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General Consent for Limited Queries

Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

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I (Driver's Name)
hereby provide my consent to
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. The consent I agree to by the terms of this document, is good for the duration of my employment at the company state above.
I understand that if the limited query conducted by Nitrogen Solutions indicates that drug and alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to the Nitrogen Solutions without first obtaining addition specific consent from me.
I further understand that if I refuse to provide consent for Nitrogen Solutions to conduct a limited query of the Clearinghouse, Nitrogen Solutions must prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
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