Consent Form 1/3 50% 50% b) Consent Form (Basic Terms & Cond.) Consent I authorize Indiana Transport Inc. to make such inquiries and investigations of my personal, employment, driving, financial or medical history and other related matters as may be necessary in arriving at a leasing decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of a lease has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of a lease agreement being offered, I understand that false or misleading information given in my application or interview(s) may result in cancellation of the lease agreement. I agree to abide by the rules and regulations of the Indiana Transport Inc. as well as the Federal Motor Carrier Safety Regulations. I also agree and understand that if I sign a lease agreement with Indiana Transport I will be on a probationary period during which time I may be discharged without recourse. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Signature * Clear Date * Full Name (Typed) * If you are human, leave this field blank. Next
