Employee Information
Are you able to perform the essential functions of the position with or without accommodations? yes no
If necessary for the job are you older than: (check one) 18 19 21
I am legally eligible for employment in the U.S.? yes no
I am seeking a permanent position: yes no
I will be able to report to work this many days after being notified I am hired. Immediately One Week Two Weeks Three Weeks Four Weeks More Than Four Weeks
If necessary for the job, I am able to:
Work Overtime? yes no
Provide a valid driver's license? yes no
If so, fill out the following:
Endorsement(s): Hazardous Material Passengers Tankers Tank with Hazardous Materials School Bus Double/Triple Trailers
Work the following shifts: (check all that apply) Any Day Night Swing Rotating Split Graveyard/Other
Employment History
Note: List most recent employment first. Include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here or in the summary following this section or. No more than 10 years history recommended.
Most Recent
Next Most Recent
Next Most Recent
Next Most Recent
Summarize other employment related to this job:
Education
Please List High School, College/University, Business/Technical Or Additional
Military
Are you a veteran? yes no
Duty/Specialized Training:
Skills & Qualifications
Other qualifications such as special skills, abilities or honors that should be considered:
Types of computers, software, and other equipment you are qualified to operate or repair:
Professional licenses, certifications or registrations:
Additional skills, including supervision skills, other languages or information regarding the career/occupation you wish to bring to the employer’s attention:
Typing speed per minute:
References
Note: List two personal references who are not relatives or former supervisors.
Reference #1
Reference #2
Contact
In case of accident or illness, please contact:
Information to the applicant
As part of our procedure for processing your employment application, your personal and employment references may be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discharged from your job. You may make a written request for information derived from the checking of your references.
If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United States, have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by its terms. I understand and agree to the information shown above.
Equal Employment Opportunity: While many employers are required by federal law to have an Affirmative Action Program, all employers are required to provide equal employment opportunity and may ask your national origin, race and sex for planning and reporting purposes only. This information is optional and failure to provide it will have no affect on your application for employment.
