VEHICLE RECORDS
FORM DSMV 505 (Rev. 9/2020)
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Elizabeth A. Bielecki
Director of Motor Vehicles
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| DRIVER information: |
REGISTRATION information: |
TITLE information: |
TICKET, ACCIDENT OR COURT information: |
OTHER information: |
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Check ONE of the three boxes below:
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I AM THE RECORD HOLDER OR VEHICLE OWNER of the above documents I am seeking.
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I AM NOT THE RECORD HOLDER, but the record holder has approved this request and has had their signature notarized in Step 4. The requestor may NOT be the Notary or Justice of the Peace.
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I AM NOT THE RECORD HOLDER but I am a member of a bank or lienholder, a tow company, a private investigator licensed by this state, an employer, an insurance company, a public utility, or a law firm/lawyer, all pursuant to RSA 260:14. If checking this box, you must disclose what you intend to use this information for. You must also submit a Certificate of Authority, or a current one must be on file at the DMV (see Step 5 for both requirements). |
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Whose information are you looking for (the record holder's information)? *Required information
Full name (include hyphen if applicable):
*Date of birth:
Last known address:
Driver license or ID #:
- - - - - - - - - - - - - - - - OR - - - - - - - - - - - - - - - -
Plate or Bow #: ______________________________________
Vehicle or Boat Identification Number (VIN/HIN):
_________________________________________________________
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*Required information
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| *Your full name: |
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Your phone number: |
( ) - |
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(Be sure to include hypen if applicable.) |
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| *Mailing address: |
Street/PO Box |
City/Town |
State |
Zip |
If Applicable:
| Company name: |
iStanDrive Recruiting and transportation services |
NHB#: |
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Prepaid account # |
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This acknowledgement is required to be signed by the record holder ONLY if the record holder is authorizing someone else to get the requested information.
If the requestor is asking for his/her own information, this section DOES NOT need to be completed, and you may proceed to Step 6.
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I am the record holder and I authorize my record to be released to the requester listed in Step 3:
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Date: |
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| Signature of record holder |
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| State of |
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, County Of |
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,ss. Date: |
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| The above named personally appeared and made oath that the above declaration by him/her is true. |
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| Notary Public / Justice of the Peace |
Commission Expires |
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To be completed only if you are a member of a bank or lienholder, a tow company, a private
investigator licensed by this state, an employer, an insurance company, a public utility, or a law
firm/lawyer, all pursuant to RSA:14 (see sections below).
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For use in connection with any civil, criminal, administrative or arbitral proceeding
. [RSA 260:14, V(a)(2)].
Docket#:_________________________ Court:___________________________________
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By a bank or similar institution to verify the accuracy of personal
information submitted by the individual to the bank [RSA 260:14, V(a)(3)].
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For providing notice to the owner(s) of a towed or impounded vehicle
[RSA 260:14, V(a)(5)].
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For providing notice to the owner(s) for storage or a Mechanic's Lien
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For use by any private investigative agency or security service licensed by
this state for any purpose permitted pursuant to RSA 260:14, V(a), other than for bulk
distribution for surveys, marketing or solicitations pursuant to RSA 260:14 V(a)(8).
Indicate specific reason here: _________________________ [RSA 260:14, V(a)(6)].
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By an employer or its agent or insurer to obtain or verify information relating
to a holder of a commercial drivers license [RSA 260:14, V(a)(7)].
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By a public utility to perform its public service obligation provided the
individual has given their express consent [RSA 260:14, V(a)(9)].
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For an insurance company or its authorized agent [RSA 260:14, IV(a)(2)].
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For use by a life insurance company authorized to write life insurance
policies, or its authorized agent. In checking this, I represent that the named person's
written consent to the release of the record has been obtained and that the record will be
used solely in connection with claims investigation, rating and underwriting.
[RSA 260:14, V(a)(6)].
Initial here: ___________
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- Must be on company letterhead.
- Must list the types of DMV documents you want.
- Must state what you intend to do with the DMV documents named.
- Must name employees who may make requests in person/mail for your company, if any.
- Must be signed by the attorney/owner/principal.
- The NH DMV must have a new C.O.A. each calendar year. All expire december 31st.
- All requests requiring a C.O.A. must be completed at Concord DMV.
- A requestor may not sign or authorize their own C.O.A.
