Employment Application

Employment Application

Please answer all questions completely! If more space is needed to give complete answers, please use the additional space provided. Please print clearly! Equal Employment Opportunity / Affirmative action policy: All qualified applicants will receive consideration without regard to race, color, religion, national origin, ancestry, sex, age, marital or veteran status, a medical condition unrelated to the job, handicap, or another legally protected status.

APPLICANT INFORMATION:

Careers

Full Name *

Position Applied for: *

How did you hear about this opportunity? *

Date *

Phone *

Address *

City *

State/Province *

Zip *

Date Available to Start: *

Desired pay rate: *

Please answer the questions by checking the appropriate box

Are you willing to work out of town (overnights)? *

Yes

Are you willing to work Saturdays as needed? *

Yes

Are you willing to work overtime? *

Yes

If you have any limitations on the hours that you can work, please explain: *

Do you know anyone that works for us? *

Yes

If yes, who?

Do you have reliable transportation to get to and from work? *

Yes

Are you authorized to work in the US? *

Yes

Are you 18 years of age or older? *

Yes

EDUCATION:

High School:

City / State

Did you graduate?

Yes

College Degree (if applicable)

College:

City / State

Did you graduate?

Yes

College Degree (if applicable):

Other

City / State

Did you graduate?

Yes

Other Degree (if applicable):

PREVIOUS EMPLOYMENT:

Please list at least 3 previous employers

Previous Employer1 *

Phone *

Supervisor *

Address(City/State) *

Job Title *

Job responsibilities & duties *

Start Date *

End Date *

Reason for leaving *

May we contact your previous supervisor for a reference? *

Yes

PREVIOUS EMPLOYMENT-2

Previous Employer2 *

Phone *

Supervisor *

Address(City/State) *

Job Title *

Job responsibilities & duties *

Start Date *

End Date *

Reason for leaving

May we contact your previous supervisor for a reference?

Yes

PREVIOUS EMPLOYMENT-3

Previous Employer3

Phone

Supervisor

Address(City/State)

Job Title

Job responsibilities & duties

Start Date

End Date

Reason for leaving

May we contact your previous supervisor for a reference?

Yes

Add Remove

REFERENCES:

Please list 3 professional references that we can contact.

Professional Reference #1: *

Relationship *

Phone *

Professional Reference #2: *

Relationship *

Phone *

Professional Reference #3: *

Relationship *

Phone *

SKILLS & QUALIFICATIONS:

List any skills, course work, certificates, and licenses that you’ve acquired that would be of benefit to you for the position that you are applying for *

DRIVER INFORMATION:

Do you have an active driver's license? *

Yes

Do you currently possess a valid Class A CDL? *

Yes

If yes, list the endorsements that you have

When does your current license expire? *

Do you have a DOT medical examiner’s Cert?

Yes

If yes, when does it expire?

DRIVING EXPERIENCE:

Equipment Description Straight Truck

Type (Van, tank, flat, etc.)

Dates (years)

Approx. total miles

Equipment Description Tractor & Semi

Type (Van, tank, flat, etc.)

Dates (years)

Approx. total miles

Equipment Description Other

Type (Van, tank, flat, etc.)

Dates (years)

Approx. total miles

Can you drive a manual (stick shift) transmission? *

Yes

Have you completed any special courses on driver training?

Yes

If yes, list the training

ACCIDENT REVIEW:

Include information from the previous 3 yrs. Write “none” if none. Use additional space provided if needed!

. Most recent accident

Description of Accident *

Date

List Injuries

Fatalities?

Most recent accident Most recent accident

Description of Accident

Date

List Injuries

Fatalities?

TRAFFIC VIOLATIONS / CONVICTIONS:

other than parking tickets. List info. from the previous 3 yrs. Write “none” if none. Use addtl. space provided if needed!

. #1

Violation *

City/State

Date

Penalty

2 #2

Violation

City/State

Date

Penalty

ADDITIONAL INFORMATION:

(list any info. about yourself here that you care to add)

Work Authorization
Before any applicant can begin work, the person must be able to verify, under Federal law, that he or she is authorized to work in the United States. All applicants offered a position with The Hole Deal, Inc. will have to document their authorization to work before the hiring process will be complete. All applicants are being notified that, if selected for hire, it will be your responsibility to provide The Hole Deal, Inc. with the documentation showing your right to work. The Hole Deal, Inc. is giving you this notice so you that you may have those documents ready if you should be offered a position with The Hole Deal, Inc. If/when a conditional offer of employment is made, the Human Resources Department will review the documents at that time.

Drug Screen / Background Check

Any job offers made by The Hole Deal, Inc. are conditional upon the results of a drug screen and a criminal and driving background check. These tests/check will be conducted at The Hole Deal, Inc.

CERTIFICATION AND AGREEMENT

Please read carefully

1.Certification of Truthfulness
I certify that all statements on this application for employment and any attached resume are made completely,truthfully, and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed, or if employed, may result in my dismissal.
2. Authorization for Release of Information
I authorize the references and any academic institution I have listed above, and any prior or current employer of mine, to give The Hole Deal, Inc. any information concerning my previous employment or education, including any disciplinary information, and any pertinent information they may have, personal or otherwise. I release all parties from liability for any damage that may result from furnishing this information to The Hole Deal, Inc. Also, I hereby waive any right to receive written notice that employment information is being provided by any person or organization
3. Authorization to Obtain Motor Vehicle Record & Background Check
I authorize The Hole Deal, Inc. to obtain a report from any state or local agency concerning my motor vehicle operator’s record. I furthermore authorize The Hole Deal, Inc. to obtain a background check on me. I understand that the information contained in those records may be considered in determining my eligibility for employment. I also understand that if I am hired, The Hole Deal, Inc. has the right to obtain a report of my motor vehicle operator’s record & background check from time to time, and that such records may be considered in determining my eligibility qualifications for continued employment.
4. Employment at Will
If hired, in consideration of my employment, I agree to abide by the rules and policies of The Hole Deal, Inc. I further agree that such employment and all compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either The Hole Deal, Inc. or myself. I understand that no agent or representative of The Hole Deal, Inc. has any authority to make any agreement contrary to the foregoing, except by a written employment contract signed by the President of The Hole Deal, Inc.

Signature *

Clear

Date *

Please submit your cover letter and resume (optional)

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Employment Application