Job Application Employment Application Form *All information is required* "*" indicates required fields Name* First Middle Last Phone Number*Email Address* Alternate Phone Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you able to perform the essential function of the position with or without accommodations?* Yes No If necessary for the job, are you older than...* 13 16 18 21 Are you legally eligible for employment in the U.S.?* Yes No Are you seeking a permanent position?* Yes No How long will you be able to work after you're notified to be hired?* If necessary for the job, are you able to work overtime?* Yes No If necessary for the job, provide a valid Texas Driver's License?* Yes No If able to provide a valid Texas Driver's License, fill out the license info. Type:* C B A Endorsement:* H Transport of Hazardous Materials N Use of Tank Trucks P Transport of Passengers S Use of School Buses T Towing Double or Triple Trailers X Hazardous and Tank Trucks What period of the day do you prefer to work in?* Any Days Nights Swing Rotating Splits Graveyard Employment HistoryEmployment 1Employer* Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Pay-Rate:* Position title/duties, skills:*Supervisor:* Telephone:* Reason for leaving:* Employment 2Employer 2* Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Pay-Rate:* Position title/duties, skills:*Supervisor:* Telephone:* Reason for leaving:* Employment 3Employer 3* Start Date* MM slash DD slash YYYY End Date* MM slash DD slash YYYY Pay-Rate:* Position title/duties, skills:*Supervisor:* Telephone:* Reason for leaving:* EducationHigh SchoolSchool Name:* Graduated:* College/UniversitySchool Name:* Years Completed:* Field of Study:* Graduate or Degree:* Business/TechnicalSchool Name:* Years Completed:* Field of Study:* Graduate or Degree:* Another EducationSchool Name:* Years Completed:* Field of Study:* Graduate or Degree:* MilitaryAre you a Veteran? If so, what was your duty or specialized training?*Skills & QualificationsAre there any Qualification such as special skills, abilities or honors that should be considered?*What software, app, service, and equipment are you qualified to operate, specialize, or repair.*What licences or certifications do you have?*What are any human inderation skill--such as problom solving or foren laguage-- or any career/occupation you wish to bring the employer's attentions*ReferencesList two personal references who are not relatives or former supervisors.1. Name* 1. Address* 1. Phone* 1. Occupation* 1. Years Known* 2. Name* 2. Address* 2. Phone* 2. Occupation* 2. Years Known* Emergency ContactIn a case of an accident or medical issues, please provide your preferred contact.Name* Phone 1* Phone 2* Address* Relationship* Information to the ApplicantAs part of our procedure for processing your employment application, your personal and employment references my be checked. If you have misrepresented or omitted any facts on this application, and are subsequently hired, you may be discarged from your job. You may make a written request for information derived from the checking of your references. If necessary for employment, you may be required to: supply your birth certificate or other proof of authorization to work in the United Staes, Have a physical examination and/or a drug test, or to sign a conflict of interest agreement and abide by this terms.* I agree to the information shown above
