I certify that I personally completed this application and that all of the information is true and correct. I hereby request and authorize Midwest Specialized Transportation, Inc. to cause to be conducted, at any time, an investigation of my background for employment purposes, which may include, but is not limited to, any information relating to my character, general reputation, personal characteristics, criminal history, past work experience, educational background, alcohol or drug test results, or failure to submit to an alcohol or drug test, or any other information about me which may reflect upon my potential for employment gathered from any individual, organization, entity, agency, or other source which may have knowledge concerning any such items of this information. I have completed this application of my own free will and hold Midwest Specialized Transportation, Inc. harmless of all liability for providing this application for my use.

In connection with my application for certification (including contract for services) with you, I understand that consumer reports which may contain public record information may be requested. These reports may include the following type 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 maintain such records; as well as information concerning previous driving record requests made by others from such state agencies, and state provided driving records.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY TO FURNISH THE ABOVE-MENTIONED INFORMATION.