General Application for Employment

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hear by release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.

TO BE READ AND SIGNED BY APPLICANT

Applicant to Complete

List your addresses of residency for the past 3 years.

Employment History

Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall provide 10 years’ information on those employers for whom the applicant operated such a vehicle. (Most recent to oldest)

Employer

Date

Employer

Date

Employer

Date

EXPERIENCE AND QUALIFICATIONS - OTHER

Education

High School

College

College

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.