PRIOR EMPLOYER VERIFICATION INQUIRY
Driver safety history and employment inquiry form · 49 CFR 391.23
| Driver Name | Driver ID | CDL Number |
|---|
| Maria Lopez | DRV-002 | DLN-00002 |
| Address | Phone | Email |
|---|
| 450 N Michigan Ave, Chicago, IL 60611 | 707-773-6386 | maria.lopez@boftransport.com |
| Prior Carrier Name | Employment Period | Reason for Leaving |
|---|
| Northline Freight LLC | 2022-01 to 2024-09 | Career advancement |
| Accident History Provided | Drug/Alcohol Violations | Eligible for Rehire |
|---|
| No reportable incidents in previous 36 months | No violations reported | Yes |
Karen Brooks
Delta Advanced Trucking, Inc. Safety Officer Signature
Samantha Hughes
Prior Carrier Representative Signature
Maria Lopez
Driver Consent Signature · 2026-05-11