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DISCLOSURE AND AUTHORIZATION FORM TO OBTAIN CONSUMER REPORTS FOR EMPLOYMENT PURPOSES

Please read carefully before signing the authorization.

DOUBLE R TRANSPORT 2024

DISCLOSURE

Double R Transport or its affiliates (“the Company”) may request one or
more consumer reports or investigative consumer reports about you for employment purposes.


For explanation purposes, these reports may include information on your credit worthiness,
credit standing, credit capacity, character, general reputation, personal characteristics, or mode
of living which may be used as a factor in making an employment-related decision about you.
Such information may include, for example, credit information, criminal history reports, driving
records, or personal interviews with your prior employers, neighbors, friends, or associates, or
with others who may have knowledge concerning any such items of information.

The Company will obtain the consumer reports and investigative consume reports from Safety
Holdings, Inc. dba SambaSafety. SambaSafety can be contacted by mail at Attn:
Compliance Department, P.O. Box 92890, Albuquerque, NM 87199-2890; or phone: (888)
947-2622; or website: www.safetyholdingsinc.com.

AUTHORIZATION

By signing below, I agree that have read and understand the foregoing Disclosure, and authorize
the Company to obtain consumer reports or investigative consumer reports about me for
employment purposes and, if I am hired or I have already been hired, from time to time while I
am employed by Company without further authorization from me. I further authorize the
Company to share the information in the consumer reports and investigative consumer reports
with any person involved in the employment decision about me.

Clear
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