A. Duie Pyle
West Chester, PA 19381
**-**-**** *:23:52PM CDT
IntelliApp
Thank you for your interest in a position with A. Duie Pyle. To apply for a driving position, please complete our online application for employment. Incomplete information will delay the processing of your application or prevent it from being submitted.
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, veteran status, non-job related disability, or any other protected group status.
Personal Information
Referral Code: INDLTLPDNYALA
Name Vic Khandai Parmanand
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
Current Address 1235 Main St
City, State/Province Zip/Postal Schenectady, NY 12303 Country United States
Residence 3 years or longer (If No,
previous addresses shown below)
Yes
SSN/SIN 8178
Date of Birth
Primary Phone 718-***-****
Cell Phone 718-***-****
Preferred method of contact Cell Phone
Best time to contact you Any
Email *************@*****.***
Yes, I agree to receive information
concerning future opportunities or
promotions from A. Duie Pyle by email or
other commercial electronic
communications.
Yes
Would you like to receive communication
from A. Duie Pyle via text message?
By participating, you consent to receive
text messages sent by an automatic
Yes
1
telephone dialing system, which may
contain recruiting/advertising messages.
Consent to these terms is not a condition
of being hired, contracted, or leased. You
may opt out at any time by texting STOP to
unsubscribe. You also agree that A. Duie
Pyle's service provider receives in real
time and logs your text messages with A.
Duie Pyle.
Company Questions
GENERAL INFORMATION
What position are you applying for? Dedicated Tank/Flat Driver What location are you applying for? NY, Albany
If you have spoken to a recruiter, please
select their name:
How did you hear about us? Facebook
Are you legally eligible for employment in
the United States?
Yes
Are you currently employed? Yes
What date did your last employment end?
Do you read, write, and speak English? Yes
Have you ever worked for this company
before?
No
Enter start and end dates, location,
position, and reason for leaving:
Do you have a current TWIC card? No
Expiration date:
Please enter the names of any relatives
employed here:
None
Have you ever been known by any other
name?
No
Enter name:
Who referred you?
In case of Emergency, notify (list name,
address, and phone):
Jasmattie Parmanand 1235 main st
Schenectady ny
DRIVING EXPERIENCE
For each class of equipment, enter type of equipment (van, reefer, tank, etc.), start and end dates, and approximate number of total miles. If no experience in a class, enter
"NONE".
2
Straight Truck 1000000 mi
Tractor and Semi-Trailer 1000000 mi
Tractor - Two Trailers O
Other N0
Which safe driving awards do you hold and
from whom?
EQUIPMENT (OWNER/OPERATORS ONLY)
Equipment Description (Tractor):
Type:
Year:
Make:
Model:
Color:
VIN:
Weight
Mileage
Fifth Wheel Height
Tire Size
EDUCATION
List highest grade completed: GED
List last school attended (name, city, and
state):
Guyana
PERSONAL REFERENCES
List name, address, city, state, phone number, and relationship: First Reference: Frank 518
Second Reference: Kumar 518
Licenses
License Number 445
State/Province NY
Country United States
License Class Class A
License Expiration Date 09-11-2023
Physical Expiration Date 08-15-2021
Current License Yes
3
Commercial Driver License Yes
Endorsements
Tanker Endorsement Yes
HAZMAT Endorsement Yes
Hazmat Expiration Date 03-11-2025
X Endorsement Yes
Doubles Triples Endorsement Yes
Other Endorsement No
Employment / Unemployment
VKP TRANSPORT LLC
Company VKP TRANSPORT LLC
Start Date 04-2017
End Date 04-2021
Address 1235 main st
City, State/Province Zip/Postal Schenectady, NY 12303 Country United States
Phone 718-***-****
Position Held Owner
Reason for leaving? Closed buisness
Were you terminated/discharged/laid off? No
Is this your current employer? No
May we contact this employer at this time? Yes
Did you operate a commercial motor
vehicle?
Yes
Were you subject to the Federal Motor
Carrier or Transport Canada Safety
Regulations while employed/contracted by
this employer/contractor?
Yes
Did you perform any safety sensitive
functions in this job, regulated by DOT,
and subject to drug and alcohol testing?
