JASKO - Rebuttal of Safety Performance History Information

DRIVER/APPLICANT REBUTTAL OF SAFETY PERFORMANCE HISTORY INFORMATION — 391.23

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 employers for the duration of the three year data retention requirements.

SECTION 1: COMPLETED BY THE DRIVER/APPLICANT

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.

I request that this rebuttal be sent to the attached list of motor carriers.

SECTION 2: COMPLETED BY THE PREVIOUS EMPLOYER

Received by the previous employer: signature and date (Month/Day/Year) are recorded at the office upon receipt.

JASKO Enterprises, Inc. — 1122 N. 189th Ave, Buckeye, AZ 85326