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FORM F <br />CABARRUS COUNTY GOVERNMENT <br />Date: <br />Company Name: <br />Company Address: <br />Subject: <br />(Name of applicantlemployee) <br />Dear Human Resources Representative: <br />Release of Information Form <br />The individual named above is being considered for a position with DOT safety- sensitive duties. We are requesting the <br />information in Section II on the reverse side of this letter from DOT regulated employers who have employed this <br />individual during the past two years as required by 49 CFR Part 40.25 Drug and Alcohol Testing Records. <br />Please complete and return this form by mail or fax to: <br />Cabarrus County Human Resources Department <br />PO BOX 707 <br />Concord NC 28026 <br />Phone 704 - 920 -2200 <br />Fax 704 - 920 -2250 <br />Thank you for your assistance, <br />Cabarrus County Representative Signature <br />Title <br />Phone <br />Cc: Human Resources <br />24 <br />Attachment number 1 <br />F -6 Page 135 <br />