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R&J
Trucking Company Inc. Maintenance Department |
Employment Application |
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We
are an Equal Opportunity Employer. We consider applicants for all positions
without regard to race, color, creed, religion, sex, national origin, age,
marital or veteran status, the presence of a non-job related medical
condition or handicap, and any other legally protected status. It is our
policy to abide by all Federal, State and local laws concerning
discrimination in employment. No question in this application is intended to
elicit information in violation of any such law nor will any information
obtained in response to any question be used in violation of any such law. |
PERSONAL INFORMATION |
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Last
Name
First Middle |
Date
of Application |
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Street
Address |
Home
Phone ( ) |
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City,
State, Zip |
How
Long at Present Address ? |
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Were
you previously employed by this organization ? [ ] Yes, Date (s) Department:
[ ] No |
Social
Security Number |
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Have
you previously applied for work to this organization ? [ ] Yes, Date (s) Department:
[ ] No |
Drivers
License No. (State) CDL ?
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Referral
source: (circle one)
Advertisement Employee Relative Employment Agency
Walk-in If
advertisement which Newspaper or other source: |
Birth
Date |
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Check
the following options which you would consider: [ ] Full-Time [ ] Part-Time [
] Temporary [ ] Seasonal |
Date
Available for work |
Position
Applying for |
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Are
you willing to work overtime ? [ ] Yes
[ ] No (Explain) |
Are
you employed now ? [ ] Yes
[ ] No May
we contact ? [ ] Yes
[ ] No |
Wages
Expected |
EDUCATION AND TRAINING |
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SCHOOL |
NAME AND LOCATION OF SCHOOL |
COURSE OF STUDY |
NO. OF YEARS COMPLETED |
DID YOU GRADUATE |
DIPLOMA OR DEGREE |
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HIGH SCHOOL |
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[ ] YES [
] NO |
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COLLEGE OR UNIVERSITY |
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[ ] YES [
] NO |
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COLLEGE OR UNIVERSITY |
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[ ] YES [
] NO |
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TRADE SCHOOL |
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[ ] YES [
] NO |
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APPRENTICE SCHOOL |
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[ ] YES [
] NO |
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List
any other education, training, special skills or certificates/licenses that
you posess: __________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ |
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List
any machines or equipment that you are qualified and experienced at
operating: ____________________________________________________ ________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________ |
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EXPERIENCE List Present and Former Employers beginning with the most recent |
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1 |
Company
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Type
of Business Phone
No.
( ) |
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Address |
Employed
(month and year) From: To: |
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Name
and Title of Supervisor |
May
we Contact ? [ ] Yes
[ ] No |
Employed [ ] Full-Time [ ] Part-Time |
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State
Last Job Title and Describe Your Work |
Wages Starting: Last: |
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Reason
For Leaving |
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2 |
Company
|
Type
of Business Phone
No.
( ) |
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|
Address |
Employed
(month and year) From: To: |
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Name
and Title of Supervisor |
May
we Contact ? [ ] Yes
[ ] No |
Employed [ ] Full-Time [ ] Part-Time |
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State
Last Job Title and Describe Your Work |
Wages Starting: Last: |
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Reason
For Leaving |
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3 |
Company
|
Type
of Business Phone
No.
( ) |
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Address |
Employed
(month and year) From: To: |
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Name
and Title of Supervisor |
May
we Contact ? [ ] Yes
[ ] No |
Employed [ ] Full-Time [ ] Part-Time |
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State
Last Job Title and Describe Your Work |
Wages Starting: Last: |
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Reason
For Leaving |
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PLEASE LIST ADDITIONAL EMPLOYERS HERE |
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_______________________________________________________________________________________________________________________ Employer
From: To: Address Telephone _______________________________________________________________________________________________________________________ Employer
From: To: Address Telephone _______________________________________________________________________________________________________________________ Employer From: To: Address Telephone _______________________________________________________________________________________________________________________ Employer
From: To: Address Telephone |
REFERENCES List business persons known but not related to you, other than listed above |
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NAME
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TITLE
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BUSINESS
|
PHONE
NO.
