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1.
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Name:
*
Date:
2.
*
Address:
*
City:
*
State:
*
Zip:
3.
*
Home Phone #:
Cell Phone #:
Referred by:
4.
Are you legally eligible to work in the united states?
Yes
No
(A conviction will not necessarily disqualify you from the job for which you have applied.)
5.
*
Position desired:
Date available:
6.
Click one: Full time only
Part time Only
Either full time or part time
7.
Check boxes to indicate all days/ hours available:
Approximate
hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Early a.m.
6am - 10 am
Standard business hours
8am - 4:30 pm
Afternoon/ Evening
2pm - 11 pm
Sleep over
10pm - 6 am
Awake overnight
10pm - 6 am
If you are only available for a portion of the above listed hours, then please list the specific hours in the box below.
8.
Have you ever been convicted of a crime?
Yes
No
(A conviction will not necessarily disqualify you from the job for which you have applied.)
9.
If you have been convicted of a crime, please explain in the box provided below:
10.
Do you have any functional limitations that would prohibit you from any of the following. These are essential for you to adequatley perform your job duties:
Functional Limitations
Please explain all "
Yes
" answers below:
Lifting
Yes
No
Bending
Yes
No
Reaching
Yes
No
Squatting
Yes
No
Twisting
Yes
No
11.
Educational Record
Name & Location of
Educational Institution
# of Years
Completed
List any Diplomas/
Degrees Earned
Major Course of Study
High School
College or University
Graduate or Professional
12.
List any other training and/or experience that is applicable to the job for which you are applying:
13.
Do you have a current valid driver's license?
Yes
No
Type:
Operator
CDL
14.
List restrictions noted on driver's license:
15.
Driver's License #:
State of issue:
Exp. date:
16.
Do you have a minimum of 2 years of driving experience?
Yes
No
17.
Have you had any accidents during the past 4 years?
Yes
No
How many?
18.
Have you had any moving violations during the past 4 years?
Yes
No
How many?
I understand that my employment is conditioned upon meeting requirements of insurance.
19.
1.
Name of Employer:
Address:
Phone #:
Position/Title:
Date of hire:
Mo.
Yr.
Last day worked:
Mo.
Yr.
Reason for leaving:
Name of last supervisor:
Discribe job duties:
2.
Name of Employer:
Address:
Phone #:
Position/Title:
Date of hire:
Mo.
Yr.
Last day worked:
Mo.
Yr.
Reason for leaving:
Name of last supervisor:
Discribe job duties:
3.
Name of Employer:
Address:
Phone #:
Position/Title:
Date of hire:
Mo.
Yr.
Last day worked:
Mo.
Yr.
Reason for leaving:
Name of last supervisor:
Discribe job duties:
4.
Name of Employer:
Address:
Phone #:
Position/Title:
Date of hire:
Mo.
Yr.
Last day worked:
Mo.
Yr.
Reason for leaving:
Name of last supervisor:
Discribe job duties:
I hereby affirm that my answers to the foregoing questions are true and correct and I undersatnd that misrepresentation or omission of facts called for in the application may cause for immediate dismissal without notice. I authorize inquiry with regard to my character, ability and habits of any other persons and agree to hold such persons harmless with respect to any information they may give.
If employed, I agree to conform to the policies of The Shadowfax Corporation and acceot the Personnel Practices of the Corporation.
I authorize The Shadowfax Corporation to verify any information contained on this application. I also authorize the above named individual/organization to supply the information requested and I release you from any liability connected with submission of the requested information.
Updated 3/15/07
*
Applicant's Name:
*
This indicates a required field and it must be filled in.