What is the reason for the test?
DOT Testing If you need to authorize a Department of Transportation test, please ensure the employee has a valid CDL or permit.
Non-DOT Testing If you are wanting to authorize any test not required by federal regulations.
What is the reason for the test? *
Test Authority *
If Pre-Employement DOT Test, who is performing pre-employment query in Clearinghouse? *
Test Type *
Company Name *
Company Representative Requesting Test *
Donor Name, First and Last *
Donor Driver License Number and State *
Donor Birth Date *
Employee Phone Number *
What day would you prefer the donor to test? *
Current Location of Donor (City and State) *
How would you like CleanFleet to contact your company regarding this test? *
Additional contact information or questions (optional)