APPLICATION FOR EMPLOYMENT

PERSONAL

First Name

Middle Name

Last Name

Address

City

State

Zip

Email

Phone

Best Time to Call

EDUCATION

High School

High School Name and Location

High School Graduate
YesNoGED

College

College Name and Location

College Areas of Study

College Graduate
YesNo

College Degree

Post High School/Technical Training

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

WORK AVAILABILITY

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

JOB RELATED SKILLS

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

DRIVER'S LICENSE INFORMATION

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

CERTIFICATIONS

Are you CPR Certified?
YesNo

Date Certificate Expires

Are you First Aid Certified?
YesNo

Date Certificate Expires

Are you MSAH Certified?
YesNo

Hours of OSHA Training

Date of OSHA Training

PHYSICAL HISTORY

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

REFERENCES

Include only individuals familiar with your work experience. Do not include relatives.

1.

Name

Position

Company

Address

Phone

Years Known

2.

Name

Position

Company

Address

Phone

Years Known

MILITARY SERVICE EXPERIENCE

Duties

Discharge Date

Are you a Special Disabled Veteran?
YesNo

Are you a Vietnam Era Veteran?
YesNo

EMPLOYMENT HISTORY

Are you currently employed?
YesNo

May we contact your present employer?
YesNo

1. Previous Employer

Employer

Start Date

End Date

Phone

Address

Job Title

Duties

City, State

Supervisor's Name

Starting Pay

Final Pay

Reason For Leaving

2. Previous Employer

Employer

Start Date

End Date

Phone

Address

Job Title

Duties

City, State

Supervisor's Name

Starting Pay

Final Pay

Reason For Leaving

APPLICANT'S STATEMENT

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