General Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse

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I, {{firstName}} {{lastName}} , hereby provide consent to {{companyNameC}} and their C/TPA Quality Consortium Services, 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. Each motor carrier you work for (including yourself as an owner operator) is required to query the Clearinghouse at the time of hire and annually over your duration of employment. I understand that if the limited query indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information without first obtaining additional specific consent from me. I understand that I will have 24 hours to login to the Clearinghouse and provide this additional consent. I further understand that if I refuse to provide consent to conduct a limited query of the Clearinghouse, I am prohibited from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations. This consent for limited queries in the FMCSA Clearinghouse is valid from the date listed on this form until I am no longer employed with {{companyNameC}} or I am no longer subject to FMCSA drug and alcohol testing regulations.

Notice to Motor Carrier: This consent form authorizes you to run a limited query in the FMCSA Clearinghouse. If a full query is required, it must be obtained from the Clearinghouse within 24 hours. This record of consent must be kept for 3 years after the date of the last limited query. Quality Consortium Services does not maintain this record on your behalf.