Driver Qualification and Release of Information

    I hereby authorize you to release the following information to NELSON FREIGHT SERVICE, INC. as required by 49 CFR Part 40, Part 382.405 (f) (h), Part 382.413 (b) (e) (f), and Part 391.23 of the Federal Motor Carrier Safety Regulations. You are hereby released from any and all liability which may result from furnishing such information.

    A photocopy of this release shall be as valid as the original. This authorization shall be valid for one year from the date of signing hereof.


    BusStraight TruckTractor/SemiTrailer ComboOther

    NoYes

    NoYes

    DischargedLaid-OffMilitary Call-UPResignation

    ExcellentGoodFairPoor

    ExcellentGoodFairPoor

    ExcellentGoodFairPoor

    ExcellentGoodFairPoor

    ExcellentGoodFairPoor

    ExcellentGoodFairPoor

    NoYes

    Pursuant to 49 CFR Part 40, Part 382, we request that any and all information related to alcohol and controlled substances testing of Commercial Motor Vehicle licensed drivers be released to us, covering a period of time of two years prior to the date of this inquiry. Please be aware that the regulations clearly state that this information must be answered and released to us, regardless of any company policy which may be in effect at this time.


    Breath and Alcohol TestingDrug Testing

    If yes, please answer the following:


    NoYes

    NoYes

    NoYes

    NoYes