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Employment_(Const.)

Fields With * are Mandatory
Position Applied for * Date of Application *
Name *
Last
First
Middle
Social Security Number *
List address for past 3 years
Current Address *
Street   Zip Code
City   State
Phone #: (Home)   (Cell)
How Long?      
Do you have the legal right to work in the United States? *


Date of Birth? (MM-DD-YY)
(Required for Commercial Drivers)*
Can you provide proof of age? *
Have you worked for this company before?*
Where? *    
Dates: *


Positions *
FROM TO

   
Are you currently employed? *    
If not, how long since leaving last employment? * How did you hear about Stranco? *
Is there any reason you might be unable to perform the functions of the job for which you have applied ?If yes, please explain:* Expected Rate of Pay *
EMPLOYMENT HISTORY
Most Recent Employer *
Name
FROM:     TO:  
MO YR MO YR
Position Held
Address City
State Zip
Phone# Type Of equip. operated/pulled?
Contact Person    
IF NO ACCIDENTS HAVE OCCURED FOR THE PAST 3 YEARS, PLEASE INDICATE NONE IN TOP FIELDS ONLY
DATES NATURE OF ACCIDENT FATALITIES INJURIES
LAST ACCIDENT *
Previous
Previous
TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS. IF NONE, PLEASE INDICATE NONE IN TOP FIELDS ONLY
LOCATION DATE CHARGE PENALITY
* * * *
DRIVER QUALIFICATIONS AND EXPERIENCE
DRIVER'S LICENSE *    
STATE TYPE
LICENSE NO. EXPIRATION DATE
A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No

B. Has a license, permit or privilage ever been suspended or revoked? Yes No


IF THE ANSWER TO EITHER A OR B IS YES, PLEASE GIVE DETAILS *
TO BE READ BEFORE SUBMITTING
This certifies that this application was completed by me, and that all entries and information are true and complete to the best of my knowledge.
I authorize you to make such knowledge, investigations and inquiries of my personal, employment, financial, medical or drug and alcohol history and other related matters as may be necessary in arriving at an employment decision. (General inquiries regarding medical history will be made, only if after a conditional offer of emploment has been extended.) I hereby release employers, schools, healthcare 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 Stranco, Inc.
Date *  
APPLICANT'S NAME * SOCIAL SECURITY NUMBER *
YOU ARE AUTHORIZED TO FURNISH STRANCO, INC. ALL INFORMATION REGARDING MY SERVICES, CHARACTER, AND CONDUCT WHILE IN YOUR EMPLOYMENT. YOU ARE
RELEASED FROM ANY/ALL LIABILITY WHICH MAY RESULT FROM PROVIDING SUCH INFORMATION. I ALSO AUTHORIZE YOU TO PROVIDE STRANCO, INC. WITH
INFORMATION IN ACCORDANCE WITH SECTION 382.413 OF THE FMCSR REGARDING ALCOHOL TESTS WITH A CONCENTRATION OF 0.04 OR GREATER; POSITIVE
CONTROLLED SUBSTANCE TEST RESULTS, REFUSALS TO BE TESTED, ANY VIOLATIONS OF DOT AGENCY DRUG AND ALCOHOL TESTING REGULATIONS,
DOCUMENTATION OF COMPLETED DOT RETURN TO DUTY REQUIREMENTS, IF APPLICABLE; AND ANY DRUG AND ALCOHOL INFORMATION RECEIVED FROM
PREVIOUS EMPLOYERS WITHIN THE THREE (3)YEARS PRECEDING THE DATE OF THIS SIGNED RELEASE. I HEREBY AUTHORIZE STRANCO, INC. TO RELEASE ANY SUCH
INFORMATION TO ANY OF ITS PERSONNEL WHOSE DUTIES REQUIRE THEM TO ASSESS THIS APPLICATION OR TO MAKE ANY RECOMMENDATIONS OR DECISIONS
WITH RESPECT TO IT. I FURTHER AUTHORIZE STRANCO, INC. TO PHOTOCOPY THIS FORM AS MANY TIMES AS REQUIRED TO OBTAIN INFORMATION FROM ALL
PREVIOUS EMPLOYERS. A COPY OF THIS FORM IS VALID.
APPLICANT'S SIGNATURE * DATE *
*
 
 
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