New Driver Application | NPS Express, Inc. NPS Express, Inc.

Application for Authorization to Drive for NPS Express, Inc.

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 disability.
Date of Application*
Date Format: MM slash DD slash YYYY
Position(s) Applied For*
Name*
First Last
Phone*
List your addresses of residency for the last 3 years.
Current Address*
Street Address Address Line 2 City State ZIP Code
How long have you lived here?*
Previous Address 1
Street Address Address Line 2 City State ZIP Code
How long have you lived here?
Previous Address 2
Street Address Address Line 2 City State ZIP Code
How long have you lived here?

This certifies that this application was completed by me, and that all entries on it and information on it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquires and releasing information in connection with my application.

In event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand also, that I am required to abide by all rules and regulations of the Company. I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:
- Review information provided by current previous employers.
- Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information in the prospective employer; and
- Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.*
PREVIOUS PRE EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT
In the past three years, have you tested positive, or refused to test, on any pre-employment drug or alcohol test, but did not get hired for a safety-sensitive-position as a result of the refusal or failure?*
- Yes
- No
Please provide proof that you have successfully completed the SAP Evaluation, recommended treatment, return to duty testing and follow-up testing.
Date*
Date Format: MM slash DD slash YYYY
Applicant's Name*
First Last

Application for Authorization to Drive for NPS Express, Inc.

Step 1 of 5

Employent History for Past 10 Years

Employer 2

Employer 3

Accident Record

Traffic Convictions

Driving Experience

PREVIOUS PRE EMPLOYMENT EMPLOYEE ALCOHOL AND DRUG TEST STATEMENT