Cbp Form 823f - Fast Commercial Driver Application - Mx Page 2

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SECTION C - EMPLOYMENT HISTORY FOR THE LAST 5 YEARS

48. Current employer

49. Employer's name

(yyyy/mm)

From:

To:

50. Street Address, incl. Apt. No.

51. City

52. Colonia/Neighborhood

53. State

54. Postal/Zip code

55. Country

56. Telephone number

Ext.

57. Occupation (attach separate sheet if necessary).

Previous Employer name and address if current employer is less than five years (attach separate sheet if necessary).

58.

59. Employer's name

(yyyy/mm)

From:

To:

60. Street Address, incl. Apt. No.

61. City

62. Colonia/Neighborhood

63. State

64. Postal/Zip code

65. Country

SECTION D - ADDITIONAL INFORMATION

66.

Yes

Have you ever been convicted of an offense in any country?

What country were you convicted in?

Yes

If yes, have you ever received a waiver of inadmissibility to the U.S. from the CBP (former USINS)?

Have you ever been found in violation of customs or immigration laws?

Yes

If you have answered YES, please give details;

SECTION E - CERTIFICATION

67.

I certify that all information given on this application, and in support of this application, was provided voluntarily and is true and complete. I understand that any information on

this application, including any supporting documentation, background information, and biometric data may be shared among Customs and Immigration authorities in both Mexico

and the U.S. and among law enforcement and other government agencies in accordance with applicable laws. I certify that I have read, understood, and agree to abide by all

conditions required for use of the FAST program, including all instructions and notices accompanying this application.

(yyyy/mm/dd)

Name (print)

Signature

Date

Applicant

U.S. PRIVACY ACT STATEMENT

The authority to collect the information on this application, any supporting documentation, fingerprints, and other requested information is contained in Titles 8 and 19 of the U.S.

Code and corresponding regulations. Furnishing the information on this form is voluntary; however, failure to provide all the requested information may result in the delay of a final

decision or denial of your application. The information collected will be used to make a determination on your application. It may also be provided to other government agencies

(Federal, state, local, and/or foreign) as permitted under the Privacy Act of 1974, 5 U.S.C. § 552a (2002), and other applicable law. All applicants are subject to a check of criminal

information databases and other immigration and customs databases in order to determine eligibility for this program.

Please mail or take your completed application along with fee to the nearest U.S./Mexico FAST Enrollment Center. Locations and addresses of U.S./Mexico FAST Enrollment

Centers can be found at

SECTION F - FEE PAYMENT (non-refundable)

69.

The fee for an applicant to the FAST program is $50.00 US only

All credit card fees will be processed as U.S. funds

Visa

MasterCard

Card holder's name (please print)

I am enclosing a certified check or money order payment

Discover

American Express

Once an application has been processed, absolutely no refunds will be granted. No exceptions.