FILL OUT THE FORM BELOW TO APPLY We are an equal opportunity employer and will not discriminate in the hiring process on the basis of sex, religion, race, color, age, disability, sexual orientation, marital or veteran status, national origin or genetic information. APPLICANT INFORMATION APPLICANT NAME (REQUIRED) LAST 4 OF SOCIAL SECURITY (REQUIRED) PRESENT ADDRESS PRESENT STATE PRESENT CITY PRESENT ZIP CODE PERMANENT ADDRESS PERMANENT STATE PERMANENT CITY PERMANENT ZIP CODE PHONE NUMBER (REQUIRED) HOW DID YOU HEAR ABOUT THIS OPENING? EMPLOYMENT DESIRED POSITION DESIRED? EMPLOYMENT START DATE? SALARY DESIRED? ARE YOU CURRENTLY EMPLOYED? —Please choose an option—NOYES MAY WE INQUIRE THIS EMPLOYER? —Please choose an option—NOYES HAVE YOU EVER APPLIED TO THIS COMPANY? —Please choose an option—NOYES WHERE? WHEN? EDUCATION HISTORY DID YOU ATTEND HIGH SCHOOL? —Please choose an option—NOYES NAME OF HIGH SCHOOL ATTENDED? LOCATION OF HIGH SCHOOL ATTENDED? YEARS OF HIGH SCHOOL ATTENDED? DID YOU GRADUATE HIGH SCHOOL? —Please choose an option—NOYES DID YOU ATTEND COLLEGE OR UNIVERSITY? —Please choose an option—NOYES NAME OF COLLEGE/UNIVERSITY ATTENDED? LOCATION OF COLLEGE/UNIVERSITY ATTENDED? YEARS OF COLLEGE/UNIVERSITY ATTENDED? DID YOU GRADUATE COLLEGE/UNIVERSITY? —Please choose an option—NOYES COURSE OF STUDY AT COLLEGE/UNIVERSITY? DID YOU ATTEND A TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL? —Please choose an option—NOYES NAME OF TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL ATTENDED? LOCATION OF TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL ATTENDED? YEARS OF TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL ATTENDED? DID YOU GRADUATE TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL? —Please choose an option—NOYES COURSE OF STUDY AT TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL? GENERAL INFORMATION SUBJECT OF SPECIAL STUDY OR RESEARCH WORK: SPECIAL TRAINING AND/OR SKILLS: U.S. MILITARY OR NAVAL SERVICE? (REQUIRED) —Please choose an option—NOYES BRANCH OF SERVICE? RANK AT DISCHARGE? DATE STARTED MILITARY/NAVAL SERVICE? DATE ENDED MILITARY/NAVAL SERVICE? WORK EXPERIENCE: PLEASE LIST ALL PREVIOUS EMPLOYMENT, BEGINNING WITH MOST RECENT. EMPLOYER START DATE: EMPLOYER FINISH DATE: NAME OF EMPLOYER: JOB POSITION: REASON FOR LEAVING: EMPLOYER LOCATION: SALARY: POSITION & DUTIES: PHONE NUMBER: SUPERVISORS NAME: MAY WE CONTACT THEM? —Please choose an option—NOYES EMPLOYER START DATE: EMPLOYER FINISH DATE: EMPLOYER NAME: JOB POSITION: REASON FOR LEAVING: EMPLOYER LOCATION: SALARY: POSITION & DUTIES: PHONE NUMBER: SUPERVISORS NAME: MAY WE CONTACT THEM? —Please choose an option—NOYES EMPLOYER START DATE: EMPLOYER FINISH DATE: EMPLOYER NAME: JOB POSITION: REASON FOR LEAVING: EMPLOYER LOCATION: SALARY: POSITION & DUTIES: PHONE NUMBER: SUPERVISORS NAME: MAY WE CONTACT THEM? —Please choose an option—NOYES REFERENCES GIVE BELOW THE NAMES OF THREE PERSONS NOT RELATED TO YOU, WHOM YOU HAVE KNOWN ATLEAST ONE YEAR. REFERENCE 1 NAME ADDRESS | CITY OCUPATION | TITLE YEARS KNOWN PHONE NUMBER REFERENCE 2 NAME ADDRESS | CITY OCUPATION | TITLE YEARS KNOWN PHONE NUMBER REFERENCE 3 NAME ADDRESS | CITY OCUPATION | TITLE YEARS KNOWN PHONE NUMBER EXPERIENCE AND QUALIFICATIONS-DRIVERS STATE TYPE LICENSE No. EXPIRATION DATE STATE TYPE LICENSE No. EXPIRATION DATE STATE TYPE LICENSE No. EXPIRATION DATE STATE TYPE LICENSE No. EXPIRATION DATE Have you ever been denied a license permit or privilege to operate a motor vehicle? NOYES DATE Any license, permit or privilege ever been suspended or revoked? NOYES DATE Have you ever been convicted of any crime? NOYES DATE Have you been convicted of