Yes
Areas Driven Ny
Miles driven weekly 2500-3000
Most common truck driven Bus - Straight
4
Most common trailer Tank Trailer
Trailer length 53 feet or more
Motor Vehicle Record
1. Has any license, permit or privilege ever
been denied, suspended or revoked for
any reason?
No
2. Have you ever been convicted of driving
during license suspension or revocation, or
driving without a valid license or an expired
license, or are any charges pending?
No
3. Have you ever been convicted for any
alcohol or controlled substance related
offense while operating a motor vehicle, or
are any charges pending?
No
4. Have you ever been convicted for
possession, sale or transfer of an illegal
substance (including but not limited to,
marijuana, amphetamines, or derivatives
thereof) while on duty, or are any charges
pending?
No
5. Have you ever been convicted of
reckless driving, careless driving or
careless operation of a motor vehicle, or
are any charges pending?
No
6. Have you ever tested positive, or
refused to test on a pre-employment drug
or alcohol test by an employer to whom
you applied, but did not obtain
safety-sensitive transportation work
covered by DOT agency drug and alcohol
testing rules in past three years, or have
you ever tested positive or refused to test
on any DOT-mandated drug or alcohol
test?
No
Vehicle Accident Record
Were you involved in any accidents/incidents with any vehicle in the last 3 years (even if not at fault)?
No Accidents
5
Traffic Convictions \ Violations
Have you had any moving violations or traffic convictions in the past 3 years? No Violations
Signature
Full Name Vic Khandai Parmanand
IP Address 2607:fb90:ab82:1
Signature Date/Time 04-21-2021 3:23 PM
By signing my application below, I agree to use an electronic signature to demonstrate my consent. An electronic signature is as legally binding as an ink signature. 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.
Signed Date: 04-21-2021 3:23 PM
Signed:
Federal FCRA Summary of Rights Acknowledgment
By checking this box, I (a) acknowledge
that I have read and understand the
federal FCRA Summary of Rights and
have been given the opportunity to
copy/print the Summary of Rights and (b)
agree to use an electronic signature to
demonstrate my consent. An electronic
signature is as legally binding as an ink
signature.
Yes
New York State Article 23-A Notice
By checking the box, I (a) acknowledge
that I have read and understand the New
York State Correction Law Article 23-A and
have been given the opportunity to
copy/print it and (b) agree to use an
electronic signature to demonstrate my
acknowledgment. An electronic signature
is as legally binding as an ink signature.
Yes
6
PSP Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the PSP
Disclosure and Authorization and also
have been given the opportunity to
copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Additional Consent or Certification
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
FCRA Disclosure and Authorization
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Employment Verification Acknowledgment and Release (DOT Drug and Alcohol) By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
Clearinghouse Release
By checking the box, I (a) acknowledge
that I have read and understand the above
and also have been given the opportunity
to copy/print it, and (b) agree to use an
electronic signature to demonstrate my
consent. An electronic signature is as
legally binding as an ink signature.
Yes
7
User Requested Copy
User requested a copy to be sent to this
email address
*************@*****.***.
Yes
8
DISCLOSURE
In connection with your employment or application of employment (including contract for services) through A. Duie Pyle, consumer reports
(Investigative Consumer Reports in California) may be requested from the various consumer reporting agencies below. These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and drug/alcohol use. Such reports may contain public record information concerning your driving record, workers compensation claims, credit, bankruptcy proceedings, criminal records, etc. from federal, state and other agencies that maintain such records; as well as information from Consumer reporting agencies concerning previous driving record requests made by others from such state agencies and state provided driving records.
