Application for Employment

PERSONAL INFORMATION

Position Applying For:

Last Name:	First: M. I.:
Address:
City:
State:
Zip:
Home Phone:
E-Mail:

Mobile/Beeper/Other Phone:
Social Security Number:

If applying for a driving position:

Date of Birth:

Years of Experience:

Driver's License number:

State:

Moving Violations For Prior Three Years:

Accidents For Prior Three Years:

EMPLOYMENT INFORMATION

Provide the following information for your past and current employers, assignments

Employer:

Address:

City:

State:

Zip:

Phone:

Dates Employed: to

Reason for change:

Employer:
Address:
City:
State:
Zip:
Phone:

Dates Employed: to

Reason for change:

Employer:
Address:
City:
State:
Zip:
Phone:

Dates Employed: to

Reason for change:

By submitting this application, I give the employer the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives for seeking, gathering and using such information and all other persons, corporations or organizations for furnishing such information.

The employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by local, state or federal law.

This application is current for 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 to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that any such assurances must be in writing and signed by an authorized officer.

I understand it is this company's policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accomodation as required by the ADA.

I also understand that if I am hired, I will be required to provide proof of identity and legal work authorization.

Final employment offer is contingent upon passing physical and drug screen. (Alcohol testing included when legal). I represent and warrant that I have read and fully understand the foregoing and seek employment under these conditions.

Equal Opportunity Employer

Š1998-2010 Gordon Sevig Trucking Co.