Apply Application with Shelba D. Johnson Trucking, Inc.

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Employment

Office Staff Employment Application

Required fields are marked with an * asterisk.

Signature of Applicant* (Typing Name Signifies Signature)

09/08/2010
Date*

Name:			Phone:*
First*	Middle*	Last*	Cell:*

*Current Address:

Street*

City / State / Zip*

How Long*

*If at the above residence less than three years, list below all residences for the past three years. Attach a separate sheet if necessary.

Previous Address 1:

Street*

City / State / Zip*

How Long*

Previous Address 2:

Street*

City / State / Zip*

How Long*

Previous Address 3:

Street*

City / State / Zip*

How Long*

Previous Address 4:

Street*

City / State / Zip*

How Long*

Previous Address 5:

Street*

City / State / Zip*

How Long*

Position Applying for:* Temporary Part Time Full Time

Who referred you? Rate of pay expected?*

Have you worked for this company before? YesNo Dates:

From
month/year

To
month/year

Where? Rate of Pay Position

Reason for Leaving

Names of any relatives employed by this company

Are you currently employed? YesNo If not, how long since leaving last employment?

EDUCATION

Select highest grade completed: 123456789101112 College: 1234Higher

Last School attended?

Name

Address

GENERAL

Have you ever been bonded? YesNo Name of bonding company?
(Answer only if a job requirement)

Have you ever been convicted of a felony? YesNo
If yes, please explain fully below. Conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Have you ever worked for this company under another name? YesNo If, so, under what name?

EMPLOYMENT RECORD

The U.S. Department of Transportation requires that driver applicants show all employment for last three years. Effective July 1987 they
also show commercial driver employment for the seven years immediately preceeding this three year period. §391.21 (b)(10),(11).

   Current Employer:    Supervisor Name:
   Address:*    Phone:
   City:*    State:*    Zip:      Fax:
   Position Held:    From:*    To:*    Salary:
   Reason for Leaving:

   Second Employer:    Supervisor Name:
   Address:*    Phone:
   City:*    State:*    Zip:      Fax:
   Position Held:    From:*    To:*    Salary:
   Reason for Leaving:

   Third Employer:         Supervisor Name:
   Address:*    Phone:
   City:*    State:*    Zip:      Fax:
   Position Held:    From:*    To:*    Salary:
   Reason for Leaving:

   Fourth Employer:       Supervisor Name:
   Address:*    Phone:
   City:*    State:*    Zip:      Fax:
   Position Held:    From:*    To:*    Salary:
   Reason for Leaving:

   Fifth Employer:           Supervisor Name:
   Address:*    Phone:
   City:*    State:*    Zip:      Fax:
   Position Held:    From:*    To:*    Salary:
   Reason for Leaving:

CLERICAL EXPERIENCE & QUALIFICATIONS

List courses and training in office work below.

Indicate training and experience in the following:	Formal Training	Years of Experience	Area	Formal Training	Years of Experience
Typing (see below)			Dictating Machine
Shorthand (see below)			Bookkeeping Machine
Billing			Switchboard Equipment - below
Filing			Tabular
Computers (see below)			Accounting
Word Processing			OS&D
Key Punch			Interline
Calculator			Claims
Adding Machine			Cashier
Telecopier			Dispatcher
Photocopier

Typing Words Per Minute
Shorthand Words Per Minute
Computer Software Knowledge
Switchboad Equipment Types
Rates (indicate tariffs with which you have worked)

APPLICANT MUST READ AND SIGN

I certify that I have read and understand all of this employment application, 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 investigations and inquire of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an 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 connections with my application. It is also agreed and understood that under the Fair Credit Reporting Act, Public Law 91-508, I have been told that this investigation may include an Investigative Consumer Report, including information regarding my character, general reputation, personal characteristics, and mode of living. I also understand that if offered a job, it may be conditioned on the results of a physical examination and drug test. I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I understand that, as an applicant for a position with this company, I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job. I understand that false, misleading or omitted information from my application or interview(s) may result in my rejection as an applicant or discharge as an employee. I understand, also, that I am required to abide by all rules and regulations of the Company.
09/08/2010 Date*	Signature of Applicant* (Typing Name Signifies Signature)
	Send me a copy of application? Email Address*
ATTACHMENTS