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Contents

The History Records Request form serves as a crucial tool in the hiring process for prospective employees, particularly in the transportation sector. This form is designed to collect essential safety performance history related to an applicant's previous employment. It consists of several sections that must be completed by both the applicant and their previous employer. In the first part, the prospective employee provides their personal details, including their name, social security number, and contact information, while also authorizing the release of their alcohol and controlled substances testing records from the last three years. The subsequent sections require the previous employer to report on the applicant’s accident history and drug and alcohol testing results, ensuring compliance with Department of Transportation regulations. The form emphasizes confidentiality and mandates that the information be shared in a secure manner, such as through fax or email. Additionally, it outlines the timeframe in which the prospective employer must provide the requested information to the applicant, reinforcing the importance of transparency in the hiring process. By understanding the components and requirements of the History Records Request form, both applicants and employers can navigate this essential procedure with greater ease and clarity.

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SAFETY PERFORMANCE HISTORY RECORDS REQUEST
PART 1: TO BE COMPLETED BY PROSPECTIVE EMPLOYEE
I, (Print Name) ________________________________________________________ ____________________________
First M.I. Last Social Security Number
Hereby authorize: ____________________
Date of Birth
Previous Employer: _____________________________________________________ Email: _____________________
Street: ____________________________________________________________ Telephone: _____________________
City, State, Zip: _______________________________________________________ Fax No.: _____________________
To release and forward the information requested by section 3 of this document concerning my Alcohol and Controlled
Substances Testing records within the previous 3 years from ________________________________.
(employment application date)
To: Prospective Employer: ________________________________________________________________
Attention: _________________________________ Telephone: ____________________
Street: ________________________________________________________________
City, State, Zip: ________________________________________________________________
In compliance with §40.25(g) and 391.23(h), release of this information must be made in a written form that ensures
confidentiality, such as fax, email, or letter.
Prospective employer’s fax number: ___________________________________
Prospective employer’s email address: _________________________________
_________________________________________________________________ ____________________________
Applicant’s Signature Date
This information is being requested in compliance with §40.25(g) and 391.23.
PART 2: TO BE COMPLETED BY PREVIOUS EMPLOYER
ACCIDENT HISTORY
The applicant named above was employed by us. Yes No
Employed as __________________________ from (m/y) ______________________ to (m/y) ______________________
1. Did he/she drive motor vehicle for you? Yes No If yes, what type? Straight Truck Tractor-Semitrailer
Bus Cargo Tank Doubles/Triples Other (Specify) ________________________________________________
2. Reason for leaving your employ: Discharged Resignation Lay Off Military Duty
If there is no safety performance history to report, check here , sign below and return.
ACCIDENTS: Complete the following for any accidents included on your accident register (§390.15(b)) that involved the
applicant in the 3 years prior to the application date shown above, or check here if there is no accident register data for
this driver.
Date Location # Injuries # Fatalities Hazmat Spill
1. __________________ ___________________ __________________ __________________ __________________
2. __________________ ___________________ __________________ __________________ __________________
3. __________________ ___________________ __________________ __________________ __________________
Please provide information concerning any other accidents involving the applicant that were reported to government
agencies or insurers or retained under internal company policies: _____________________________________________
_________________________________________________________________________________________________
__________________________________________________________________________________________________
Any other remarks:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Signature: ____________________________________________________
Title: ______________________________ Date: ____________________
PREVIOUS EMPLOYER – COMPLETE PAGE 2 PART 3
PART 3: TO BE COMPLETED BY PREVIOUS EMPLOYER
DRUG AND ALCOHOL HISTORY
If driver was not subject to Department of Transportation testing requirements while employed by this employer, please
check here , fill in the dates of employment from _______________ to _______________, complete bottom of Part 3,
sign, and return.
Driver was subject to Department of Transportation testing requirements from _______________ to _______________.
1. Has this person had an alcohol test with the result of 0.04 or higher alcohol concentration?
YES NO
2. Has this person tested positive or adulterated or substituted a test specimen for controlled substances?
YES NO
3. Has this person refused to submit to a post-accident, random, reasonable suspicion, or follow-up alcohol or
controlled substance test?
YES NO
4. Has this person committed other violations of Subpart B of Part 382, or Part 40?
YES NO
5. If this person has violated a DOT drug and alcohol regulation, did this person complete a SAP-prescribed
rehabilitation program in your employ, including return-to-duty and follow-up tests? If yes, please send
documentation back with this form.
YES NO
6. For a driver who successfully completed a SAP’s rehabilitation referral and remained in your employ, did this
driver subsequently have an alcohol test result of 0.04 or greater, a verified positive drug test, or refuse to be tested?
YES NO
In answering these questions, include any required DOT drug or alcohol testing information obtained from prior previous
employers in the previous 3 years prior to the application date shown on page 1.
Name: ___________________________________________________________________________________________
Company: ________________________________________________________________________________________
Street: ___________________________________________________________________________________________
City, State, Zip: ____________________________________________________ Telephone: _____________________
Part 3 Completed by (Signature): ___________________________________________ Date: _____________________
PART 4a: TO BE COMPLETED BY PROSPECTIVE EMPLOYER
This form was (check one) Faxed to previous employer Mailed Emailed Other __________________
By: __________________________________________________________________ Date: ______________________
PART 4b: TO BE COMPLETED BY PROSPECTIVE EMPLOYER
Complete below when information is obtained.
Information received from: ____________________________________________________________________________
Recorded by: _______________________________________ Method: Fax Mail Email Telephone
Date: _____________________________________________ Other _____________________________________
INSTRUCTIONS TO COMPLETE THE SAFETY PERFORMANCE HISTORY RECORDS REQUEST
PAGE 1 PART 1: Prospective Employee
Complete the information required in this section
Sign and date
Submit to the Prospective Employer
PAGE 2 PART 4a: Prospective Employer
Complete the information
Send to Previous Employer
PAGE 1 PART 2: Previous Employer
Complete the information required in this section
Sign and date
Turn form over to complete SIDE 2 SECTION 3
PAGE 2 PART 3: Previous Employer
Complete the information required in this section
Sign and date
Return to Prospective Employer
PAGE 2 PART 4b: Prospective Employer
Record receipt of the information
Retain the form
RECORDS REQUEST FOR
DRIVER/APPLICANT SAFETY PERFORMANCE HISTORY
This request is made by the driver/applicant in compliance with the Department of Transportation regulations.
§391.23(i)(2) Drivers who have previous Department of Transportation regulated employment history in the preceding
three years, and wish to review previous employer-provided investigative information must submit a written
request to the prospective employer, which may be done at any time, including when applying, or as late as
thirty (30) days after being employed or being notified of denial of employment. The prospective employer
must provide this information to the applicant within five (5) business days of receiving the written request.
If the prospective employer has not yet received the requested information from the previous employer(s),
then the five-business-days deadline will begin when the prospective employer receives the requested
safety-performance history information. If the driver has not arranged to pick up or receive the requested
records within thirty (30) days of the prospective employer making them available, the prospective motor
carrier may consider the driver to have waived his/her request to review the records.
PART 1: COMPLETED BY THE DRIVER/APPLICANT
TO:
Prospective Employer: ________________________________________________________________
Street/P.O. Box: _____________________________________________________________________
City, State, Zip: ____________________________________ Telephone # _____________________
FROM:
Driver/Applicant: _____________________________ Social Security/I.D. # _____________________
Street: _____________________________________________________________________________
City, State, Zip: ____________________________________ Telephone # _____________________
I am submitting this written request to obtain copies of my Department of Transportation Safety Performance History for the
preceding three years. I understand, for records requested from a prospective employer, that I must arrange to pick up or
receive the requested records within thirty (30) days of the records being made available or I have waived my request to
review the records.
This information should be: sent to me at the above address.
I will arrange to pick up.
Driver/Applicant Signature: ___________________________________________ Date: _______/_______/_______
M D Y
PART 2: COMPLETED BY THE PROSPECTIVE EMPLOYER
The information must be provided to the applicant within five (5) business days of receiving the written request. If the
prospective employer has not yet received the requested information form the previous employer(s), then the five-business-
days deadline will begin when the prospective employer receives the requested safety performance history information.
Information supplied to:
Name: ___________________________________________________________________________________________
Street: ____________________________________________________________________________________________
City, State, Zip: ____________________________________________________________________________________
Comments: _______________________________________________________________________________________
__________________________________________________________________________________________________
By:
_______________________________________________ ______________ Release Date: _______/_______/_______
Signature/person providing information Telephone # M D Y
COPY 1 PROSPECTIVE EMPLOYER
SAFETY PERFORMANCE HISTORY INFORMATION
DRIVER/APPLICANT REBUTTAL
