Employment Application - Area Wide Transport

Applicant Information

First Name

Last Name

Middle Initial

Address

State

City

Zip

Phone

Date Available

Desired Salary

Position Applying For

Date of Birth

Social Security Number

Driver’s License Number

Are you a citizen of the United States?

Yes

Are you authorized to work in the U.S.?

Yes

Have you ever worked for this company?

Yes

When?

Have you ever been convicted of a felony?

Yes

Explain

Education

High School

HS Address

HS Start Date

HS End Date

Did you graduate from high school?

Yes

College

College Address

College Start Date

College End Date

Did you graduate from college?

Yes

Degree

Other Education

Other Education Address

Other Education Start Date

Other Education End Date

Did you graduate?

Yes

Other EducationDegree

References

Reference 1 Full Name

Reference 1 Relationship

Reference 1 Address

Reference 1 Phone

Reference 1 Years Known

Reference 2 Full Name

Reference 2 Relationship

Reference 2 Address

Reference 2 Phone

Reference 2 Years Known

Reference 3 Full Name

Reference 3 Relationship

Reference 3 Address

Reference 3 Phone

Reference 3 Years Known

Previous Employment

Company 1

Company 1 Address

Company 1 Supervisor

Company 1 Phone

Company 1 Job Title

Company 1 Starting Salary

Company 1 Ending Salary

Company 1 Responsibilities

Company 1 Start Date

Company 1 End Date

Company 1 Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

Company 2

Company 2 Address

Company 2 Supervisor

Company 2 Phone

Company 2 Job Title

Company 2 Starting Salary

Company 2 Ending Salary

Company 2 Responsibilities

Company 2 Start Date

Company 2 End Date

Company 2 Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

Company 3

Company 3 Address

Company 3 Supervisor

Company 3 Phone

Company 3 Job Title

Company 3 Starting Salary

Company 3 Ending Salary

Company 3 Responsibilities

Company 3 Start Date

Company 3 End Date

Company 3 Reason for Leaving

May we contact your previous supervisor for a reference?

Yes

Military Service

Branch

From

Rank at Discharge

Type of Discharge

If other than honorable, explain

Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature

Date

Background Authorization

Disclosure and Authorization

IMPORTANT: Please read carefully before signing authorization

DISCLOSURE REGARDING BACKGROUND INVESTIGATION

Area Wide Transport may obtain information about you from a third party consumer reporting agency for employment purposes. Thus, you may be the subject of a “consumer report” and/or an “investigative consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living, and which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records (“driving records”), verification of your education or employment history, or other background checks. Credit history will only be requested where such information is substantially related to the duties and responsibilities of the position for which you are applying.

You have the right, upon written request made within a reasonable time, to request whether a consumer report has been run about you, and disclosure of the nature and scope of any investigative consumer report and to request a copy of your report. Please be advised that the nature and scope of the most common form of investigative consumer report is an employment history or verification. These searches will be conducted by Occuscreen, LLC, 805 Broadway Street, Suite 215, Vancouver, WA 98660, (800) 833-5304, www.occuscreen.com. The scope of this disclosure is all-encompassing, however, allowing the Company to obtain from any outside organization all manner of consumer reports throughout the course of your employment to the extent permitted by law.

I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

Signature*

Date

Guardian Signature

if under 18

If you are human, leave this field blank.