General Application

Transcripción

General Application

Application for Employment
Uso para el empleo
FORM # P001a
Page 1
2447 E. Hwy 356 Irving, Texas 75060
Personal Information \ Información Personal
Date \ Fecha:
Drivers License Number:
✔ ✔
CDL [ ] YES [ ] NO
Name \ Nombre
Social Security Number:
Seguro Social:
Address \ Dirección
Home Phone:
Teléfono de Casa #
City, State, Zip Code
Ciudad, Estado, Código postal
Other Number:
Teléfono Cellular #
EMAIL ADDRESS:
Have you ever applied for employment with us?
[ ] yes
[ ] no
If Yes:
¿Usted ha solicitado trabajo con Dallas Trailer Repair Co. anteriormente?
Month:
Year:
February
Have you ever been employed with us?
¿Has trabajado con Dallas Trailer Repair Co. anteriormente?
[ ] yes
[ ] no
If Yes:
Month:
Do you have relatives employed with us?
¿Es usted relacionado con cualquier persona empleada aquí?
[ ] yes
[ ] no
Name \ Nombre:
Year:
February
Relation \relacionado cómo:
Are you legally eligible for employment in the United States?
[ ] yes
[ ] no
¿Es usted legalmente elegible para el empleo en los Estados Unidos?
Apart for religious observance, are you available for full time work?
Are you over the age of 18?
[ ] yes [ ] no
¿Es usted mayor de 18 años? [ ] sí [ ]
no
[ ] yes
[ ] no
[ ] yes
[ ] no
¿Aparte de observancia religiosa, está usted disponible para el trabajo a
Have you ever been convicted of a felony?
¿Has estado condenado por un crimen?
* Conviction will not necessarily disqualify an applicant for employment *
* Trabajado horas extra si se te pide *
Will you work overtime if asked?
¿Trabajará horas extras si en necesario?
[ ] yes
Position Desired?
¿qué posición está usted solicitando?
[ ] no
Pay Expected
¿La Paga Esperó?
$
Other Special Training or Skills (languages, machine operation, etc.)
¿Hay habilidades o entrenamiento especiales que usted tenga? (idiomas, operación de máquina, etc.)
How did you learn about us?
¿Cómo supo de nosotros?
[ ] FRIEND
[ ] RELATIVE
[ ] WALK-IN
[ ] EMPLOYMENT AGENCY
[ ] ADVERTISEMENT
AMIGO
PARIENTE
CAMINÓ
ADENTRO
AGENCIA DE COLOCACIÓN
ANUNCIO
[ ] OTHER
OTRO
Military
Did you serve or are you serving in the United States armed forces?
✔[ ] yes
✔[ ] no
[ ] yes
[ ] no
What Branch?
Describe any relevant training?
Are you still in Reserve for service which could effect your attendance?
How?
Uso para el empleo
FORM # P001a
Page 2
Employment Experience / Experiencia del Empleo
1
Employer
Patron
Address
direccion
Telephone #
telefono
Supervisor
Starting
Comienzo
Employer
Patron
Address
direccion
Telephone #
telefono
Dates Employed
Fechas Empleadas
From
To
Hourly Rate / Salary
Salarios Cada hora / Sueldo
Supervisor
Starting
Comienzo
Employer
Patron
Address
direccion
Telephone #
telefono
Dates Employed
Fechas Empleadas
From
To
Supervisor
Starting
Comienzo
Employer
Patron
Address
direccion
Telephone #
telefono
Work Performed
Trabajas Realizado
Final
Extremo
Dates Employed
Fechas Empleadas
From
To
Job Title
Titulo del trabajo
Supervisor
Starting
Comienzo
Reason For Leaving?
Razon de irse?
Work Performed
Trabajas Realizado
Final
Extremo
Job Title
Titulo del trabajo
Reason For Leaving?
Razon de irse?
Work Performed
Trabajas Realizado
Final
Extremo
Job Title
Titulo del trabajo
Reason For Leaving?
Razon de irse?
4
Dates Employed
Fechas Empleadas
From
To
3
No entre en contacto con por favor a patrones siguientes (indique porqué)
circundan por favor número correspondiente: 1 2 3 4
Job Title
Titulo del trabajo
Reason For Leaving?
Razon de irse?
