Thurel Mason Trucking, Inc.
 1420 South 400 West, Aurora, Utah 84620
435.529.3734 • 800.448.8829 • E-mail

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Authorization for Release of Your Drug & Alcohol Testing Information from Previous Employers

Please read the following information carefully. If you have any questions, concerns, or would prefer to issue this release via paper copies, please contact Mason Trucking directly.
To Whom it May Concern:

By submitting this form I, , hereby authorize and release the previous employers which I list below to submit information regarding my alcohol and controlled substances testing record to Mason Trucking.

I understand that the information requested from my previous employers will include, but may not be limited to, the following:
  • Whether I have had an alcohol text with a result of 0.04 or higher alcohol concentration;
  • Whether I have had a positive drug test;
  • Whether I have refused to be tested for drugs/alcohol;
  • Whether I have committed other violations of DOT agency drug and alcohol testing;
  • Whether a previous employer has reported a DOT violation to another previous employer;
  • If there was a previous DOT drug or alcohol violation, if return-to-duty requirements and testing were fulfilled and if they are available;
  • And, any other information your previous employers may have concerning any applicable DOT agency regulations, including 40.25.

To signify your agreement to this release of information, please enter "I AGREE" here:

Please list your previous employers' contact information below:

Past Employer: Company Name:
Full Address:
Telephone Number:
Fax Number:

Past Employer: Company Name:
Full Address:
Telephone Number:
Fax Number:

Past Employer: Company Name:
Full Address:
Telephone Number:
Fax Number:

Past Employer: Company Name:
Full Address:
Telephone Number:
Fax Number:


This certifies that this authorization was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

In lieu of a signature, please enter the following personal information:
The last four digits of my social security card are: Today's date:



Home  •  About Us  •  New! Trucks for Sale  •  Drivers Wanted  •  Apply Now  •  Authorize
Thurel Mason Trucking, Inc.
1420 South 400 West, Aurora, Utah 84620
435.529.3734 • 800.448.8829 • Fax 435.529.7007 • E-mail