General Consent For Limited Queries Of The FMCSA Drug And Alcohol Clearinghouse
Employee Name ____________________________________________________________________________________________
Driver`s License Number _____________________ State ___________________ Country ___________________________
I,_______________________________________ , hereby provide consent to Woodland Logistics INC 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
My consent is for unlimited number of limited queries for my employment application processing and
the duration of my employment with Woodland Logistics INC .
I understand that if the limited query conducted by Woodland Logistics INC indicates that drug or alcohol violation information about me exists in the Clearinghouse, FMCSA will not disclose that information to Woodland Logistics INC without first obtaining additional specific consent from me.
I further understand that if I refuse to provide consent for Woodland Logistics INC to conduct a limited query of the
Clearinghouse, Woodland Logistics INC must prohibit me from performing safety-sensitive functions, including
driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol program regulations.
Employee Signature: ____________________________________________________________________________________
Date of Consent: _______________________________________________________________________________________
Employer Name: Woodland Logistics INC
Employer Address: 5044 W 127th st Alsip, IL 60803