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Position Desired: Full-TimePart-Time
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Date:
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Name (Please Print): LastFirstMiddle
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What shift(s) are you available to work? (Please Select)
Any ShiftsDaytimeNight
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What days are you available to work? (Please Select)
Any DaysSundayMondayTuesdayWednesdayThursdayFridaySaturdayHolidays
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Current Address:Street and NumberCityStateZip
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Length of Time There? (Years/Months)
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Previous Address:Street and NumberCityStateZip
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Length of Time There? (Years/Months)
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Evening Telephone:
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Daytime/Cellular Telephone:
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Email Address:
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Have you ever worked for this Company before?YesNo If yes, please give dates and position:
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Record of Employment: Please list the names of your present and/or previous employers in chronological order with present or last employer listed first. Be sure to account for all periods of time including military service or any unemployment. If self-employed, give firm name and supply business references.
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Present or Last Employer:
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Employed From: (month/year)
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Employed To: (month/year)
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Your Title or Position:
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Address: Street and Number
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Pay Start: $
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Pay Final: $
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Exact Reason for Leaving:
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CityStateZip
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Name & Title of Supervisor:
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Telephone:
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Previous Employer:
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Employed From: (month/year)
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Employed To: (month/year)
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Your Title or Position:
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Address: Street and Number
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Pay Start:$
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Pay Final: $
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Exact Reason for Leaving:
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CityStateZip
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Name & Title of Supervisor:
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Telephone:
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Previous Employer:
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Employed From: (month/year)
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Employed To: (month/year)
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Your Title or Position:
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Address: Street and Number
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Pay Start: $
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Pay Final: $
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Exact Reason for Leaving:
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CityStateZip
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Name & Title of Supervisor:
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Telephone:
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Previous Employer:
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Employed From: (month/year)
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Employed To: (month/year)
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Your Title or Position:
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Address: Street and Number
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Pay Start: $
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Pay Final: $
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Exact Reason for Leaving:
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CityStateZip
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Name & Title of Supervisor:
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Telephone:
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Please indicate any actual experience, special training and/or qualifications that you have which you feel are relevant to the position for which you are applying:
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Have you ever used another name? YesNo
Is any additional information relative to change of name, use of an assumed name, or nickname necessary to enable a check on your work and educational record? If yes, please explain:
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If hired, can you furnish proof that you are at least 18 years of age?YesNo
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Please explain fully any gaps in your employment history:
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Have you ever been terminated or asked to resign from any job?YesNo
If yes, please explain:
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Have you ever pled guilty or no contest to, or have been convicted of, a misdemeanor or felony? YesNo
If yes, please provide date(s) and details:
NOTE: Answering Yes to the above question does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account. (Do not include minor traffic infractions, and convictions for which the record has been sealed or expunged, any conviction for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed, referrals to and participation in any pretrial or post trial diversion programs.
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This application will be considered active for a maximum of ninety (90) days. If you wish to be considered for employment after that time, you must reapply.
I CERTIFY THAT ALL OF THE INFORMATION THAT I HAVE PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE.
Signature of Applicant:
Date:
Applicant’s Statement & Agreement
In the event of my employment to a position in this Company, I will comply with all rules and regulations of this Company, of which I have been made aware either directly or indirectly. I understand that the Company reserves the right to require me to submit to a test for the presence of drugs in my system prior to employment and at any time during my employment, to the extent permitted by law. I understand that if my position involves operating a vehicle on company business that any offer of employment may be contingent upon a satisfactory driving record. I also understand that any offer of employment may be contingent upon the passing of a physical examination. I consent to the disclosure of the results of any physical examination and related tests to the Company. I also understand that I may be required to take other tests such as personality and honesty tests, prior to and during my employment. I understand that should I decline to sign this consent or take any of the above tests, my application for employment may be rejected or my employment may be terminated. I understand that bonding may be a condition of hire. If it is, I will be so advised either before or after hiring and a bond application will have to be completed.
I further understand that the Company may contact my previous employers. I authorize those employers to disclose to the Company all records and information pertinent to my employment with them. In addition to authorizing the release of any information regarding my employment, I hereby waive any rights or claims I have or may have against my former employers, their agents, employees, and representatives, as well as other individuals who release information to the Company, and release them from any and all liability, claims, or damages that may directly or indirectly result from the use, disclosure, or release of any such information by any person or party, whether such information is favorable or unfavorable to me. I authorize the persons named herein as personal references to provide the Company with any pertinent information they may have regarding me.
I hereby state that all the information that I have provided on this application or any other documents completed in connection with my employment, and in any interview is true and accurate. I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that if I am employed and any information provided to the Company is found to be false or incomplete in any respect, I may be dismissed. I understand if selected for hire, it will be necessary for me to provide satisfactory evidence of my identity and legal authority to work in the United States, and that federal immigration laws require me to complete an I-9 Form in this regard.
I understand that I may be required to work a variety of shifts and/or weekends depending on my work assignment and the needs of the business and that I am required to work my regularly scheduled shifts. I further understand that since Blue Star Xpress Location are continually open, these will include shifts during holidays. I understand that staffing is dependent on sales and, at times, I may work alone during the late shifts. In all cases, I agree to follow the Company’s safety procedures.
If hired, I agree as follows: My employment and compensation is terminable at-will, is for no definite period, and my employment and compensation may be terminated by either the Company (employer) or me at any time and for any reason whatsoever, with or without good cause.
This is the entire agreement between the Company and in regarding the length of my employment and the reasons for termination of employment, and this agreement supersedes any and all prior agreements regarding these issues. It is further agreed and understood that any agreement contrary to the foregoing must be entered into, in writing, by the President or Owner of the Company. No supervisor or representative of the Company, other than its President or Owner, has any authority to enter into any agreement for employment for any specified period of time or make any agreement contrary to the foregoing. Oral representations made before or after you are hired do not alter this Agreement.
If any term or provision, or portion of this Agreement is declared void or unenforceable it shall be severed and the remainder of this Agreement shall be enforceable.
IF YOU HAVE ANY QUESTIONS REGARDING THIS STATEMENT, PLEASE ASK A COMPANY REPRESENTATIVE BEFORE SIGNING. I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE STATEMENTS AND UNDERSTAND THE SAME.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE STATEMENT & AGREEMENT.
Signature of Applicant:
Date:
