Basic Application - Stevens Transportation Inc

Basic Application Form

Non-driver Application Form

Position applying for:*
Legal Name:*
First Middle Last
(As it appears on your Social Security Card)
Date:*
Month
Day
Year
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:*
MM slash DD slash YYYY
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?*
- Advertisement
- School
- Agency
- Employee
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
Month
Day
Year
End Date
Month
Day
Year
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
Month
Day
Year
End Date
Month
Day
Year
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
Month
Day
Year
End Date
Month
Day
Year
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
Month
Day
Year

Basic Application Form

Education - High School

Education - College/University

Education - Other

Reference #1

Reference #2

Reference #3

Military

Language

Past Employer History