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RSA 260:14, IX states as follows: (a) A person is guility of a misdemeanor if such person knowingly
discloses information from a department record to a person known by such person to be an unauthorized
person; knowingly makes a false representation to obtain information from a department record; or
knowingly uses such information for any use other than the use authorized by the department. In
addition, any professional or business license issued by this state and held by such person may, upon
conviction and at the discretion of the court, be revoked permanently or suspended. Each such
unauthorized disclosure, unauthorized use or false representation shall be considered a seperate offense.
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RSA 260:14, IX states as follows: (a) A person is guility of a misdemeanor if such person knowingly
discloses information from a department record to a person known by such person to be an unauthorized
person; knowingly makes a false representation to obtain information from a department record; or
knowingly uses such information for any use other than the use authorized by the department. In
addition, any professional or business license issued by this state and held by such person may, upon
conviction and at the discretion of the court, be revoked permanently or suspended. Each such
unauthorized disclosure, unauthorized use or false representation shall be considered a seperate
offense.
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Signature of requestor:
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Date:
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- Mail: NH DMV, 23 Hazen Drive, Concord NH 03305 (Please indicate "DSMV 505"
on the envelope).
- In Person: You are required to bring photo identification that has not been
expired for more than 3 years.
- Payment: Please make checks payable to: "State of NH - DMV."
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iStanDrive Recruiting and transportation services will order an 'investigative consumer report' concerning you for employment purposes or, if you are an owner-operator (independent contractor), for the legitimate business purpose of evaluating your suitability for an independent contractor engagement pursuant to your written instructions.
An 'investigative consumer report' is defined as a consumer report or portion thereof in which information on a consumer's character, general reputation, personal characteristics, or mode of living is obtained through personal interviews with neighbors, friends, or associates of the consumer reported on or with others with whom he is acquainted or who may have knowledge concerning any such items of information.
The investigative consumer report the Company will order concerning you will contain information concerning your character, general reputation, personal characteristics, and mode of living, obtained through personal interviews.
You have the right to request the additional disclosures provided for under the Fair Credit Reporting Act, 15 U.S.C. 1681d(b), which reads as follows:
Any person who procures or causes to be prepared an investigative consumer report on any consumer shall, upon written request made by the consumer within a reasonable period of time after the receipt by him of the disclosure required by subsection (a)(1) of this section, make a complete and accurate disclosure of the nature and scope of the investigation requested. This disclosure shall be made in a writing mailed, or otherwise delivered, to the consumer not later than five days after the date on which the request for such disclosure was received from the consumer or such report was first requested, whichever is the later.
At present, the specific 'nature and scope' of the investigative consumer report the Company may request is as follows: Employment Verifications, Motor Vehicle Reports, CDLIS, Criminal Records, and PSP. The report(s) will be requested from the following:
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
Phone: (877) 219-9283
Email: support@tenstreet.com
Web: http://www.tenstreet.com/drivers/
You have the right to request whether an investigative consumer report was ordered. You can also make a written request for a complete and accurate disclosure of the nature and scope of the investigation that was requested, request a copy of the report, a copy of any federal or state local notices of rights that may apply to you, or request the name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries of each consumer reporting agency issuing an investigative consumer report about you, by sending a letter or email to the Company. You may also request and promptly receive from all such consumer reporting agencies free copies of any such investigative consumer reports.
MARYLAND: You have the right to request additional disclosures from the Company regarding the nature and scope of the requested investigation.
MASSACHUSETTS: If you contact the Company, you have the right to know whether the Company ordered an investigative consumer report about you. You also have the right to ask the CRA for a copy of any such report.
MINNESOTA: You have the right in most circumstances to submit a written request to the CRA for a complete and accurate disclosure of the nature and scope of any consumer report the Company ordered about you. The CRA must provide you with this disclosure within five business days after its receipt of your request or the report was requested by the Company, whichever date is later.
NEW JERSEY: You have the right to submit a request to the CRA for a copy of any investigative consumer report the Company ordered about you.
NEW YORK: If you contact the Company, you have the right to know whether the Company ordered a consumer report or investigative consumer report about you. Shown above is the CRA's address and telephone number. You have the right to contact the CRA to inspect or receive a copy of any such report. A copy of Article 23-A of the Correction Law is provided in connection herewith.
WASHINGTON STATE: If you submit a written request to the Company, you have the right to a complete and accurate disclosure of the nature and scope of any investigative consumer report the Company ordered about you. You are entitled to this disclosure within five business days after the date your request is received or we ordered the report, whichever is later. You also have the right to request a written summary of your rights under the Washington Fair Credit Reporting Act.
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