This easy-to-use form can help you satisfy 49 CFR Section 391.23(d) which requires the prospective employer to obtain driver identification, employment verification, and accident information from a driver/applicant's previous employer(s).

Use J. J. Keller's Request For Information From Previous Employer form if you keep confidential alcohol & drug records separate from other driver records, or if you are not required to obtain alcohol & drug records from previous employers. This form covers:

• Driver/applicant's authorization to release information
• Employment verification and accident information (including date, location, injuries, fatalities, and hazardous material spill details)

Snap-out format, 2-ply carbonless, 8-1/2" x 11-3/4". Sold in multiples of 10.
Padded format, single-sheet 8-1/2" x 11". 50 forms per pad.

Can be used in combination with the Previous Employer Alcohol & Drug Test Information form for a complete Safety Performance History Solution! Or consider the all-in-one Safety Performance History Records Request.

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