This rebuttal is made by the driver/applicant in compliance with the Department of Transportation regulations.
§391.23(j)(3) Drivers wishing to rebut information in records received pursuant to paragraph (i) of this section must send
the rebuttal to the previous employer with instructions to include the rebuttal in that driver’s safety
performance history.
§391.23(j)(4) After October 29, 2004, within five business days of receiving a rebuttal from a driver, the previous employer
must:
(i) Forward a copy of the rebuttal to the prospective motor carrier employer;
(ii) Append the rebuttal to the driver’s information in the carrier’s appropriate file, to be included as part of
the response for any subsequent investigating prospective employers for the duration of the three-year
data retention requirements.
PART 1: COMPLETED BY THE DRIVER/APPLICANT
TO:
Previous Employer: ___________________________________________________________________
Street/P.O. Box: _____________________________________________________________________
City, State, Zip: ______________________________________________________________________
Telephone: ________________________________ Fax: ___________________________________
FROM:
Driver/Applicant: ____________________________________ ________________________________
Social Security #
Street: _____________________________________________________________________________
City, State, Zip: ____________________________________ Telephone No.: ___________________
I have submitted this rebuttal to my previous employer requesting that it be attached to my Safety Performance History and
provided to subsequent prospective employers.
Reason for the rebuttal (attach documents as necessary): ___________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
I request that this rebuttal be sent to the attached list of motor carriers.
Driver/Applicant Signature: _____________________________________________ Date: _______/_______/_______
M D Y
PART 2: COMPLETED BY THE PREVIOUS EMPLOYER
Received by:
Signature: ___________________________________________________________ Date: _______/_______/_______
M D Y
COPY 1 PREVIOUS EMPLOYER
CORRECTION REQUEST
OF
ERRONEOUS SAFETY PERFORMANCE HISTORY INFORMATION
This request is made by the driver/applicant in compliance with the Department of Transportation regulations, §391.23,
investigations and inquiries, paragraphs (j)(1) and (2) as printed below.
§391.23(j)(1) Driver wishing to request correction of erroneous information in records received pursuant to paragraph (i) of
this section must send the request for the correction to the previous employer that provided the records to
the prospective employer.
§391.23(j)(2) After October 29, 2004, the previous employer must either correct and forward the information to the
prospective motor carrier employer, or notify the driver within 15 days of receiving a driver’s request to
correct the data that it does not agree to correct the data. If the previous employer corrects and forwards the
data as requested, that employer must also retain the corrected information as part of the driver’s safety
performance history record and provide it to subsequent prospective employers when requests for this
information are received. If the previous employer corrects the data and forwards it to the prospective motor
carrier employer, there is no need to notify the driver.
PART 1: COMPLETED BY THE DRIVER/APPLICANT
TO: Prospective Employer: ________________________________________________________________
Street/P.O. Box: _____________________________________________________________________
City, State, Zip: ____________________________________ Telephone # ______________________
FROM: Driver/Applicant: _____________________________________________________________________
Social Security/I.D. # ________________________
Street: _____________________________________________________________________________
City, State, Zip: ____________________________________ Telephone # ______________________
I request correction of erroneous information in my Safety Performance History. Please forward to the following
prospective employer: Company Name: ______________________________________
Attention: ____________________________________________
Street: ______________________________________________
City, State, Zip: _______________________________________
Explanation of desired correction (attach documents as necessary)____________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Driver/Applicant Signature: ______________________________________________ Date: _______/_______/_______
M D Y
Driver: Retain COPY 4 DRIVER RECORD for your files, Submit copies 1, 2, and 3 to your previous employer.
PART 2: COMPLETED BY THE PREVIOUS EMPLOYER
Disposition of the requested information:
Information was corrected and forwarded to the prospective motor carrier employer.
The driver was notified on _____/_____/_____ that the previous employer does not agree to correct the data.
Return copy 3 to the driver.
Information sent to: Company Name: ____________________________________
Attention: __________________________________________
Street: ____________________________________________
City, State, Zip: _____________________________________
Comments: _______________________________________________________________________________________
__________________________________________________________________________________________________
By: ________________________________________ __________________ Release Date: ______/_______/_______
Signature/person providing information Telephone # M D Y
PART 3: COMPLETED BY THE PROSPECTIVE MOTOR CARRIER EMPLOYER
The corrected information was received on _____/_____/_____
Prospective Employer: ______________________________ Location: _______________________________________
Received by: __________________________________________ __________________________________________
Signature Title
COPY 1 PROSPECTIVE EMPLOYER

