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Human Resources Department <br />Date: <br />Company Name: <br />Company Address: <br />Subject: ,Release of Information Form <br />(Name of applicant/employee) <br />Dear Human Resources Representative: <br />The individual named above is being considered for a position with DOT safety-sensitive duties. We are <br />requesting the information in Section 11 on the reverse side of this letterfrom DOT regulated employers <br />who have employed this individual during the past two years as required by 49 CFR Part 40.25 Drug and <br />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 /> <br />65 Church Street SE (28025) • P.O. Box 707 Concord, NC 28026-0707 <br />Phone: 704.920.2200 • Fax: 704.920.2250 <br />Website: www.cabarrusc~~nt~r us <br />F-6 ac ment number 1 <br />Page 292 of 362 <br />