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Application For Employment

Answer all questions completely.

Do not leave any sections blank as this may be cause for rejection of your application.


Personal Information

First Name
Last Name
Middle Initial
Address
City
State
Zip
Home Phone
Cell Phone
Email


Position Applying For

Position
Full Time or Part Time
Date
Desired Salary
Referred By
Are you legally eligible for employment in the United States:
Yes No
Have you ever applied for a position with us before?
Yes No
If so, when, and what position?
Are you age 18 or older?
Yes No
Date you can start?
Are you employed now?
Yes No


Educational Background

High School
Address or Location
Program
Years Completed
Did you graduate?
Yes No
Diploma
College/University
Address or Location
Major
Years Completed
Did you graduate?
Yes No
Diploma
Vocational Training
Address or Location
Major
Years Completed
Did you graduate?
Yes No
Diploma
Other Training and/or Certifications (Including Adult Education Programs):
Use space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.


Employment History

EMPLOYER #1

Employer's Name
Address
Phone
Position Title
Employment
Wage
Duties
Supervisor's Name
Reason For Leaving

EMPLOYER #2

Employer's Name
Address
Phone
Position Title
Employment
Wage
Duties
Supervisor's Name
Reason For Leaving

EMPLOYER #3

Employer's Name
Address
Phone
Position Title
Employment
Wage
Duties
Supervisor's Name
Reason For Leaving

EMPLOYER #4

Employer's Name
Address
Phone
Position Title
Employment
Wage
Duties
Supervisor's Name
Reason For Leaving
Have you ever been terminated, asked to resign, or left a job without notice? If so, give details.
Have you ever been convicted for any violation(s) of law, including moving traffic violations?
Yes No
Description of Offense
Statute or Ordinance (if known)
Date of Charge
Date of Conviction
County/City and State of Conviction


May we contact your present employer?
Yes No

Did you complete this application yourself?
Yes No
If not, who did?


REFERENCES – PLEASE DO NOT INCLUDE RELATIVES. WORK-RELATED, PROFESSIONAL REFERENCES PREFERRED.

REFERENCE #1

Reference Name
Address
Occupation
Phone
Years Acquainted

REFERENCE #2

Reference Name
Address
Occupation
Phone
Years Acquainted

REFERENCE #3

Reference Name
Address
Occupation
Phone
Years Acquainted

REFERENCE #4

Reference Name
Address
Occupation
Phone
Years Acquainted


DRIVING INFORMATION

Do you have a Driver’s License?
Yes No
License Type
Operator Commercial (CDL) Chauffeur
State of Issue
Expiration Date
Driver's License Number
Have you had any accidents during the past three years?
Yes No
How many?
Have you had any moving violations during the past three years:
Yes No
How many?


Military Information

Have you ever been in the Armed Forces?
Yes No
Are you now a member of the National Guard?
Yes No
Date Entered/Discharged
Specialty


APPLICATION FORM WAIVER

PLEASE READ CAREFULLY

In exchange for the consideration of my job application by Cornhusker International Trucks, Inc. (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Cornhusker International Trucks, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the Owner/President of the Company. Both the undersigned and Cornhusker International Trucks, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies, and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I understand and agree that (in connection with this application and at any time during my employment) the Company may require me to sign a consent form so that the Company may investigate my driving record. I further understand that the Company may contact my previous employers, and 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 fully 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 myself.

In the event of my employment to a position in this Company, I will comply with all rules and regulations of this Company. 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 also understand that any offer of employment may be contingent upon the passing of a physical examination and a test for the presence of alcohol in my system, performed by a doctor selected by the Company. Further, I understand that at any time after I am hired, the Company may require me to submit to a physical examination and an alcohol test, to the extent permitted by law. 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 a specialized physical for my particular work area, prior to my employment and during my employment. I understand that should I decline to sign this consent or decline to take any of the above tests, my application for employment may be rejected or my employment may be terminated.

I further understand that my employment with the Company shall be probationary for a period of ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relationship with the Company is terminable at will for any reason by either party.



We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age, disability or gender identity.

Thank you for completing this application form and for your interest in our business!



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