JASKO - Previous Employer Safety Performance Authorization

JASKO ENTERPRISES, INC. · FORM EMP-FRM-006 · REV. 0 · EFFECTIVE NOVEMBER 1, 2026

This form authorizes the investigation of required previous-employer safety-performance information and explains the driver’s rights to review, correct or rebut information received.

AUTHORIZATION

I authorize previous employers to release information JASKO is permitted or required to investigate, including employment verification, qualifying crash information and other safety-performance information. JASKO may document contact attempts and information received as required by law.

DRIVER RIGHTS

• You may submit a written request to review qualifying previous-employer safety-performance information received by JASKO.
• You may ask the previous employer to correct information you believe is inaccurate.
• If you and the previous employer cannot agree, you may submit a rebuttal statement to be attached to the information.
• Exercise of these rights does not extend or replace other rights available under law.

REQUEST TO REVIEW RECORDS

☐ I request a copy now     ☐ I do not request a copy now

CERTIFICATION AND SIGNATURE

I certify that the information I provided is true, complete and accurate. I understand that an electronic signature has the same effect as a handwritten signature where permitted by law.