Join Our Team Application for Employment Step 1 of 5 20% NOTICE: Applicant should read the following information carefully BEFORE filling out any of the questions on this form. Title VII of the Civil Rights Act of 1964, as amended, prohibits discrimination in employment because of race, color, sex, religion, or national origin. It is also illegal to discriminate in employment of persons because of their age if over forty. WE ARE AN EQUAL OPPORTUNITY EMPLOYER.Name First Middle Last Social Security Number Present Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have you lived at this address?YearsMonthsPhonePrevious Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have you lived at this address?YearsMonths Position Applied For Date You Can Start MM slash DD slash YYYY Salary DesiredAre you applying for Full-Time Part-Time Temporary Referred By Have you worked for this company before? Yes No If yes, where? If yes, when? If related to anyone in this organization, give name. EducationElementary SchoolName & LocationFrom (Month/Year)To (Month/Year)Graduate? (Y or N) High SchoolName & LocationFrom (Month/Year)To (Month/Year)Graduate? (Y or N) College or UniversityName & LocationFrom (Month/Year)To (Month/Year)Graduate? (Y or N) Business, Trade or Military (Specify)Name & LocationFrom (Month/Year)To (Month/Year)Graduate? (Y or N) ExperienceCheck kinds of work in which you have experience. Route Sales Vending Repair Fork Lift Driver Truck Driver (CDL) Warehouse Merchandising Grocery Retail Sales Auto/Truck Maintenance Production (Manufacturing) Food Service ExplainCDL Type: Have you ever been convicted or plead guilty or no contest to a crime other than a minor traffic violation? Yes No If yes, state citation, date, court, and place where offense occurred:Have you ever been terminated or asked to resign from any job? Yes No If yes, explain circumstances.A "yes" answer does not automatically eliminate you from consideration for employment. Former EmployersList below previous employers, starting with the last one first.Dates (MO/YR - MO/YR)Employer Name & AddressPhone #SalaryReason for Leaving U.S. Military ServiceDates (MO/YR - MO/YR)BranchHighest RankDuty SpecialtySalary Driving & Vehicle OperationApplicant to answer ONLY if applying as a Driver or Vehicle Operator.Check the types of vehicles you are qualified, through experience to operate. Passenger Car Light Truck Heavy Truck or Tractor Other Driver's License No.Date Expires MM slash DD slash YYYY Ever been suspended or revoked? Yes No Do you have auto insurance? Yes No Has it ever been cancelled or renewal refused? Yes No How many convictions for moving violations within the past three years? I understand that if I am hired, my employment will be for no definite period regardless of the period of payment of my wages. I further understand that I have the right to terminate my employment at any time, with or without notice, and that the Company has the same right. No one other than the General Manager of the Company has the authority to modify this relationship or make any agreement to the contrary. Any such modification or agreement must be in writing. I understand that the Company reserves the right to require me to submit a drug test at any time and also reserves the right to require me to submit to an alcohol test and/or medical examination to the extent permitted by law. I understand that a confirmed positive test or my refusal to submit to such testing is grounds for dismissal. I authorize the Company to investigate my driving record, my criminal record, references provided by me, and my credit history. I understand that I have the right to make a written request within a reasonable period of time to receive additional detailed information about the nature and scope of this investigation. I further understand that the company may contact previous employers, and I authorize those employers to disclose to the Company all records and other information pertinent to my employment with them. I also authorize the Company to provide truthful information concerning my employment with it to my future prospective employers, and I agree to hold it harmless for providing such information. I certify that all of the information I provide in my resume and in any interview will be true and accurate. I understand that if I am employed and any such information is later found false or misleading in any respect, I may be dismissed. This company intends to check and hold you responsible for the accuracy of the statements you make on this application. This application will receive consideration for sixty (60) days. If you have not heard from the Company within sixty (60) days and wish to receive further consideration for employment, you must reapply in person. DO NOT SIGN UNTIL YOU HAVE READ AND UNDERSTAND THIS STATEMENT.Date MM slash DD slash YYYY Signature of Applicant
