JASKO - Safety Performance History Records Request

DRIVER/APPLICANT SAFETY PERFORMANCE HISTORY RECORDS REQUEST — 391.23

This request is made by the driver/applicant in compliance with Department of Transportation Regulation §391.23(i)(2).

SECTION 1: COMPLETED BY THE DRIVER/APPLICANT

I am submitting this written request for 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.

The information should be: Mailed to me at the above address. / I will arrange to pick up. / Faxed to the number listed above. / Emailed to address listed above.

SECTION 2: TO BE 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 from the previous employer(s), then the five business days deadline will begin when the prospective employer receives the requested safety performance history information.

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