Office & Shop – J&R Schugel Trucking

J&R Schugel Office & Shop Application

Today's Date:*
MM slash DD slash YYYY
Position Applied For:*
Name:*
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone / Cell Phone:*
Email Address:*
AVAILABILITY
Are you legally authorized to work in the United States?*
- Yes
- No
Are you 18 years of age or older*
- Yes
- No
On what date can you start?*
MM slash DD slash YYYY
What job category would you prefer?*
For what schedules would you be available?*
- Select All
- Weekdays
- Weekends
- Days
- Evenings
- Overtime
- All Shifts
- Other
If other, please explain:
EDUCATION
Highest grade completed:*
HIGH SCHOOL NAME
CITY/STATE
DEGREE EARNED
COLLEGE NAME
CITY/STATE
DEGREE EARNED
OTHER
CITY/STATE
DEGREE EARNED
JOB-RELATED SKILLS
If the job requires you to drive, do you have the appropriate valid driver's license?*
- Yes
- No
DL#
Type
State of Issue
Please list any other skills, licenses or certificates that may be job-related or that you feel would be of value to this job or our organization.
EMPLOYMENT HISTORY
Your application may not be considered unless every question is answered. Since we may contact previous employers, correct telephone numbers are essential.
MOST RECENT EMPLOYER
Company Name*
City*
State*
Phone*
Dates Employed*

(month/yr) To (month/yr)
Supervisor's Name/Number*
Job Title*
Duties*
Reasons for Leaving*
SECOND MOST RECENT EMPLOYER
Company Name*
City*
State*
Phone*
Dates Employed*

(month/yr) To (month/yr)
Supervisor's Name/Number*
Job Title*
Duties*
Reasons for Leaving*
THIRD MOST RECENT EMPLOYER
Company Name*
City*
State*
Phone*
Dates Employed*

(month/yr) To (month/yr)
Supervisor's Name/Number*
Job Title*
Duties*
Reasons for Leaving*
REFERENCES
Include only individuals familiar with your work capabilities. Do not include relatives.
NAME*
ADDRESS/PHONE*
YEARS KNOWN/RELATIONSHIP*
NAME*
ADDRESS/PHONE*
YEARS KNOWN/RELATIONSHIP*
NAME*
ADDRESS/PHONE*
YEARS KNOWN/RELATIONSHIP*
AUTHORIZATION*
I understand that background, drug, or medical testing may be conducted on me as part of the process to determine my fitness for employment, and hereby agree to submit to such testing. I authorize all persons, schools, companies, medical practitioners, current and/or former employers, and law enforcement authorities to release any information concerning my background or test results, and hereby release any said persons, schools, companies, medical practitioners, current and/or former employers, and law enforcement authorities from any liability for any damage whatsoever for issuing this information.
CERTIFICATION*
I certify the answers given by me to the foregoing questions and any statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omissions, or misrepresentations of facts regarding information called for in this application may result in rejection of my application, or discharge at any time during my employment. I also agree that, if company policy requires, I am willing to submit to drug testing to detect the use of illegal drugs prior to and during employment. I understand that if I am hired, my employment shall be “at-will,” and that either the Company or I can choose to terminate the employment relationship for any reason, or no reason at all, with or without notice.
Name - By typing your name below you acknowledge that an electronic signature is equivalent to an ink signature.*
First Last
Date*
MM slash DD slash YYYY
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