DOT / FMCSA Clearinghouse Query

Step 5 of 5 — FMCSA Drug & Alcohol Clearinghouse Limited Query Consent

FMCSA Commercial Driver's License Drug & Alcohol Clearinghouse Consent

I hereby provide consent to TRANSWORTH LEASING LLC to conduct a limited query of the FMCSA Commercial Driver’s License Drug and Alcohol Clearinghouse (Clearinghouse) to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I consent to having an annual limited query conducted each year that I am employed at TRANSWORTH LEASING LLC.

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

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

First Name *

Middle Name

Last Name *

Date *

I Agree: I consent to the FMCSA Clearinghouse Limited Query above. *

Applicant Signature *

Please sign inside the box above using your mouse or finger.