Application for Employment

Transcription

1 Application for Employment In compliance with Federal and State equal employment opportunity, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, martial status, or the presence of a non-job related medical condition or handicap. Date of Application / / PLEASE PRINT Name First Middle Last Address Phone # Please list any other names you have used (alias) Please list any other addresses you have lived at during the past three years Are you legally authorized to work in the United States? Can you provide proof of eligibility to work? Have you ever been convicted of a crime? if yes, please explain

2 Rate of pay expected? When can you start? May we contact your previous employer? If no, please explain Education High School Field of Study (ex. college prep., vo-ag, business, electrical, carpentry) Years completed Graduated yes no College, Trade or Business School, Etc. Field of Study Years completed Graduated yes no Additional Skills/Training/Experience Please check any additional training/experience you have. Well Drilling Forklift Water Treatment Plumbing Truck Repair Welding Electrical Hazardous Materials Physical History Position applying for? Driller Drillers Helper Pump Installer Laborer Office Position Water Treatment Technician Do you have any physical condition which may limit your ability to perform the job applied for? If yes, explain Are you physically capable of heavy manual work? Date of last DOT prescribed physical examination Would you be willing to take a physical examination? (required to be a CDL driver by FMCSR, Title 49, Part 391)

3 Driving History Have you had any accidents in the past 3 years? Last accident: List Traffic Convictions and License Forfeitures for the past 3 years (other than parking violations) Driver License # State Expiration Date Class Endorsements Restrictions Are you over the age of 21 (required for interstate CDL drivers)? Have you ever been denied a license, permit or privilege to operate a motor vehicle? If yes, please describe all facts and circumstances Has any license, permit or privilege ever been suspended or revoked? If yes, please describe all facts and circumstances

4 Type of Equipment Driven Employment History Please list information of all employers during the preceding ten years. List most recent position first. Job Title Supervisor Phone Job Title Supervisor Phone Pay Rate start final Dates Employed from to Job Title Supervisor Phone Job Title Supervisor Phone Job Title Supervisor Phone Job Title Supervisor Phone

5 ACKNOWLEDGEMENTS ALL APPLICANTS I affirm that the information provided on this application or in connection with the processing of this application (and any resume or other accompanying documents) is true and complete to the best of my knowledge. I understand that if employed, false statements, significant omissions, or misleading information regardless of when discovered, made on or in connection with my application and accompanying documents may result in dismissal. I authorize investigation of all statements contained in this application (and any resume or accompanying documents) as may be necessary in arriving at an employment decision. I understand that my prior employers may be contacted for the purpose of investigating my background as required by 49CFR I authorize all personnel, schools, companies, corporations, credit bureaus, and law enforcement agencies to supply any and all pertinent information and release the same from any liability resulting from providing such information. I understand that from time to time the company may be asked to submit/release certain information, including but not limited to, my employment or application for employment. I release the company and its agents from any liability resulting from submitting/releasing such information. I acknowledge that the company may request, as a condition of any offer of employment that is made or for continued employment, that I undergo a medical exam, drug and alcohol testing, and I consent and agree to any such exam, if required now or in the future. I understand that when drug testing is required, a satisfactory result may be a condition of employment. I understand that federal law prohibits the employment of unauthorized aliens and requires satisfactory proof of employment authorization and identity inspection. All persons hired must submit satisfactory proof of employment authorization and identity. Please have necessary documents available for inspection as required by law. If employed, I agree to abide by the rules and regulations of the company. I understand that if I am employed, my employment is for no fixed period and is at-will. I understand that I could be terminated at any time for any or no reason and I understand that I may quit at any time for any or no reason. This understanding cannot be altered by anyone unless it is in writing and signed by the owner of the company. I understand that this application does not create an offer of employment. I understand that this company is an Equal Opportunity Employer. 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. I have read and understand the above notice. Signature of Applicant Print Name Date