Notice to Driver and Safety Sensitive Applicants

More documents

Recommendations

Info

An Equal Opportunity EmployerPLEASE PRINT930 Tamalpais Avenue, San Rafael, CA 94901APPLICATION FOR EMPLOYMENTDateLast Name First Name MiddleMAILING ADDRESSNo. & Street City State ZipTELEPHONE NUMBERBusiness PhoneHome PhonePermanent Address (if different from present address)No. & Street City State Zip(No PO Boxes)EMPLOYMENT DESIREDPosition applying for: ______________________________________________Are you applying for:Regular full-time work?……………………….……….. Yes NoRegular part-time work?………………………… … Yes NoWhat days and hours are you available for work? ______________________________________If hired, on what date can you start work? __________Salary desired: _____________________________________________PERSONAL INFORMATIONHave you ever applied to or worked for Whistlestop before?……. Yes NoIf yes, when? ___________________________________Do you have any friends or relatives working for Whistlestop?…… Yes NoIf yes, state name(s) and relationship:NameNameRelationshipRelationshipWhy are you applying for work at Whistlestop?If hired, would you have a reliable means of transportation to and from work?…... Yes No1
Are you at least 18 years old? (If under 18, hire is subject to verification that you are ofminimum legal age.)……….. Yes NoIf hired, can you present evidence of your U.S. citizenship or proof of your legal right to liveand work in this country?….. Yes NoAre you able to perform the essential functions of the job for which you are applying, eitherwith or without reasonable accommodation?…….. Yes NoIf no, describe the functions that cannot be performed.(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligibleapplicants/employees to perform essential functions. Hire may be subject to passing a medical examination, skilland agility tests.)Have you ever been convicted of a criminal offense (felony or misdemeanor)? Yes No(Convictions for marijuana-related offenses that are more than two years old need not be listed.)If yes, state nature of the crime(s), when and where convicted, and disposition of the case.(Note: A conviction will not necessarily exclude you from consideration.)Are you currently employed?………………………. Yes NoIf so, may we contact your current employer?…. Yes NoEDUCATION, TRAINING, AND EXPERIENCESchool Name No. of years Did you Degreeand Address Completed Graduate? or DiplomaHigh ___________________________ ___ Yes No ________School NameAddressCity State ZipCollege/ ___________________________ ___ Yes No ________University NameAddressCity State Zip2
Page 1: 930 Tamalpais AvenueSan Rafael, Cal
Page 5 and 6: Name of EmployerType of BusinessTel
Page 7 and 8: DISCLOSUREDISCLOSURE - Must be a cl
Page 9 and 10: I have the right to make a request
Page 11 and 12: REQUEST/CONSENT FOR INFORMAnON FROM

Notice to Driver and Safety Sensitive Applicants

Create successful ePaper yourself

Delete template?

Save as template?