Basic Application - Stevens Transportation Inc

Position applying for:*

Legal Name:*

First Middle Last

(As it appears on your Social Security Card)

Date:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone No.*

Home Phone No.

Msg. Phone No.

Can you, if hired, submit verification of your legal right to work in the United States?*

Yes
No

Have you ever worked for Stevens Transportation Inc.?*

Yes
No

If yes, what was your position and what years did you work?

Date you are available for work:*

Are you available to work on the weekends?*

Yes
No

Salary Desired*

(Desired yearly salary)

Type of Employment your are seeking?

Full-Time
Seasonal
Temporary
Part-Time

How were you referred to our Company?*

Are you employed now?*

Yes
No

May we contact your current employer?*

Yes
No

Are there any reasons that may cause absenteeism, lateness or daily early departure from the job during your employment?*

Yes
No

If yes, explain:

Education - High School

High School Name and Location

High School Course of Study

# of years completed

Education - College/University

College/University Name and Location

College/University Course of Study

# of years completed

Education - Other

Name and Location

Course of Study

# of years completed

If hired, would you have a reliable means of transportation to and from work?

Yes
No

If hired, are you able to perform the essential functions of the job for which you applying, either with or without reasonable accommodation?

Yes
No

If not, please describe the functions that cannot be performed.

Have you ever been convicted of a criminal offense? (felony or serious misdemeanor) (Convictions for a marijuana-related offenses that are more than two years old need not be listed).

Yes
No

No applicant will be denied employment solely on the grounds of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.

If yes please state the nature of the crime(s), when and where convicted, and disposition of the case

Reference #1

Name

First Last

Phone

Occupation

Number of years known

Reference #2

Name

First Last

Phone

Occupation

Number of years known

Reference #3

Name

First Last

Phone

Occupation

Number of years known

Military

U.S. Military Service?

Yes
No

Branch

Special Training

Language

Do you speak English?

Yes
No

Do you speak Spanish?

Yes
No

Past Employer History

Employer's Name

Start Date

End Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position Held

Salary/Wage

Phone

Contact Person

First

Reason for Leaving

May we contact this employer for a reference?

Yes
No

Employer's Name

Start Date

End Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position Held

Salary/Wage

Phone

Contact Person

First

Reason for Leaving

May we contact this employer for a reference?

Yes
No

Employer's Name

Start Date

End Date

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position Held

Salary/Wage

Phone

Contact Person

First

Reason for leaving

May we contact this employer for a reference?

Yes
No

List course and training other than shown elsewhere in this application

List special equipment or technical materials you can work with (other than those already shown)

I hereby certify that I have not knowing withheld any information that might adversely affect chances for employment and any answers given by me are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any immediate discharge, if already employed, regardless of the time lapse before discovery. I hereby authorize the Company to thoroughly investigate my references, work record, education and other matter related to my suitability of employment and further authorize the references, I have listed, to disclose to this Company any and all letters, reports and other information related to my work record without receiving prior notice of such disclosure. In addition, I hereby release to this Company, my former employers' and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosures. I understand that nothing contained in this application or conveyed during any interview, which may be granted, or during my employment, if hired, is intended to create any employment contract between me and this Company. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company president. I hereby, read and understand the foregoing statements, and accept the same as condition of employment.

Signature (type name)

First Last

Date

Basic Application Form

Education - High School

Education - College/University

Education - Other

Reference #1

Reference #2

Reference #3

Military

Language

Past Employer History