operating a commercial vehicle while under the influence of alcohol? NOYES DATE Have you been known by any other than the one on this application? NOYES DATE * A “YES” answer to any of the above questions will not automatically disqualify you from employment. We will consider the nature and date of the offense and the job for which you are applying for job related purposes only, and only to the extent permitted by applicable law. PLEASE READ THE FOLLOWING & AGREE TO TERMS & CONDITIONS AUTHORIZATION “I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained heroin and the references and employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have personal or otherwise and release the company from all liability to any damage that may result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment to any specialized period of time, or to make any agreement contrary to the foregoing unless. It is in writing and signed by an authorized company representative. This waiver does not permit the release of use of disability-related or medical information in manner prohibited by the American with Disabilities Act (ADA) and other relevant federal and state laws” PRE- EMPLOYMENT DRUG SCREEN RELEASE "I understand that in accordance with Service Bros. Transport drug policy, all prospective employees must successfully complete a drug screen urinalysis as a condition employment. Further I understand and acknowledge that my submission to a drug screen urinalysis is required to be administered by a licensed company of Service Bros. Transport choice. The results of said test should preclude any further consideration of my employment with Service Bros. Transport. Consequently, I hereby agree to submit to a drug screen urinalysis and authorize the release of the results of my screen test to authorized representatives of Service Bros. Transport. If employed, with Service Bros. Transport Inc. you are subject to random drug testing." APPLICATION NOTIFICATON AND RELEASE "In connection with my application for employment (including contract for services) with you, I understand that a consumer report which may contain public record information is being requested. This report may include the following types of information: name and dates of previous employers, reason for termination, accidents etc. I further understand that such report may contain public record information concerning my driving record, workers compensations claims, credit bankruptcy proceeding, criminal records, etc, from federal, state and other agencies or any other party concerning previous driving records. I AUTHORIZE WITHOUT RESERVATIONS; ANY ANGENCY CONTACTED BY US TO FURNISH THE ABOVE- MENTIONED INFORMATION" (Break-downs. Shutdowns. Failed Services): Northern California Runs are allowed one hour of idle time. The rate after idle time will be $11.00 (minimum wage) for every hour after that is spent in idle. Once active at regular duties idle is no longer applicable. Refusal of work duties: Refusal of work duties including unexcused absences results in Automatic Employment Resignation from Service Bros. Transport Inc. If employed with Service Bros. Transport I agree to terms and condition. Training Wages Our training consists of 2-3 days at a wage of $11.00 hourly rate. After the completion of your training you will resume to agreed rate. You will be on probation for 90 days. After the 90 days’ probation, you will have an employee evaluation, and you can be eligible for company benefits. Lifting Capabilities Are you fit and capable of lifting 50lbs or more multiple times a day? AGREE TO TERMS & CONDITIONS PLEASE SIGN GREY BOX BELOW W/ FINGER OR MOUSE
