Next Previous Accident:
Provide traffic convictions and forfeitures for the previous 3 years, other than parking.
If you answered "YES" to any of the above questions, please provide details below
Applicant: Read the following statement, then date and sign the application form
I authorize Emerson Express Co., Inc. to make any such inquiries and investigations of my driving history, past employment background, personal, financial and/or medical history. I hereby release state agencies, past employers, schools, health care providers and/or any other person from all liability in connection to their responding to any and all inquiries from Emerson Express Co., Inc., and the subsequent release of information to verify the accuracy of this application.
I understand that in the event of my employment by Emerson Express Co., Inc., any false or misleading statments given in my applicaiton or interview(s) may result in my discharge. I also understand that I am required to abide by all rules and regulations of Emerson Express Co., Inc..
This certifies that this applicaiton was completed by me, and that all entries on it and information in it are true and complete to the best of my knowlege.
Fill out the attached DOT DA and the PSP authorization and disclosure form , then submit them to the dropbox below.
For the DOT D/A disclosure below, please print off your application, fill out the disclosure then scan it back onto the computer and submit the PSP And DOT form in file form in the dropbox below.
If you cannot scan these back onto a computer, feel free to mail them at:
Emerson Express Safety
545 Lyell Ave
Rochester, N.Y. 14606