Rider Authorization - Imlach & Collins

Careers > Rider/Helper Authorization Form

Rider/Helper Authorization and
No Controlled Substance or Alcohol Agreement Form

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Step 1 of 2 - No Controlled Substance - No Alcohol Agreement Form

Today's Date*
Date Format: MM slash DD slash YYYY
Professional Van Operator/Driver*
Helper Consent to No Alcohol/Drugs*
- By selecting yes, this confirms that you do not have any illegal drugs, drug paraphernalia or alcohol in your possession and you consent to the search of any items you bring on to the PVO/Driver's equipment.
Helpers Full Name*
First Middle Last

Rider/Helper Authorization
Date of background check*
Date Format: MM slash DD slash YYYY
CID #
Today's date
Date Format: MM slash DD slash YYYY
Full Name*
First Last
Age*
No one under 18 years of age is allowed on any unit in Atlas Service.
Name of Person to Contact in Case of Emergency*
First Last
Address of emergency contact*
Street Address City State ZIP Code
Phone Number of Emergency Contact*
Authority For Rider Begins on this Date*
Date Format: MM slash DD slash YYYY
Authority For Rider Begins in this City & State*
Authority For Rider Expires on this Date*
Date Format: MM slash DD slash YYYY
Authority For Rider Expires in this City & State*
City State
Unit Number*
Driver*
Code*
Atlas Agent and Code*
Selecting "Yes" acts as the Signature of the Agent Manager*
NOTE: There is to be a separate letter for each rider and unit. The original must be carried by the helper, a copy should be mailed to Atlas/Safety and a second copy must be kept in the agency's/PVO/Driver's file.
Consent*
I agree to the content below.
As a Professional Van Operator/Driver with Atlas Van Lines, the professionalism I exhibit is very important to me in my chosen career. I expect anyone working with me to perform their duties with the same professionalism.

I have zero tolerance for the use of any controlled substances or alcohol on the job. For myself, and my crew, we must follow all federal, state and local laws, as well as the rules and regulations of Atlas Van Lines, as they pertain to drugs/alcohol. Anyone associated with me will not be in possession of any type of illegal substance, paraphernalia or alcohol, in any quantity or amount, while in my employ. To ensure that a member of my crew does not have any of these forbidden articles in their possession, I reserve the right to search any item brought on to my equipment.

If drugs/alcohol are found on my truck/trailer: I can be arrested, handcuffed, fined and terminated by Atlas. My career and my life can be severely/negatively impacted and cost me thousands of dollars. My career and reputation are too important to me, to allow anything illegal to interfere with my life and my chosen career.