Document Specifics

Fact Name Description
Purpose The History Records Request form is designed to facilitate the collection of a prospective employee's safety performance history, specifically regarding alcohol and controlled substances testing.
Governing Laws This form complies with federal regulations found in §40.25 and §391.23 of the Department of Transportation (DOT) guidelines.
Confidentiality Requirement Information must be released in a manner that ensures confidentiality, such as through fax, email, or written letter.
Time Frame for Records The form requests records pertaining to the applicant's performance over the past three years from the date of application.
Completion Responsibility Part 1 of the form must be completed by the prospective employee, while Parts 2 and 3 are to be filled out by the previous employer.
Submission Timeline The prospective employer is required to provide the requested information to the applicant within five business days of receiving the request.
Accident Reporting The previous employer must report any accidents involving the applicant that occurred in the three years prior to the application date.
Rebuttal Process Drivers may submit a rebuttal to any adverse information received, which the previous employer must then include in the driver's safety performance history.
Correction of Errors Drivers can request corrections to erroneous information, and the previous employer has 15 days to respond to this request.

History Records Request: Usage Instruction

After completing the History Records Request form, the next step involves submitting it to the appropriate parties. This includes providing the completed form to the prospective employer and ensuring all sections are filled out correctly. Make sure to follow the instructions carefully to avoid any delays in processing.

  1. Print your name clearly in the designated space.
  2. Fill in your Social Security Number and Date of Birth.
  3. Provide the name of your previous employer along with their contact information, including email and telephone number.
  4. Complete your address, including street, city, state, and zip code.
  5. Indicate the date of your employment application.
  6. Specify the prospective employer's name and contact details.
  7. Fill in the prospective employer's fax number and email address.
  8. Sign and date the form in the designated area.
  9. Submit the form to your prospective employer.

Learn More on History Records Request

What is the History Records Request form?

The History Records Request form is a document used by prospective employees to authorize their previous employers to release safety performance history records. This includes records related to alcohol and controlled substances testing for the past three years. The form ensures compliance with Department of Transportation regulations.

Who needs to complete the form?

The form must be completed by both the prospective employee and the previous employer. The employee fills out the first part, providing their personal information and authorizing the release of records. The previous employer then completes the second part, detailing the employee's safety performance history.

What information is required from the prospective employee?

The prospective employee must provide the following information:

  • Full name
  • Social Security Number
  • Date of Birth
  • Email address
  • Telephone number
  • Address
  • Prospective employer's details

How does the previous employer fill out the form?

The previous employer must complete sections regarding the applicant's employment history, including:

  1. Employment dates and job title.
  2. Whether the applicant drove a motor vehicle.
  3. Accident history, if any.
  4. Drug and alcohol testing history.

They must also sign and date the form before returning it to the prospective employer.

What happens if there is no safety performance history to report?

If there is no safety performance history, the previous employer should check the designated box on the form and sign it. This indicates that no relevant data is available.

How quickly must the information be provided?

The prospective employer must provide the requested information to the applicant within five business days of receiving the completed request form from the applicant. If the prospective employer has not yet received the information from the previous employer, the five-day period begins when they receive that information.

What if the prospective employee does not receive the records in time?

If the prospective employee does not arrange to pick up or receive the requested records within thirty days of them being made available, the prospective motor carrier may consider the request waived. This means the employee may lose the opportunity to review their records.

Can the applicant rebut the information received?

Yes, the applicant has the right to submit a rebuttal if they disagree with the information received. This rebuttal must be sent to the previous employer, who is then required to forward it to the prospective employer within five business days.

What should the prospective employer do after receiving the records?

Once the prospective employer receives the records, they must record the details of the receipt on the form. This includes noting the method of receipt and retaining the form for their records.

Is there a specific format for submitting the request?

The request must be submitted in written form. This can be done via fax, email, or traditional mail. The prospective employee should ensure that all required information is clearly provided to avoid delays in processing.

Common mistakes

Completing the History Records Request form accurately is crucial for a smooth employment process. However, many individuals make mistakes that can delay or complicate their requests. One common error is failing to provide a complete name. It's essential to include the full name, including the middle initial, as requested. Omitting any part of the name can lead to confusion and potential mismatches in records.

