Grading Application For Employment

In compliance with Federal and State equal employment opportunity laws, qualifed applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, or non-job related disability.

Name

List your addresses (starting with the most current) for the past 3 years:

Current Address:

Previous Addresses

Do you have the legal rigth to work in the United States?

Dates:

Employment History

List complete mailing address, street number, city, state and zip code.

EMPLOYER

(MOST RECENT)

DATE

EMPLOYER

DATE

EMPLOYER

DATE

EDUCATIONAL AND EXPERIENCE

LAST SCHOOL ATTENDED:

EXPERIENCE AND QUALIFICATIONS

TO BE READ AND SIGNED BY THE APPLICANT

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquires of my personal, employment, financial, medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understood, also, that I am required to abide by all rules and regulations of the Company.

THIS SECTION TO BE FILLED IN BY RESPONSIBLE OFFICER OR COMPANY REPRESENTATIVE

1. APPLICATION

SUPERIOR

2. INTERVIEW

3. PAST EMPLOYMENT

SUPERIOR

4. WRITTEN EXAM

5. ROAD TEST

SUPERIOR

6. CRIMINAL/TRAFFIC CONVICTIONS

TRANSFERS

TERMINATION OF EMPLOYMENT