APPLICATION FOR EMPLOYMENT

Transcription

1 FOR OFFICE USE ONLY Blue Whale Moving Company, Inc Springdale Road, Suite 100 Austin, TX UA Background Check Reference Check Hire Date First Work Date Date APPLICATION FOR EMPLOYMENT Blue Whale Moving is an equal opportunity employer and will consider all applicants for all positions without regard to their race, sex, age, color, religion, national origin, veteran status or any disability as provided in the Americans with Disabilities Act. This application will be given even consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and accurate manner as no action will be taken on this application until all questions have been answered. Name (First) (Middle) (Maiden, if any) (Last) Date of Birth: Social Security Number: Address for Past Three Years: Home Phone: Mobile Phone: Other Phone: Address: (Attach Sheet If More Space Is Needed) 1

2 DRIVER SECTION COMPLETE IF APPLYING FOR DRIVER POSITION EXPERIENCE AND QUALITICATIONS - DRIVER STATE LICENCE NO. TYPE EXPIRATION DATE Driver License DRIVING EXPERIENCE CLASS OF EQUIPMENT TYPE OF EQUIPMENT (VAN, TANK, FLAT, ETC.) FROM DATES TO APPROX. NO. OF MILES (TOTAL) ACCIDENT RECORD FOR PAST # YEARS OR MORE (ATTACH SHEET IF MORE SPACE NEEDED) DATES NATURE OF FATALITIES INJURIES ACCIDENT (HEAD-ON, REAR- END, UPSET, ETC.) LAST ACCIDENT NEXT ACCIDENT PREVIOUS ACCIDENT 2

3 TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) LOCATION DATE CHARGE PENALTY (ATTACH SHEET IF MORE SPACE NEEDED) A. Have you ever been denied a license, permit or privilege to operator a motor vehicle? Yes No B. Has any license, permit or privilege ever been suspended or revoked? Yes No IF THE ANSWER TO EITHER A OR B IS YES, ATTACH STATEMENT GIVING DETAILS END OF DRIVER SECTION EMPLOYMENT RECORD (Attach sheet if more space is needed) NOTE: DOT Requires that Employment for at least 3 years and / or Commercial Driving Experience for the Past 10 Years Be Shown LAST EMPLOYER: Name ADDRESS: POSITION HELD: FROM TO SALARY REASON FOR LEAVING: SECOND LAST EMPLOYER: Name: ADDRESS: POSITION HELD: FROM TO SALARY REASON FOR LEAVING: THIRD LAST EMPLOYER: Name ADDRESS: POSITION HELD: FROM TO SALARY REASON FOR LEAVING: 3

4 Are you a citizen of the U.S. or do you have the legal right to be employed in the U.S.? If yes, state the offense, location, date and disposition: Note: A conviction will not necessarily disqualify you from employment; however failure to disclose may result in immediate termination. Do you have the ability, with or without reasonable accommodations, to work overtime, work weekends, (Saturday and/or Sunday), or to travel if travel and or/overtime/weekends are required by the job for which you are applying? EMPLOYMENT DESIRED: Full Time Part Time Temporary or Summer Employment Position applied for: Salary Desired: Dave Available for Start: $ Have you ever applied to our company before? Have you ever worked for our company before? If yes to any of the above, state when and where you applied and/or worked: How did you learn of our company and/or position? Are you now, or do you expect to be, working in any other business or job? If yes, please specify those days or hours you would be unable or unwilling to work: EDUCATION Name, Address and Location Dates Graduate Courses Studied 4

5 High School College Trade School If you did not graduate, why did you leave high school or college? Are you planning to pursue further studies? If yes, when, where and what courses: List any scholastic honors, offices held, activities involved in during high school or college: List and describe any other School or Specialized Training: MILITARY: Have you ever served in the military? Service Branch: Date Entered: Would you be willing and able to perform all of the tasks required by the job you are applying for? If no, explain which tasks: Have you ever filed any type of fraudulent claim against any of your present or past employers? If yes, explain: Will you abide by the safety rules of this company? 5

6 Are you able to work overtime and/or weekends? Are you willing and able to report to work on time every day? If hired, do you have reliable means of transportation to get to work? Do you type? Words per minute: Have you had any computer or word processing experience? List any other special skills you have that may contribute to the position for which you are currently applying: REFERENCES NAME PHONE OCCUPATION RELATION I authorize Blue Whale Moving Company to conduct a criminal background check, request copies of driving records, motor vehicle insurance documents or any other documented information pertaining to my position. I understand and agree to a drug screening required of all Blue Whale employees upon hire. I fully agree and understand that any physical and mental examination can be requested. I do understand and agree that if I am employed by Blue Whale that employment is for an indefinite period of time and that during my employment, wages, benefits and conditions of employment may change at any time. I do fully understand and agree with all conditions and statements of this application, and that any untruths or falsified information I have given on this application may result in no hire or an immediate dismissal. 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. Applicant s Signature: Date: 6