Employment Application

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Employment Application

The below form is for those applying for one of our open office positions at Trekker. Drivers wishing to join our team should fill out the drivers' application.
Personal Information
Hidden
Date
Name*
First Middle Last
Social Security #*
Present Address*
Street Address City State ZIP Code
Phone*
Is your permanent address the same as my present address?
- Yes
- No
Permanent Address*
Street Address City State ZIP Code
Are you 18 years or older?
- Yes
- No
Are you either a U.S. citizen or an alien authorized to work in the United States?
- Yes
- No
Employment Desired
Position Desired*
Date Available to Start*
Are you employed now?*
- Yes
- No
May we inquire of your present employer?
- Yes
- No
Have you ever applied to this company before?
- Yes
- No
When and where did you apply?*
Have you been convicted of a felony within the last 7 years?
- Yes
- No
Felony Details*
(Conviction will not necessarily disqualify applicant from employment)
Education
Check Box If Applicable
- Grammer School
- High School
- College
- Trade/Business/Correspondence School
Grammar School
Grammar School Name & Location*
Grammar School # Years*
Please enter a number from 0 to 9.
Did You Graduate?
- Yes
- No
High School
High School Name & Location*
High School # Years*
Please enter a number from 0 to 9.
Did You Graduate?
- Yes
- No
College
College Name & Location
College # Years
Please enter a number from 0 to 9.
College Area of Study
Did You Graduate?
- Yes
- No
Trade / Business / Correspondence School
Trade School Name & Location*
Trade School # Years*
Please enter a number from 0 to 9.
Trade School Area of Study*
Did You Graduate?
- Yes
- No
Military Service
Have you served in the U.S. military?
- Yes
- No
Military Branch*
Rank*
Present Membership in National Guard or Reserves
- Yes
- No
Employment History
Former Employers
List last three employers, starting with most recent

Most Recent Employer - Start Date*
Most Recent Employer - End Date*
Most Recent Employer - Name & Address*
Most Recent Employer - Position*
Most Recent Employer - Salary*
Most Recent Employer - Reason for Leaving*

2nd Most Recent Employer - Start Date*
2nd Most Recent Employer - End Date*
2nd Most Recent Employer - Name & Address*
2nd Most Recent Employer - Position*
2nd Most Recent Employer - Salary*
2nd Most Recent Employer - Reason for Leaving*

3rd Most Recent Employer - Start Date*
3rd Most Recent Employer - End Date*
3rd Most Recent Employer - Name & Address*
3rd Most Recent Employer - Position*
3rd Most Recent Employer - Salary*
3rd Most Recent Employer - Reason for Leaving*

Favorite Job*
Reason for Favorite Job*
Skills, Qualifications, & Experiences
Additional Information
References
Give the names of three persons, not related to you, whom you have known at least one year

1st Reference Name*
1st Reference Company*
1st Reference Position*
1st Reference Phone*
1st Reference Email
1st Reference Years Aquainted*

2nd Reference Name*
2nd Reference Company*
2nd Reference Position*
2nd Reference Phone*
2nd Reference Email
2nd Reference Years Aquainted*

3rd Reference Name*
3rd Reference Company*
3rd Reference Position*
3rd Reference Phone*
3rd Reference Email
3rd Reference Years Aquainted*

Emergency Contact
Emergency Contact Name*
Emergency Contact Address*
Street Address City State ZIP Code
Emergency Contact Phone*
Application Agreement
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigation and inquires of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at any employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers, and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Earl L. Henderson Trucking Company.
Agreement*
- I have read and accept the terms described in the above agreement.

8122 Bunkum Road

Caseyville, IL 62232

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