|
YEARS
KNOWN
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1 |
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2 |
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3 |
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4 |
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ADDITIONAL EMPLOYMENT RELATED INFORMATION |
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List
any relatives or friends working for this organization: Name Relationship
________________________________ ______________________________ ________________________________ ______________________________ |
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Can
you verify your legal right to work in the U.S. by providing a birth
certificate, proof of U.S. Citizenship, or by some other means ? [
] Yes (Proof
of U.S. Citizenship or immigration
status is required upon employment)
[ ] No Are
you over age 18 ? [ ] Yes
[ ] No |
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Are
you able to perform the job (s) for which you are applying ? [ ] Yes
[ ] No |
In
Case of emergency notify: __________________________________ Phone
Number: ________________________________ |
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Have
you been convicted of a crime in the past 7 years, excluding misdemeanors and
summery offences, which have not been annulled, expunged, or sealed by a
court ? [ ] Yes
[ ] No If
Yes please describe in detail:
____________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ |
MILITARY SERVICE |
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Branch
Served:
Active Duty From: To: |
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Discharge
Date:
Discharge Rank/Grade |
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Nature
of Military Duties |
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Additional
Remarks Special
Skills and Qualifications: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ |
APPLICANTS CERTIFICATION Please read carefully before signing |
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I
certify that, to the best of my knowledge and belief, the answers given by me
to the forgoing questions and statements made by me in this application are
correct and complete. I understand that misrepresentation or omission of the
facts in this application may result in my discharge. I
authorize you to communicate with those employers I designated, school
officials and persons named as references concerning my skills, character and
responsibility. If
employed, I understand and agree that such employment may be terminated at
any time, without prior notice, and that my employment will not be governed
by any expressed or implied contract but is at-will. |
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Applicants
Signature |
Date |
RELEASE AND AUTHORIZATION |
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DISCLOSURE:
A CONSUMER REPORT MAY BE PROCURED FOR EMPLOYMENT PURPOSES. A
consumer report or investigative consumer report including information about
your character, general reputation, personal characteristics or mode of
living may be obtained. According to the Fair Credit Reporting Act, upon
receiving a written request, Employment Screening Services, Inc (627 E.
Sprague, Suite100, Spokane, WA 99202) will provide information regarding the
nature and scope of the report, should it include information about your
character, general reputation, personal characteristics or mode of living and
a summary of your rights. California
Residents only: Per California civil code,
you will be notified within three days should an investigative consumer
report be ordered. You
will receive a copy of the report at the time of a meeting or interview or within seven days of the date the
employer or prospective employer received the report, whichever is earlier. RELEASE
AND AUTHORIZATION I
voluntarily and knowingly authorize for employment purposes only, any present
or past employer or supervisor, university or institution of learning,
administrator, law enforcement agency, state agency, federal agency, credit
bureau, private business, military branch or the National Personnel Records
Center, the Minnesota Bureau of Criminal Apprehension, personal reference
and/or other persons, to give records or other information they may have
concerning my criminal history, motor vehicle history, earnings history and
employment records, credit history, workers compensation claims (including
from the state of MN ), general
reputation, character, or any other information requested to Employment
Screening Services, Inc and/or its agents or representatives. I voluntarily
and knowingly unconditionally any named or unnamed informant from any and all
liability resulting from the furnishing of this information. |
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EMPLOYMENT SCREENING SERVICES INC |
___________________________________________________________ SIGNATURE DATE ___________________________________________________________ FULL
NAME (Type or print legibly) ___________________________________________________________ LIST
ANY OTHER NAMES UNDER WHICH YOU HAVE WORKED OR RECEIVED A DEGREE ___________________________________________________________ STREET
ADDRESS ___________________________________________________________ CITY,
STATE, ZIP ___________________________________________________________ SOCIAL
SECURITY NUMBER
DATE OF BIRTH * ___________________________________________________________ DRIVERS
LICENSE NUMBER STATE OF ISSUE ___________________________________________________________ NAME
EXACTLY AS IT APPEARS ON DRIVERS LICENSE ___________________________________________________________ POSITION
FOR WHICH YOU ARE APPLYING MAY
WE CONTACT YOUR CURRENT EMPLOYER ? (Φ box below) [
] YES
[ ] NO [ ] NOT APPLICABLE *
Optional |
CA,
OK, & MN APPLICANTS ONLY: You have the right to receive a copy of your Consumer Credit Report (for CA & OK) or Consumer Report (for MN) should one be requested for employment reasons [ ] I wish to be furnished with a copy of my consumer report should one be ordered. |
Revised 08/02