We also will obtain driving/accident and safety inspection history records maintained by the Federal Motor Carrier Safety Administration ("FMCSA"). You have the right to make a request to Consumer reporting agencies, upon proper identification, to request the nature and substance of all information in its files on you at the time of your request, including the explaining of any coded information, the sources of information and the recipients of any reports on you that Consumer reporting agencies has previously furnished within the past two year period preceding your request (3 years in California). Consumer reporting agencies may be contacted: HireRight, LLC
3349 Michelson Drive, Suite 150
Irvine, CA 92612
Phone: 866-***-****
Fax: 877-***-****
E-mail: ***************@*********.***
Web: http://www.hireright.com/applicants
Driver Facts
5051 E. Orangethorpe Avenue
Suite E265
Anaheim, CA 92807
Phone: 1-888-***-****
Web: www.driverfacts.com
https://www.driverportal.com/index.asp
Tenstreet
120 W. 3rd Street
Tulsa, OK 74103
Phone: 877-***-****
Email: *******@*********.***
Web: http://www.tenstreet.com/drivers/
For Pre-Employment Screening Program (PSP):
U.S. Federal Motor Carrier Safety Administration, of the Department of Transportation, ("FMCSA-DOT") 1200 New Jersey Avenue SE
Washington, DC 20590
Phone: 800-***-****, TTY 800-***-****
Web: https://dataqs.fmcsa.dot.gov/Default.aspx
Equifax Workforce Solutions (Work Number)
ATTN: DISPUTE
3470 Rider Trail South
Earth City, MO 63045
Phone: 1-866-***-****
Web: https://www.theworknumber.com/Employees/employee-data-dispute/index.asp Sterling Talent Solutions
4511 Rockside Road
4th Floor
Independence, OH 44131
Phone: 888-***-****
Email: *******.**********@**********.***
Web: www.sterlinginfosystems.com
I AUTHORIZE, WITHOUT RESERVATION, THE AFOREMENTIONED CONSUMER REPORTING AGENCIES AND ANY OTHER PARTY OR 9
AGENCY CONTACTED BY CONSUMER REPORTING AGENCIES TO FURNISH THE ABOVE MENTIONED INFORMATION. THIS AUTHORIZATION DOES NOT APPLY TO DRUG AND ALCOHOL INFORMATION CONTAINED UNDER PART I. I hereby consent to your obtaining the above information from Consumer reporting agencies, and I agree that such information which Consumer reporting agencies has or obtains in my employment history (not DOT drug and alcohol information without a specific consent by me) with you if I am hired, will be supplied by Consumer reporting agencies to other companies which subscribe to Consumer reporting agencies. I hereby authorize procurement of consumer reports as set forth above. If hired or contracted, this authorization for reports covered by this release only shall remain on file and shall serve as an ongoing authorization for you to procure consumer reports at any time during my employment or contract period as applicable by law. I consent to you obtaining the above information from FMCSA. I understand that the FMCSA maintains sole control over that data and you cannot change or alter such information. If I dispute any information maintained by FMCSA, I must personally contact the FMCSA by accessing the DataQs System at: https://dataqs.fmcsa.dot.gov.
Printed Name:
Vic Khandai Parmanand
Social Security #:
8178
Signed Date: 04-21-2021
Vic Khandai Parmanand
1235 Main St
Schenectady, NY 12303
Gender:
10
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service In connection with your application for employment with A. Duie Pyle ("Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration
(FMCSA).
When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report. When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act. Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.
Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report. The Prospective Employer cannot obtain background reports from FMCSA without your authorization. AUTHORIZATION
If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below: I authorize A. Duie Pyle ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.
I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication. I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report. I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above. Printed Name:
Vic Khandai Parmanand
Signed Date: 04-21-2021
11
Consent for Limited Queries of the Federal Motor Carrier Safety Administration (FMCSA) Drug and Alcohol Clearinghouse
I hereby provide consent to A. Duie Pyle to conduct a limited query of the FMCSA Commercial Driver's License Drug and Alcohol Clearinghouse to determine whether drug or alcohol violation information about me exists in the Clearinghouse. I understand this consent shall remain on file and shall serve as ongoing consent for A. Duie Pyle to conduct multiple limited queries of the Clearinghouse at any time during my employment or contract period without asking me for additional consent. I understand that if I refuse to provide consent for A. Duie Pyle to conduct a limited query of the Clearinghouse, A. Duie Pyle is required to prohibit me from performing safety-sensitive functions, including operating a commercial motor vehicle. I understand that if the limited query conducted by A. Duie Pyle indicates that drug or alcohol information exists about me in the Clearinghouse, the FMCSA will not disclose that information to A. Duie Pyle unless I give additional specific consent within the Clearinghouse. However, I understand that A. Duie Pyle will be required to conduct a full query of the Clearinghouse within 24 hours after a limited query indicates that drug or alcohol information exists and that if I do not grant consent within the Clearinghouse for that full query I will be removed from performing safety-sensitive functions, including operating a commercial motor vehicle. 04-21-2021
Vic Khandai Parmanand Date
12
TO BE READ AND SIGNED BY APPLICANT
