I hereby provide consent to Mid-West Truckers Assn. to conduct a limited query of the Federal Motor Carrier Safety Administration Commercial Driver’s License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. This gives Mid-West Truckers Assn. consent for multiple limited queries for the 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 to the employer named above without first obtaining additional specific consent. I further understand that if I refuse to provide consent to conduct a limited query of the Clearinghouse, it will prohibit me from performing safety-sensitive functions, including driving a commercial motor vehicle, as required by FMCSA’s drug and alcohol testing program regulations (49 CFR Part 382).