2
Please do not contact the following employers (Indicate why)
Please circle corresponding number: 1 2 3 4
Work Performed
Trabajas Realizado
Final
Extremo
Waiver Box: By Signing, you give us permission to contact the above noted Previous employers; you give these previous employers permission to disclose information about you; you waive your right to legally pursue any person who discloses such information as a result of our
background examination.
SIGNATURE
DATE
Uso para el empleo
FORM # P001a
Education
Page 3
Name & Address of School
Completed
Elementary
[ ] Yes / Si [ ] No
High School
[ ] Yes / Si [ ] No
College
[ ] Yes / Si [ ] No
Graduate Professional
[ ] Yes / Si [ ] No
Technical
[ ] Yes / Si [ ] No
Other
[ ] Yes / Si [ ] No
Languages
Fluent
Good
Diploma or Degree
Fair
Speak
Write
Read
Please Indicate any foreign languages which you can speak, write or read.
Personal References /
1. Reference
Address
Telephone
2. Reference
Address
Telephone
3. Reference
Address
Telephone
4. Reference
Address
Telephone
I attest that I have answered these questions contained herein truthfully. ~ Atestiguo que he contestado a estas preguntas contenidas adjunto verazmente.
Signature:
Date:
APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Name
Social Security Number
FIRST
MIDDLE
LAST
Present Address
STREET
CITY
STATE
ZIP
Permanent Address
Email Address
Phone Number(s) (
)
-
/ (
)
-
DAYTIME
If you are under 18, can you furnish a work permit?
Yes
No
EVENING
Driver’s License Number
State Issued
Class
(IF REQUIRED BY YOUR POSITION)
EMPLOYMENT DESIRED
Position Applied For:
Type:
Full Time Part Time
Are you employed now?
Yes
Temporary
Salary Desired:
Date you can start:
Seasonal
No
/
/
If so, may we contact your current employer?
Have you ever applied for a position or worked at eEmployers Solutions, Inc. before? Yes No
If yes, When?
Where?
Are you on lay-off and subject to recall? Yes No
Will you travel if job requires it?
Will you relocate if the position requires it?
Yes
No
Are you able to meet the attendance requirements of the position?
Will you work overtime if required?
Yes
Yes
Yes
Yes
No
No
No
No
Have you ever been denied a bond required for employment or denied a security clearance?
Yes
No
Have you been convicted of a felony in the past seven (7) years? Yes No
(A conviction does not constitute an automatic bar to employment unless relevant to the type of employment.)
If yes, please explain:
EDUCATION
Trade,
Business
Or Other
Academic
Type of
Education
Status
Name & Location of School
# of years
Completed
Did you
graduate?
Subjects Studied
Currently Attending
Last Completed
Currently Attending
Last Completed
VOLUNTARY AFFIRMATIVE ACTION INFORMATION
We comply with government regulations including Affirmative Action. In an effort to comply with requirements regarding government
record keeping and other legal obligations, we ask that you complete this data survey. Your cooperation is appreciated. Please be
advised that your survey is considered confidential information that will not be used in any employment matters.
Sex:
r Male
r Female
Race/Ethnic Group: r Hispanic or Latino r Black or African American r White r American Indian/Alaskan Native rAsian
r Pacific Islander/Native Hawaiian r Two or more races
SPECIAL NOTICE TO VIETNAM VETERANS, DISABLED VETERANS AND INDIVIDUALS WITH PHYSICAL OR
MENTAL HANDICAPS OR DISABILITIES: Government contractors subject to the Vietnam Era Veterans Readjustment Act of
1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled
veterans and veterans of the Vietnam Era, and qualified handicapped individuals.
PLEASE CHECK IF ANY OF THE FOLLOWING ARE APPLICABLE:
r VIETNAM ERA VETERAN
r DISABLED VETERAN
r HANDICAPPED INDIVIDUAL
This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or necessitated by another federal law or regulation.
SKILLS AND QUALIFICATIONS:
Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work
with our Company
FORMER EMPLOYERS: List below, your last two employers, starting with the most recent one first.
Dates Worked
Name & Address of Previous Employer
Salary Job Title
Reason for Leaving
From
To
From
To
FORMER SUPERVISORS: List below, three supervisors for whom you have worked at some point during the last five years.
Name
Address
Phone Number
Years Acquainted
( )
( )
( )
FOREIGN LANGUAGE : List any foreign language skills that you have and check the box(s) that best describes your capabilities.
