Employment History Verification Request Form

Aim Dedicated Logistics

For employees leaving employment with us on or after 9/1/2005

Aim provides employment history verifications on past employees as required by section 391.23 of the Federal Motor carrier Safety Regulations (FMCSR) via a computerized verification system. This system will provide the same information that is provided via phone or fax verifications. Per company policy, no additional information will be provided. In order to obtain this information, you must provide all of the requested information below. Without it, verifications will not be complete. Once processed, a verification will be sent to the email address provided. Employees have provided authorization for us to perform verifications in this manner. If an employee has not provided authorization, you will receive a message that you will need to fax the verification to us.

Requestor Information   Applicant Information Requestor Name: First Name: Company Name:   Last Name: Address:   Social Security #: City/State/Zip:   Date of Birth: Phone:     (mm/dd/yyyy) Email:       Re-type Email:   * All fields are required *