Another frequent mistake involves the Social Security Number. This number must be provided accurately. Any errors can hinder the ability to retrieve the necessary records. It's advisable to double-check this information before submission to avoid complications.

People often neglect to include the correct date of birth. This detail is critical for identifying the applicant in the records. Ensure that the date is written in the correct format to prevent any misunderstandings.

Many applicants overlook the section where they authorize the previous employer to release their records. Failing to sign this section can result in the request being deemed invalid. Always remember to read through the entire form and sign where required.

Contact information is another area where mistakes frequently occur. Applicants sometimes provide incorrect phone numbers or email addresses. This can lead to missed communications from prospective employers. Verify that all contact details are accurate and up-to-date.

In Part 2, previous employers must complete their section accurately. However, they may forget to sign and date the form. This oversight can delay the process significantly. Ensure that all required fields are filled out and signed before returning the form.

Another common error is failing to include accident history details. If there are no accidents to report, it’s important to check the appropriate box. Neglecting to do so may cause confusion and lead to unnecessary follow-up inquiries.

When answering questions about drug and alcohol history, individuals sometimes provide incomplete or vague answers. It’s vital to answer all questions clearly and honestly. Incomplete answers can raise red flags and may affect employment opportunities.

Lastly, applicants often forget to keep a copy of the submitted form for their records. Retaining a copy is essential for future reference and can be helpful if there are any discrepancies or follow-up questions. Always make sure to keep a personal copy of any important documents submitted.

Documents used along the form

The History Records Request form is an essential document for prospective employees in the transportation industry. Along with this form, several other documents are often utilized to ensure a comprehensive review of an applicant's safety performance history. Below is a list of these forms and a brief description of each.

  • Accident History Report: This document provides a summary of any accidents involving the applicant during their employment with previous employers, including details such as date, location, and injuries.
  • Drug and Alcohol Testing History: This form outlines the applicant's drug and alcohol testing results, including any positive tests or refusals to submit to testing.
  • Driver/Applicant Safety Performance History Request: A written request submitted by the driver to obtain their safety performance history from previous employers, in compliance with DOT regulations.
  • Driver Rebuttal Form: This allows the driver to contest any information in their safety performance history and request that the rebuttal be attached to their records.
  • Correction Request of Erroneous Safety Performance History: A form used by the driver to request corrections to any inaccurate information in their safety performance history.
  • Previous Employer Verification Form: A document that confirms the applicant's employment details and safety performance history as reported by previous employers.
  • Safety Performance History Acknowledgment: This form is signed by the applicant to acknowledge receipt of their safety performance history from a prospective employer.
  • Consent to Release Information: A form that grants permission for previous employers to disclose the applicant's safety performance history to prospective employers.
  • Employer Reference Check: A document used by prospective employers to gather additional insights about the applicant's performance from previous employers.

Utilizing these forms alongside the History Records Request form helps create a thorough understanding of an applicant's past performance and compliance with safety regulations. This process is crucial for maintaining safety standards in the transportation industry.

Similar forms

The Safety Performance History Records Request form shares similarities with the Employment Verification form. Both documents serve to confirm the employment history of an individual, particularly in relation to safety and compliance standards. The Employment Verification form typically requires the employee to authorize the release of their employment details, including dates of employment and job titles. This process ensures that prospective employers can verify a candidate's work history and assess their qualifications for a position, similar to how the Safety Performance History Records Request form seeks to gather information about an applicant's safety performance and drug testing history.

Another document comparable to the Safety Performance History Records Request form is the Background Check Authorization form. This form is used to obtain permission from an applicant to conduct a background check, which may include criminal history, credit checks, and previous employment verification. Just as the Safety Performance History form requires an applicant's consent to gather specific safety-related information, the Background Check Authorization form necessitates the applicant's approval to access sensitive personal information that could impact their employability.

The Drug Testing Consent form is also similar, as it requires an individual to authorize drug testing as part of the employment process. This form typically outlines the types of tests that may be administered and the consequences of failing a drug test. Like the Safety Performance History Records Request form, which includes questions about an applicant's drug and alcohol testing history, the Drug Testing Consent form is essential for ensuring compliance with workplace safety regulations and maintaining a safe working environment.

Additionally, the Reference Check form aligns with the Safety Performance History Records Request form in its purpose of validating an applicant's qualifications. A Reference Check form requests information from individuals who can provide insights into the applicant's work ethic, skills, and character. Both forms aim to provide prospective employers with a comprehensive view of a candidate's background and suitability for a position, thereby enhancing the hiring process.

