Home Employment Application Step 1 of 3 - Application 33% Position You Are Applying For? Applying For..* Maintenance Clerical Other Choose All that you want to apply for What Kind of Position* Temporary Full Time Part Time How Did You Hear About Us?* Web Search Job Posting Someone Referred me Rate of Pay Expected* Your Personal Information Full Name (First + Middle + Last)* Permanent Address* Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Americas Armed Forces Europe Armed Forces Pacific State ZIP Code Have you Been At this Address less than 3 years?* Yes No Home Phone Cell Phone* Email* Age* Date of Birth* MM DD YYYY Social Security #* Other name(s) under which you have been previously employed General Information Have you ever applied to this organization before?* Yes No Do you have any relatives that worked for this company?* Yes No Have you worked for this company before?* Yes No Have you ever been convicted of a felony?* Yes No Have you ever been bonded? Yes No answer only if a job requirement Education/U.S. Military Service Select Highest Grade Completed* 123456789101112 Select Highest Grade Completed College* 1234Advanced Degree Where did you attend high school & college? (Click the + button to add a new row)* School Name & Address Major Years Completed GPA Degree/Diploma Are you taking any educational course(s) presently?* Yes No I will be soon Have you ever served in the U.S. Armed Services? Yes No Employment History Give employment record as completely as possible listing current or most recent employer first. Show unemployed or self-employed periods and indicate dates and comment on each period. Include part time or summer work. Are You Currently Employed?* Yes No Employment history the last 3 years (Click the + button to add a new row)* Company Name & Address Supervisor Name Posisition Salary From / To (Mo& YR) Reason you left References List 3-5 people we may contact who are qualified to evaluate your capabilities. Do not include relatives. (Click the + button to add a new row) Name Address Occupation Years Known Acknowledgement Resume Upload (optional) Accepted file types: doc, pdf. Would you like to add a cover letter? Yes No APPLICANT MUST READ AND SIGN I certify that I have read and understood all of this employment application . It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern 10 my employment history, whether same is of record or not, and I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with the employer and for no other reason. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508. I have been told that this investigation may include and investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal. If hired, I agree to abide by all the rules and policies of the employer. This certifies that this application was completed by me, and that all entries on it and information in it arc true and complete to the best of my knowledge . Your Signature* Use your mouse or finger to sign Today's Date* © 2015 J&L Transportation | All Rights Reserved