I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

In consideration of Double H Paving, Inc.'s review of my application for employment, I hereby voluntarily consent to and authorize Double H Paving, Inc. or its authorized agents bearing this release or copy thereof, to obtain a consumer report for employment purposes. I agree that this consumer report may include any of the following:

•  Employment Verification, Education Verification, Credential Verification
• Personal Identity Verification, Past Employment Verification, Reference Check
• Criminal Records, Civil Cases, Motor Vehicle Records, Credit Report

I authorize all persons and organizations that may have information relevant to this research to disclose such information to Double H Paving, Inc. or its authorized agents. I hereby release Double H Paving, Inc., its authorized agents, and all persons and organizations providing information from all claims and liabilities any nature in connection with this research. I hereby further authorize that a photocopy of this authorization may be considered as valid as the original.

 I understand that I have specific prescribed rights as a consumer under the federal Fair Credit Reporting Act (FCRA) and may have additional rights under relevant state law. I hereby certify that I have been presented with a summary of my rights as a consumer under the Fair Credit Reporting Act.

Consumer reports may be obtained as part of the Double H Paving, Inc.'s evaluation of my job application/employment. The reports may be procured by Boen & Associates Inc. and may include my driving record, an assessment of my insurability under the Company's insurance coverages or other- consumer reports and additional reports about me from time to time, as it deems appropriate, to evaluate my insurability or for other permissible purposes.

Dear Boen & Associates Inc,

Double H Paving, Inc. has reviewed its obligations under the Fair Credit Reporting Act as a consumer report user, and certifies that it has received or will receive in advance of requesting information about the driving records of or consumer reports about any job applicant/ employee authorizes in writing the procurement of his/her consumer reports, including driving records, and the procurement of additional reports about him/her from time to time to evaluate his/het- insurability or for other permissible purposes. Double H Paving, Inc. will retain the job applicant's/employee's authorization on file in accordance with the requirements of the law for at least two years, and provide to the applicant/employee all required notices.

Sincerely,

THE UNDERSIGNED DOES HEREBY ACKNOWLEDGE AND CERTIFY AS FOLLOWS:

 1. Certifies that the undersigned is an employee or has applied to become an employee of the below-named employer in a position that involves the operation of a motor vehicle and the undersigned gives his or her consent to the release of their driving record (MVR) for review by:

 Name of Employer or Potential Employer

 2. That the undersigned authorizes his or her driving record to be periodically obtained and reviewed for the purpose of initial and continued employment

 3. That all information presented in this form is true and correct. The undersigned makes this certification and affirmation under penalty of perjury and understands that knowingly making a false statement or representation on this form is a criminal violation

 Name of Employee/potential employee: