Larry Vititow Trucking, LLC
Non-Driver Employment Application
Personal Information |
| Last Name |
|
| First Name |
|
| Middle Name |
|
| Is any additional information relative to change of name, use of assumed name, or nickname necessary to enable a check on the information that you are providing on this form? |
|
| If yes, please explain. |
|
|
Social Security |
-
-
|
| Driver's License Number and issuing state |
,
|
| Phone Number |
(
)
|
| Alternate Phone Number |
(
)
|
| E-mail Address |
|
| Date of Birth |
Month
Day
Year
|
| Home Address - Street |
|
| City |
|
| State |
|
| Zip |
|
| Have you lived at this address for more than 3 years? |
|
| If no, list all residential addresses for the last 3 years. Include street address, city, state, and zip code. |
|
| Are you a United States citizen? |
|
| If no, can you verify legal right to work in the United States? |
|
| If you are under 18, can you furnish a work
permit? |
|
| Date Available for work |
Month
Day
Year
|
| If necessary, best time to call you at home |
|
| Are you employed? |
Yes
No
|
| May we call you at work? |
Yes
No
|
| How were you referred to us? |
|
| If yes, list work phone number and best time to call you |
|
| What type of employment are you seeking? |
Full Time
Part Time
Temporary
Seasonal
Work/Study
|
| What job position are you seeking? |
|
| How many years experience do you have in this position? |
|
Some positions require physical agility, heavy exertion, and lifting (Examples: dock, driving, yard, and shop jobs) Do
you have any physical condition that may limit your
ability to perform the job for which you are applying?
|
Yes
No
|
| If yes, what can be done to accommodate your limitation? |
|
| Have you previously applied for a position with this company? |
Yes
No
|
| If yes, provide date of previous application. |
|
| Have you been previously employed by this company? |
Yes
No
|
| If so, where? |
|
| If so, when? |
From
To
|
| Have you been convicted of felony in the last seven (7) years that resulted in imprisonment? (Such conviction may be relevant if job related, but does not bar you from employment.) |
Yes
No
|
| Have you served in the military? |
Yes
No
|
| If yes, list any skills list learned that you believe are relevant to the position for which you are applying. |
|
| Are you on a lay-off and subject to recall? |
Yes
No
|
| Are you willing to relocate, if necessary? |
Yes
No
|
| Are you willing to travel, if necessary? |
Yes
No
|
| Are you willing to work overtime, if necessary? |
Yes
No
|
| Are you willing to undergo a pre employment physical, if necessary? |
Yes
No
|
| Have you ever been bonded? |
Yes
No
|
| Personal References - Do not list relatives |
| 1. Name |
|
| Relationship |
|
| Telephone Number |
(
)
|
| How long have you known this person? |
|
| 2. Name |
|
| Relationship |
|
| Telephone Number |
(
)
|
| How long have you known this person? |
|
| 3. Name |
|
| Relationship |
|
| Telephone Number |
(
)
|
| How long have you known this person? |
|
| Employment History |
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
Dates of Employment -
Previous Employer -
Telephone number(
)
Address
State
Immediate supervisor and title
Your
Hourly Rate/Salary - Start
per
Hourly Rate/Salary - End Start
per
Summarize the nature of the work you performed and job responsibilities
May we contact your former employer for a reference?
Yes
No
Later
|
| Skills and Qualifications |
|
Summarize special skills and qualifications acquired from employment or other experiences that may qualify you for work with our Company.
|
| Education |
1. List last three (3) schools attended, starting with last one. 2. List number of years completed. 3. Indicate degree or diploma earned, if any. 4. Grade Point Average or Class Rank and 5. major and minor field of study (if applicable).
|
| Activities and Awards |
List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, ancestry, handicap, or other protected status.)
|
| Additional Information |
List any additional information you would like us to consider.
|
| Resume |
Paste your resume (in plain text) below.
|
| Agreement |
| Applicant read thoroughly and accept before submitting.
It is understood and agreed that any misrepresentation by me in this application will be sufficient cause for cancellation of this application and/or separation from the employer's service if I have been employed. Furthermore, I understand that just as I am free to resign at any time, Larry Vititow Trucking (hereinafter referred to as the Employer) reserves the right to terminate my employment at any time, with or without cause and without prior notice. I understand that no representative of the Employer has the authority to make any assurances to the contrary.
I give the Employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Employer and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.
The Employer is an equal opportunity employer. The Employer does not discriminate in employment and no question on this applications is used for the purpose of limiting or excluding any applicant's consideration for employment on a basis prohibited by local, state, or federal law.
This application is current for only (60) days. At the conclusion of this time, if I have not heard from the Employer and still wish to be considered for employment, it will be necessary for me to fill out a new application.
I certify that this application was completed by me and that all entries on it and information in it are true and complete. Furthermore, I have read and understand all of the conditions upon which this offer of employment is made.
By entering your name in the box, below, you acknowledge you have read and agree to all the content above.
|