I certify that I have read and understood all of this employment application. It is agreed and understood that the prospective employer or his agents may use the information I have provided and will contact my previous employers for the purpose of investigating my safety performance history information as required by 49 CFR 391.23 and may investigate my background to ascertain any and all information of concern to my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks that are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test. I understand that if offered a job, it may be conditioned on the results of an investigation of my workers compensation history and I give my consent to the A. Duie Pyle Companies to inquire and request from any previous employer, local, state or federal agency, the release of any information regarding past injuries or workers compensation history that may exist as part of my job application and the screening process. I understand that if my employment history includes Department of Transportation regulated employment during the preceding three years, that I have certain rights regarding investigative information that will be provided to my prospective employer from this employment history that relates to my accident record and to DOT regulated alcohol and controlled substance testing to the extent I was employed in a safety-sensitive function. This includes: the right to review information provided by DOT regulated previous employers; the right to have errors in the information corrected by the DOT regulated previous employer and for that previous employer to re-send the corrected information to the prospective employer; and the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and I cannot agree on the accuracy of the information. If I wish to review previous employer-provided investigative information from a DOT regulated employer, I must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. This written request must be submitted to the following address: Loss Prevention Department / Attention: DOT Compliance Analyst / A. Duie Pyle Companies / P.O. Box 564 West Chester, PA 19381- 0564. I further understand that the prospective employer must provide this information to me within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business days deadline will begin when the prospective employer received the requested safety performance history information. If I have not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective employer may consider me to have waived my request to review the records. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and no other reason.
It is also agreed and I understand that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an investigative Consumer Report, including information regarding my character, general reputation, personal characteristics and mode of living. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer. I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME. IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.
Printed Name: Vic Khandai Parmanand
Social Security #: 8178
Signed Date: 04-21-2021
Signed:
13
Request/Consent for Information from Previous Employer(s)/Carrier(s) For Alcohol and Controlled Substances Testing Records
And changes in Parts 390 and 391 of the FMCSA
X 04-21-2021
Date
X 8178
Social Security Number
Vic Khandai Parmanand
1235 Main St
Schenectady, NY 12303
Gender:
X Vic Khandai Parmanand
Print Name (First, MI, Last)
X
Signature
I, the above mentioned signer, hereby authorize VKP TRANSPORT LLC To release and forward in accordance with the following regulation, all known information pertaining to my alcohol and controlled substances testing/training records to A. Duie Pyle
DISCLOSURE AND RELEASE
In accordance with DOT Regulation 49 CFR Part 391.23, I authorize the release of information from my DOT regulated drug and alcohol testing records by the carriers (company/school) listed above to A. Duie Pyle, or to HireRight for the sole purpose of transmitting such records to A. Duie Pyle. I authorize release of the following information concerning DOT drug and alcohol testing violations including pre-employment tests during the past three years: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested (including verified adulterated or substituted results); (iv) other violations of DOT drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation(s); and (vi) documents, if any, of completion of a return-to-duty process following a rule violation. I also authorize the carriers (company/school) listed above to release information about names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials and other information.
The information that I have authorized A. Duie Pyle or HireRight to review involves tests required by DOT. If any carrier (company/school) listed above furnishes A. Duie Pyle or HireRight with information concerning items (i) through (vi) above, I also authorize that carrier (company/school) to release and furnish the dates of my negative drug and/or alcohol tests and/or tests with results below 0.04 during the three-year period and the name and phone number of any substance abuse professional who evaluated me during the past three years.
14
A Summary of Your Rights Under the Fair Credit Reporting Act Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552.
A Summary of Your Rights Under the Fair Credit Reporting Act The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the FCRA. For more information, including information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20552. You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of consumer report to deny your application for credit, insurance, or employment - or to take another adverse action against you - must tell you, and must give you the name, address, and phone number of the agency that provided the information.
•
You have the right to know what is in your file. You may request and obtain all the information about you in the files of a consumer reporting agency (your "file disclosure"). You will be required to provide proper identification, which may include your Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
a person has taken adverse action against you because of information in your credit report;
you are the victim of identity theft and place a fraud alert in your file;
your file contains inaccurate information as a result of fraud;
you are on public assistance;
you are unemployed but expect to apply for employment within 60 days. In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.
•
You have the right to ask for a credit score. Credit scores are numerical summaries of your