Emerson Express Application

Emerson Express Co., Inc.

Emerson Express Co., Inc. is in compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disabilities.
Driver's Application for Employment
Name *

First Name Last Name
Date *

Month Day Year
Date of birth *

Month Day Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Enter your email *
Phone Number *

Area Code Phone Number
Social Security # *
Emergency Contact *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Relationship *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
List 3 previous Addresses
Address #1)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long did you live there?
Address #2)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long did you live there?
Address #3)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
How long did you live there?
Do you have the legal right to work in the United States? *
Can you provide proof of age? *
Have you worked for Emerson Express Co., Inc. or any related company before? *
If yes, which department?
Date start

Month Day Year
Date end

Month Day Year
Position
Reasons for leaving
Are you currently employed? *
If not, how long since leaving last employment?
Who referred you?
Rate of pay expected *
Why would you like to work for Emerson Express Co., Inc.? *

List any special training that will enable you to be a better driver: *
List any safe driving awards you have earned : *
List other skills or training which will help you succeed at Emerson Express Co., Inc.: *

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.
Electronic Signature *
Applicant's Name (Print) *
Date *

Month Day Year
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

Fax: 585-697-7018
Upload here *

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