Name
*
First Name
Last Name
Email Address
*
Date You Can Start
MM
DD
YYYY
What hours are you available for work?
Position
Type of Employment
Full-Time
Part-Time
Summer
Temporary
Are you employed now?
Yes
No
If so, may we contact your present employer?
Yes
No
Have you ever applied to this company before?
Yes
No
If so, where and when did you apply?
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
(###)
###
####
Social Security Number
Referred by
High School Attended
Location
Number of Years Completed
Did you graduate?
Yes
No
College Attended
Location
Number of Years Completed
Did you graduate?
Yes
No
If so, what is your degree?
Trade, Business, or Correspondence School Attended
Location
Number of Years Completed
Did you graduate?
Yes
No
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
(###)
###
####
Type of Business
Department
Your Position
Duties
Name and Position of Immediate Supervisor
Date Employed
MM
DD
YYYY
Date Left
MM
DD
YYYY
Reason for Leaving
Name of Employer
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
(###)
###
####
Type of Business
Department
Your Position
Duties
Name and Position of Immediate Supervisor
Date Employed
MM
DD
YYYY
Date Left
MM
DD
YYYY
Reason For Leaving
Name of Employer
Employer's Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer's Phone
Type of Business
Department
Your Position
Duties
Name and Position of Immediate Supervisor
Date Employed
MM
DD
YYYY
Date Left
MM
DD
YYYY
Reason For Leaving
Account for your time during any intervals of unemployment other than when you were attending school
To
From
To
From
Reference 1 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Reference 1 Phone
(###)
###
####
Reference 1 Relationship
REFERENCE 2
Reference 2 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Reference 2 Phone
(###)
###
####
Reference 2 Relationship
REFERENCE 3
Reference 3 Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Reference 3 Phone
(###)
###
####
Reference 3 Relationship
1. Do you have a Texas Commercial driver license with a clean driving record; no more than two moving violations in the last three years; no DWI or DUI convictions.
Yes
No
2. Do you have any criminal history of felony or misdemeanor convictions of any violent crimes, abusive behavior, sex offenses, or fraud in any jurisdiction.
Yes
No
3. Age 21 or older
Yes
No
Do you have a Commercial Driver’s License (CDL)?
Yes
No
Does your CDL contain a passenger endorsement?
Yes
No
Statement
*
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changes by any written document or by conduct unless an authorized executive of this organization specifically acknowledges such change in writing.
In the event of employment, I understand that false or misleading information given in my application or interviews may result in my not being hired or, if I am hired, to my termination from employment if discovered after hire. I understand, also, that I am required to abide by all rules and regulations of employer.
I understand I must pass a pre-employment physical, DOT drug and alcohol test, road test, operational training to become employed. I understand the agency has a zero drug and alcohol workplace.
I understand the agency will use an outside agency to perform background checks and No Criminal History should reflect in criminal background check
I understand the agency will use my driver license number to verify motor vehicle violations.
I agree that the information returned and provided in this application is true and correct