Application For Employment

Answer each question fully and accurately. No action can be taken on this application until you have answered all questions. Attach a separate page if you do not have enough room on this application. In reading and answering the following questions, be aware that none of the questions are intended to imply illegal preferences or discrimination based upon non-job-related information.

Position Applying For: Choose One Driver Helper Sales Today's Date: Date Available to Start:

First Name: Last Name: Middle Name:

E-mail: Phone Number: Cell Number:

Present Address:

City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code:

Are you seeking: Full Time Part Time Temporary __Employment

Are you 18 years of age or older?................................ yes no

If hired, can you furnish proof you are eligible to work in the U.S.?............. yes no

Have you ever applied here before? Yes No       If yes, When? Date:

Were you ever employed here? Yes No       If yes, When? Date:

Have you ever been convicted of any law violation?
Include any plea of "guilty" or "no contest."
(Exclude minor traffic violations.) Yes No       If yes, give details

If employed, do you expect to be engaged in any additional business
or employment outside of our job? Yes No         If yes, give details

For Driving jobs Only: Do you have a valid driver's license?   Yes No
      Driver's License Number   Class of License A B C   State Licensed In

Have you had your driver's license suspended or revoked in the last 3 years?     Yes No
If yes, give details:      

List professional, trade, business or civic activities and offices held.
(Exclude labor organizations and memberships which reveal race, color, religion,
national origin, sex, age, disability, genetic information or other protected status.)   

List Name and Address of Schools

High School or GED

Years Completed Received Choose One Diploma Degree Certificate None Subjects studied

College or University

Years Completed Received Choose One Diploma Degree Certificate None Subjects studied

Vocational or Technical

Years Completed Received Choose One Diploma Degree Certificate None Subjects studied

What skills or additional training do you have that relate to the job for which you are applying?

What machines or equipment can you operate that relate to the job for which you are applying?

List names of employers in consecutive order with present or last employer first. Account for all periods of time
including military service and any periods of unemployment. If self-employed, give firm name and supply business
references. Note: A job offer may be contingent upon acceptable references from current and former employers.

Name of Employer      Job Title and Duties

Address     Dates of Employment(MO/YR)

City,State,Zip Code         Pay Start $ Pay Final $

Supervisor(s) Telephone Reason For Leaving

Name of Employer      Job Title and Duties

Address     Dates of Employment(MO/YR)

City,State,Zip Code         Pay Start $ Pay Final $

Supervisor(s) Telephone Reason For Leaving

Name of Employer      Job Title and Duties

Address     Dates of Employment(MO/YR)

City,State,Zip Code         Pay Start $ Pay Final $

Supervisor(s) Telephone Reason For Leaving

Have you worked or attended school under any other names? Yes No

       If yes, give names:

Are you presently employed?   Yes No

    If yes, whom do you suggest we contact? 

Have you ever been fired from a job or asked to resign?     Yes No

    If yes, please explain:  

Give three references, not relatives or former employers.

Name Address Phone

Name Address Phone

Name Address Phone