The Release of Information form is another document that bears resemblance to the Safety Performance History Records Request form. This form is often used in various contexts to allow one party to share specific information about an individual with another party. In the context of employment, it enables previous employers to disclose information regarding an applicant's job performance and safety history, much like the Safety Performance History form facilitates the sharing of an applicant's safety performance records.

Lastly, the Applicant Rebuttal form is similar in that it allows individuals to contest or clarify information obtained during the hiring process. When an applicant receives negative feedback or information from their previous employers, they can use the Rebuttal form to provide their perspective. This process mirrors the Safety Performance History Records Request form's objective of ensuring that all relevant information is considered during the hiring decision, allowing for a fair evaluation of the applicant's background.

Dos and Don'ts

Things to Do When Filling Out the History Records Request Form:

  • Print your name clearly in the designated section.
  • Provide your complete Social Security Number.
  • Include your date of birth accurately.
  • List your previous employer's full name and contact information.
  • Sign and date the form to authorize the release of your records.
  • Specify the prospective employer's name and contact details.
  • Ensure that all sections are filled out completely before submission.
  • Review the form for accuracy before sending it.
  • Keep a copy of the completed form for your records.
  • Submit the form promptly to avoid delays in the hiring process.

Things Not to Do When Filling Out the History Records Request Form:

  • Do not leave any required fields blank.
  • Avoid using abbreviations or nicknames for your name.
  • Do not forget to sign the form; an unsigned form will be invalid.
  • Do not provide incorrect or outdated contact information for previous employers.
  • Refrain from submitting the form without double-checking for errors.
  • Do not submit the form late, as this may impact your employment status.
  • Do not include personal information that is not requested.
  • Avoid using informal language in any comments or notes.
  • Do not neglect to follow up if you do not receive confirmation of receipt.
  • Do not assume the prospective employer will handle any errors for you.

Misconceptions

  • Misconception 1: The History Records Request form is only necessary for new employees.
  • This form is not limited to just new hires. Even current employees who are seeking new positions within the same industry may need to complete it to ensure their safety performance history is accurately shared with prospective employers.

  • Misconception 2: Only accidents need to be reported on the form.
  • While accident history is a significant part of the form, it also includes questions about drug and alcohol testing history. This comprehensive approach helps employers understand the overall safety performance of a driver.

  • Misconception 3: The form guarantees employment if submitted correctly.
  • Submitting the History Records Request form does not guarantee a job. It simply allows prospective employers to review an applicant’s safety performance history, which they will consider along with other factors in their hiring decision.

  • Misconception 4: Previous employers can refuse to provide information.
  • Under Department of Transportation regulations, previous employers are required to provide the requested safety performance history. However, they can only disclose information that is accurate and relevant to the applicant’s employment.

  • Misconception 5: The applicant has unlimited time to collect their records.
  • Applicants must arrange to collect their records within thirty days of being made available. If they do not, they risk waiving their right to review the information, which could affect future employment opportunities.

  • Misconception 6: The form is only relevant for commercial drivers.
  • While the form is primarily designed for drivers subject to Department of Transportation regulations, its principles can apply to other positions where safety performance history is important. This can include various roles within the transportation and logistics sectors.

Key takeaways

When filling out and using the History Records Request form, it is crucial to follow specific guidelines to ensure a smooth process. Here are key takeaways to consider:

  • Complete All Required Information: Ensure that all fields in Part 1 are filled out accurately. This includes your name, Social Security number, and contact details.
  • Authorization is Essential: By signing the form, you authorize your previous employer to release your safety performance history. This step is vital for compliance.
  • Timeliness Matters: Submit your request as soon as possible, ideally when applying for a job. You have up to 30 days after employment denial to make the request.
  • Confidentiality is Key: The previous employer must send the information in a manner that maintains confidentiality, such as via fax or email.
  • Response Timeframe: The prospective employer must provide the requested information within five business days of receiving it from your previous employer.
  • Accurate Record Keeping: The prospective employer should document how and when they received the information. This record is essential for transparency.
  • Understanding Your Rights: If you do not pick up or receive your records within 30 days, you may waive your right to review them.
  • Rebuttal Process: If you find inaccuracies in your records, you can submit a rebuttal to your previous employer, who must address it within five business days.

Being aware of these points can significantly affect the efficiency of your application process. Take the time to review and ensure everything is in order. Your future employment may depend on it.