Language
Speak
Read
Write
Fluent
Good
Fair
Fluent
Good
Fair
Fluent
Good
Fair
CONDITIONS OF EMPLOYMENT
Ø
I give the Company the right to investigate all references and to secure additional information about me, if job related. I hereby
release from liability the Company and its representatives for seeking such information and all other persons, corporations or
organizations for furnishing such information.
Ø
It is understood and agreed upon that any mis representation or omission by me in this application will be sufficient cause for
cancellation of this application and/or separation from the Company's service if I have been employed. Furthermore, I understand
that just as I am free to resign at anytime, the Company reserves the right to terminate my employment at any time, with or without
cause and without prior notice. No supervisor or other representative of the company (except the President of eEmployers Solutions,
Inc.) has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement
contrary to the above.
Ø
Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on Company or Client
premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes a
willingness on the part of the applicant or employee to agree to physical examination, and/or substance testing, if requested by the
Company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy may result in dismissal.
Ø
The Company is an Equal Opportunity Employer. The Company does not discriminate in employment and no question on this
application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by
local, state or federal law.
Ø
Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate
of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation and, failing
settlement in mediation, to binding arbitration, in accordance with the rules of the American Arbitration Association. Arbitration
shall be conducted in San Antonio, Texas. Each party will select one person to serves as arbitrator. Those arbitrators will in turn
select a single arbitrator to hear the matter. Each party is responsible for its own costs and expenses and will share equally the cost
and expenses of the Arbitrator. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act, 9
U.S.C., Section 1-et seq. The parties hereto stipulate and agree that this agreement involves matters affecting interstate commerce.
Ø
This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Company and still wish to be
considered for employment, it will be necessary to fill out a new application.
I have carefully read the above Conditions of Employment and I understand and agree to the terms.
_______________________________________
Signature of Applicant
________________________________
Date
For DTR Internal use only
SERVICES REQUESTED
MVR
Education
Criminal
Employment
Other
Prof. Cred.
EMPLOYMENT BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION
DISCLOSURE
Dallas Trailer Repair Co., Inc. / DTR Transportation Services (“Company”) may obtain information about you from [RED STAR BACKGROUNDS INC. 8000 IH 10 W. STE 600 SAN ANTONIO, TX 78230, 210-524-7707 AND WWW.REDSTARBACKGROUNDS.COM, or another third-party consumer reporting agency, for employment purposes, including without limitation, for the purpose of evaluating you for employment, promotion, reassignment and retention as an employee, at any time prior to or during your employment, if applicable, and without giving
you any further notice. Thus, you may be the subject of a background check, also known as 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. These
reports may contain, without limitation, all or some of the following types of information about you: credit history, social security number verification, address and alias history, personal references, professional references, employment history, educational history, licenses, certifications, motor vehicle records, driving records, criminal history, and civil court record history. Credit history will only be requested where such
information is substantially related to the duties and responsibilities of the applied-for position. You have the right to know whether a consumer report has been obtained about you; and you have the right to request a copy of any report obtained by Company, a copy of “A Summary
of Your Rights Under the FCRA,” and a complete and accurate written disclosure of the nature and scope of any investigative consumer report obtained by Company. An investigative consumer report is information on an individual's character, general reputation, personal characteristics, or mode of living is obtained through a personal interview with an information source. The nature and scope of the most common
form of investigative consumer report obtained for employment purposes is an interview with a reference, employer, coworker, supervisor, or
customer.
AUTHORIZATION
I acknowledge receipt of the Background Check Disclosure and A Summary of Your Rights Under the FCRA, and certify that I have read and
understand both documents. I hereby authorize Company to obtain background check information, including consumer reports and investigative consumer reports, about me from [RED STAR BACKGROUNDS INC.] or another third-party consumer reporting agency, for employment
purposes, including without limitation, for the purpose of evaluating you for employment, promotion, reassignment and retention as an employee, at any time prior to or during my employment, if applicable, and without giving me any further notice. To this end, I hereby authorize,
without reservation, any credit bureau, creditor, employer, coworker, supervisor, customer, institution, school, college, university, license or
certificate granting entity, state department of motor vehicles, state department of revenue, court, governmental agency, law enforcement
agency, information service bureau, insurance company, other record-keeping agency, person, administrator, organization, company, corporation, entity, and any other information source, to furnish any and all background information requested by [RED STAR BACKGROUNDS
INC., 8000 IH 10 W. STE 600 SAN ANTONIO, TX 78230, 210-524-7797 AND WWW.REDSTARBACKGROUNDS.COM], another third-party
acting on behalf of Company, and/or Company itself, and regardless of whether the requested information was received from another source.
