3649 E. Lake Road
Dunkirk, NY 14048
(800) 283-7284 or (716) 366-6555
Providing Exceptional Service and Value to our Customers

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* DATE OF APPLICATION
* FIRST NAME
* MIDDLE NAME
* LAST NAME
* ADDRESS 1
ADDRESS 2
* CITY
* STATE
* ZIP CODE
* PHONE
BEST TIME TO CONTACT
* SOCIAL SECURITY #
* DATE OF BIRTH
EMAIL
* DRIVERS LICENSE #
* STATE
* CLASS
* DATE OF LAST DOT PHYSICAL
* AIR BRAKE ENDORSEMENT
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HAVE YOU EVER BEEN CONVICTED OF ANY ITEM LISTED BELOW:
* FELONY
* CONTROLLED SUBSTANCE
* DUI
* ANY ACCIDENTS IN THE PAST 5 YEARS
IF YOU MARKED YES TO ANY OF THESE 4 QUESTIONS PLEASE EXPLAIN BELOW:
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* PRESENT / LAST EMPLOYER
* ADDRESS
* CITY
* STATE
* ZIP CODE
* PHONE
* EQUIPMENT DRIVEN
* DATE HIRED
* DATE LEFT
* POSITION HELD
* REASON LEFT
 
SECOND TO LAST EMPLOYER
ADDRESS
CITY
STATE
ZIP CODE
PHONE
EQUIPMENT DRIVEN
DATE HIRED
DATE LEFT
POSITION HELD
REASON LEFT
 
THIRD TO LAST EMPLOYER
ADDRESS
CITY
STATE
ZIP CODE
PHONE
EQUIPMENT DRIVEN
DATE HIRED
DATE LEFT
POSITION HELD
REASON LEFT
 
FOURTH TO LAST EMPLOYER
ADDRESS
CITY
STATE
ZIP CODE
PHONE
EQUIPMENT DRIVEN
DATE HIRED
DATE LEFT
POSITION HELD
REASON LEFT
 

AGREEMENT:
TO BE READ BY APPLICANT

It is agreed and understood that the answers to the foregoing questions are true and correct, and that any misrepresentations of the information given above shall be considered an act of dishonesty.

It is agreed and understood that PATH Truck Lines, or its agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for damages on account of his/her furnishing such information.

The applicant agrees to furnish such additional information and complete such examinations as may be required to complete his/her application file.

It is agreed and understood that the completion of this application does not constitute authorization for the applicant to drive, nor does it obligate in any way PATH Truck Lines, to authorize the applicant to drive.

It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigating Consumer Report, including information regarding my character, general reputation, personal characteristics and mode of living.

It is also agreed and understood that PATH Truck Lines will be making a request for Driver Information Records from Transportation Information Services, Inc., d/b/a/DAC Services ("DAC") relating to applicant’s previous employment, including but not limited to, previous driver employment history, Motor Vehicle Record requests, Alcohol and Drug Test results, Criminal History, and Insurance Claim Reports. Such information will also include information from various State agencies which maintain records concerning traffic offenses, accidents, etc., as well as other information on file with DAC. Applicant, by execution of this Application, consents to the obtaining and authorizes the releasing of information to other companies, the above described information.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. Undersigned applicant for PATH Truck Lines hereby understands and acknowledges that a depository account at a participating financial institution is a requirement.

By electronic submission of this authorization, I agree that my identity may be verified by a telephone call in lieu of a signature. To complete agreement and send application type your name below and click on the Submit button.

* YOUR NAME:  

* Required Fields

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