R. J. Zavoral & Sons, Inc. is an Equal Opportunity Employer
First Name Middle Name Last Name Address City State Zip Email Phone
Today's Date Referred By Position Applied For
High School Name and Location
High School Graduate YesNoGED
College Name and Location College Areas of Study
College Graduate YesNo
College Degree
Post High School/Technical Training Name and Location Post High School/Technical Training Areas of Study
Post High School/Technical Training Graduate YesNo
Post High School/Technical Training Degree
On what date would you be available for work?
Are you currently on a "lay-off" status and subject to recall? YesNo
Applying for Full TimePart TimeShift WorkTemporary
Days available for work MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Are you at least 18 years of age? YesNo
Truck Driving Experience Type Truck Driving Experience Years Equipment Operating Experience Type Equipment Operating Experience Years Other, ie Computers, Software Experience Type Other Experience Years
Do you have a valid driver's license? YesNo
Class (please select one) ABCD
Do you have a Medical Examiner's Certificate? YesNo
If Yes, Date of Expiration
CDL YesNo Hazmat YesNo Tanker YesNo
Driver's License Number State of Issue
Are you CPR Certified? YesNo
Date Certificate Expires
Are you First Aid Certified? YesNo
Are you MSAH Certified? YesNo
Hours of OSHA Training Date of OSHA Training
Do you have any physical conditions which may limit your ability to perform the job applied for? YesNo
If yes, please explain What can be done to accommodate your limitation?
Would you be willing to take a physical examination? YesNo
PRE-EMPLOYMENT DRUG TESTS WILL BE CONDUCTED
Include only individuals familiar with your work experience. Do not include relatives.
Name Position Company Address Phone Years Known
Duties Discharge Date
Are you a Special Disabled Veteran? YesNo
Are you a Vietnam Era Veteran? YesNo
Are you currently employed? YesNo
May we contact your present employer? YesNo
Employer Start Date End Date Phone Job Title Duties City, State Starting Pay Final Pay Reason For Leaving
I certify that all information given is accurate and true. I understand that if hired, any false information on this form could be cause for termination. I authorize R.J. Zavoral & Sons, Inc. to obtain and give references as well as to verify my information such as credit history, DMV records, employment, and education as needed for arriving at an employment decision. I understand that R.J. Zavoral & Sons, Inc. utilizes "employment-at-will", i.e., the employee or the Employer may terminate the employment relationship at any time for any reason other than an unlawful or discriminatory reason.
Applicant's Signature (Please type full name here.) Date