I agree that a copy of this Authorization shall be as valid as the original.
First Name
Middle Name
Social Security #
Driver’s License Number
Date of Birth
Last Name
State
Class
Authorization Signature
Maiden / Other Names
County of Residence
Date
Applicant Screening Form
Full Name (First, Middle, Last):
Maiden Name/Other Names Used:
Maiden Name/Other Names Used:
Social Security Number:
Drivers License Number:
Date last used:
Date last used:
Date of Birth:
State of Issue:
Sex: Male Female
Have you been convicted of any felonies or misdemeanors since the age of 18 or do you have any action pending with a law
enforcement agency? Include courts-martial, military tribunals, probation and deferred adjudication on misdemeanors and
felonies. Do not include juvenile convictions or traffic citations. A conviction will not necessarily disqualify an applicant from
employment.
Yes No
If yes, list all violations below, include dates and arresting agency. Attach additional pages if necessary.
(A conviction will not necessarily bar an applicant from employment)
______________________________________________________________________________________________________
______________________________________________________________________________________________________
All addresses for the last SEVEN years: (attach additional pages if necessary)
1. __________________________________________________________________________________________________
Street
City
County
State
Zip
Years From – To
2. __________________________________________________________________________________________________
Street
City
County
State
Zip
Years From – To
3. __________________________________________________________________________________________________
Street
City
County
State
Zip
Years From – To
4. __________________________________________________________________________________________________
Street
City
County
State
Zip
Years From – To
5. __________________________________________________________________________________________________
Street
City
County
State
Zip
Years From – To
. .
Employment History (Show every employment – begin with last or present employer.)
Show all employments, beginning with last or present employer. If self-employed, list at least 2 business. Check the
appropriate boxes below.
May your current employer(s) be interviewed? Yes No
Dates (month/year)
Check one: Employer self-employed
From: ____________
To: ______________
Company Name: ___________________________________Phone:_________________________
Address:__________________________ City:______________ State:____ Zip:_________________
Job Title(s): _______________________________________________________________________
Name of Supervisor or Contact: Dept: ___________________________________________________
Reason for Leaving: ________________________________________________________________
Dates (month/year)
From: ____________
To: ______________
Check one: Employer self-employed
Company Name:_______________________________________Phone:_____________________
Address:__________________________ City:______________ State:____ Zip:________________
Job Title(s): ______________________________________________________________________
Name of Supervisor or Contact: Dept: __________________________________________________
Reason for Leaving: ________________________________________________________________
Professional Credentials
1.
Issuing Authority
Phone
Issuing State
License Type
License Number
Issue Date/Exp. Date
Status
Issuing Authority
Phone
Issuing State
License Type
License Number
Status
Issuing Authority
Phone
Issuing State
License Type
License Number
Status
Issuing Authority
Phone
Issuing State
License Type
License Number
Status
2.
3.
4.
Education
1.
Institution Name and Address
From - To (mo/yr)
GPA/Class Standing
Major
Minor
Type of Degree
Date Degree
Obtained or to be
Obtained
GPA/Class Standing
Major
Minor
Type of Degree
Date Degree
Obtained or to be
Obtained
GPA/Class Standing
Major
Minor
Type of Degree
Date Degree
Obtained or to be
Obtained
2.
From - To (mo/yr)
3.
From - To (mo/yr)
I hereby certify that all information provided in this authorization is true, correct and complete.
Signed this______________ day of_________________________________, 20_____________ .
Applicant Signature: ______________________________________________________________
www.redstarbackgrounds.com
8000 IH10 West, Suite 600, San Antonio, TX 78230
References-Etc. Driving Record Authorization
Please fax the completed form to : (603) 297-1476
I, ___________________________________________________________________________________
Please print your full name
Hereby authorize References-Etc. to obtain and send a copy of my driving record to the address or fax
number I have provided. I certify that all information provided by me pursuant to this agreement is true
and accurate to the best of my knowledge and I have read, understand and agree to the terms of this
agreement.
Your Daytime Phone: ___________________________________________________________________
Your Signature: ________________________________________________________________________
Date: ________________________________________________________________________________
Uso para el empleo
FORM # P001a
Page 4
BACKGROUND INQUIRY AUTHORIZATION
In order to be considered for employment with Dallas Trailer Repair Co., Inc. (the company) and it’s affiliated businesses; a personal background inquiry is conducted on all
potential applicants. I hereby am informed and understand that this company shall obtain criminal history record information.
