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                <h1>SAFETY PERFORMANCE HISTORY INVESTIGATION</h1>
                <h2>PREVIOUS USDOT REGULATED EMPLOYERS</h2>
                <h3>In accordance with 49 CFR 40.25 and 391.23, we are hereby requesting that you supply us with the Safety Performance History of this individual. Under DOT rule 391.23(g), you must respond to this inquiry within 30 days of receipt.<br /><br /></h3>

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                <asp:Label runat="server" AssociatedControlID="txtSSN" Text="SSN" />
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                <asp:Label runat="server" AssociatedControlID="txtEmploymentDates" Text="Employment Dates" />
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                <asp:Label runat="server" AssociatedControlID="yn1" Text="1. Are the dates of employment correct as stated above?" />
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                <asp:Label runat="server" AssociatedControlID="txtEmploymentDatesCorrected" Text="If no, please provide the correct dates of employment:" />
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                <asp:Label runat="server" AssociatedControlID="yn2" Text="2. Did the applicant drive commercial vehicles for your company?" />
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                <input ID="yn2" runat="server" type="checkbox" class="form-control" data-toggle="toggle" data-on="yes" data-off="no" />
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                <asp:Label runat="server" AssociatedControlID="yn3" Text="3. Was the applicant a safe and efficient driver?" />
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                <asp:Label runat="server" AssociatedControlID="yn4" Text="4. Was the applicant involved in any vehicle accidents while employed with your company? If yes, please provide details in comment section below." />
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                <asp:Label runat="server" AssociatedControlID="ddlReasonLeft" Text="5. Reason for leaving your employment:" />
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                        <asp:ListItem Text="" />
                        <asp:ListItem Text="Lay Off" />
                        <asp:ListItem Text="Resignation" />
                        <asp:ListItem Text="Termination" />
                        <asp:ListItem Text="Other" />
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                <asp:Label runat="server" AssociatedControlID="yn6" Text="6. Has the applicant tested positive for a controlled substance in the last three (3) years?" />
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                <asp:Label runat="server" AssociatedControlID="yn7" Text="7. Has the applicant had an alcohol test with a B.A.C. of 0.04 or greater in the last three (3) years?" />
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                <asp:Label runat="server" AssociatedControlID="yn8" Text="8. Has the applicant refused a required test for drugs or alcohol in the last three (3) years?" />
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                <asp:Label runat="server" AssociatedControlID="ddl9" Text="9. Did the applicant complete a substance abuse rehabilitation program, if required? If yes, please provide documentation of the employee's successful completion of DOT return to duty requirements." />
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                        <asp:ListItem Text="N/A" />
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                <asp:Label runat="server" AssociatedControlID="yn10" Text="10. Has this person ever violated any other DOT agency drug and alcohol testing regulations?" />
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                <asp:Label runat="server" AssociatedControlID="txtComments" Text="Comments:" />
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