Application

    Kirk NationaLease Application









    YesNo





    YesNo




    Full timePart time


    1st2nd3rd


    YesNo




    YesNo











    General Consent for Limited Queries of the Federal
    Motor Carrier Safety Administration (FMCSA)
    Drug and Alcohol Clearinghouse

    I, ___ (CDL Holder Name), hereby provide consent to
    KIRK NATIONALEASE, CO. to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (the “Clearinghouse”) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. If KIRK NATIONALEASE, CO. hires me, KIRK NATIONALEASE, CO. may conduct unlimited additional limited queries of the Clearinghouse for the duration of my employment.

    I understand that the limited query conducted by KIRK NATIONALEASE, CO. indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to KIRK NATIONALEASE, CO. without first obtaining additional specific consent from me.

    I further understand that if I refuse to provide consent for KIRK NATIONALEASE, CO. to conduct a limited query of the Clearinghouse, KIRK NATIONALEASE, CO. must prohibit me from performing safety-sensitive functions, including driving a commercial vehicle, as requested by FMCSA’s drug and alcohol program regulations.

    Sign:

    Date:

    **** Full Application will be requested before hire***