I understand that I may be disqualified from further employment consideration if I have been convicted of a felony or any offense involving moral turpitude or for not disclosing
any conviction.
I understand that this criminal history record search may include local, state and nationwide law enforcement agency records and hereby expressly release any law enforcement
agency, record holder or individual from any and all liability for releasing any and all information these agencies or individuals may provide. If there is a need for further clarification of my identity, I agree to provide additional information.
I confirm that I have been informed that I may review and confirm any negative criminal history data that had been deemed to adversely impact the decision to offer employment. I understand I will be provided with the name of the reporting source, as well as the nature and substance of the criminal record information. The review and confirmation must be obtained from the providing agency.
I hereby affirm that all information I have provided in my employment application package is true and accurate to the best of my knowledge and understand that any deliberate
falsification, misrepresentation or omission of fact may be grounds for the rejecting me as an employment candidate.
By signing this form you are indicating that you understand all of the above statements and that your criminal history record will be checked. The authorization and all attachments to the employment application package become the property of the company. The company reserves the right to accept or reject any applicant. All offers of employment are conditional, upon review of your criminal history by management , and are retractable. All information, which becomes a part of this record, may be revealed to all
persons who participate in the selection of employees. I further understand that all information gathered regarding my application will be the property of the company and will
not be released to me.
The company is an Equal Opportunity Employer and will consider all applications without regard to race, color, national origin, religion, gender, martial status, veteran or military status or disability.
DISCLOSURE AND AUTHORIZATION FOR RELEASE OF MVR INFORMATION
As part of our driver controls, we may obtain motor vehicle reports (MVR’s) on your driving history. Before we seek such reports, we wish to have your
written permission to obtain the information. You have the right, upon written request, to a copy of the MVR.
Under the provisions of the Fair Credit Reporting Act, 15 USC, §1681 et.seq., the Americans with Disabilities Act and all applicable federal,
state and local laws, I hereby authorize and permit member companies of Dallas Trailer Repair Co., Inc., and all DBA’s of such, my employer
and/or my employer’s insurance agent to obtain a MVR.
I agree that a copy of this authorization has the same effect as an original.
I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, from liability that
might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.
I understand and acknowledge that I may request a copy of my MVR after I have provided proper identification.
Member companies of Dallas Trailer Repair Co., Inc., and all DBA’s of such, my employer, and/or my employer’s insurance agent have the
continuing right and authority to check and deliver my motor vehicle records on file with the state and other resource, including, without
limitation, driving record, financial responsibility information and prior driving information as set forth above and to deliver such records to
one another and the company.
Period of Active Status
This application will be active for one year. After that time, you will need to complete another application to be considered for employment,
I attest that I have answered these questions contained herein truthfully. ~ Atestiguo que he contestado a estas preguntas contenidas adjunto verazmente.
Signature:
Date:
Request for Verification of
Prior Employment
Part 1 of 2
Date:
Name/Title:
Company:
Address:
RE: Employment Verification for:
Dear:
__________________________________ has applied for employment with Dallas Trailer Repair Co., Inc. Would you kindly provide us with a
statement regarding your experience with this applicant during the applicant’s term of employment with your company? Please complete
the information requested below, and fax it back to 972-721-1606 OR email to __________________________________________________
at your earliest convenience. Feel free to call me as well at 972-579-9027.
Of course, your reply will be held in the strictest of confidence. Thank you in advance for your assistance.
Sincerely,
Return Form to:
Dallas Trailer Repair Co., Inc.
2447 East Hwy 356
____________________________________________
Irving, Texas 75060
Name, Title
Phone: 972-579-9027
Dallas Trailer Repair Co, Inc.
Email:______________________________________________
Candidate’s Reference Release
I hereby authorize __________________________________________________________ to provide Dallas Trailer Repair Co., Inc. with the
information
requested
in
the
attached
Employment
Verification
Form.
I
hereby
expressly
release
__________________________________ from any and all claims which may be related to or arise from the disclosure of the reference
information provided by ______________________________________________________ pursuant to this authorization, including, but
not limited to, claims for defamation, interference with contract, and negligence.
_______________________________________________________
Candidate’s Signature
Internal FORM # P001a
________________________________________________________
Date
Page 5

General Application

Transcripción

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