860.872.2330

Employment Application

Personal Information


Asterisk (*) indicates required field















Yes No

Yes No

Employment



   Laborer       Operator       Driver

Yes No

Class A    Class B   



   Yes       No   

Yes No



Education

Education Name/Location of School # of years attend Year of Graduation
High School
College
Other







EXPERIENCE & QUALIFICATIONS


Driver Licenses Held Within the Last 3 Years

State License # Type Expiration Date




   Yes       No   

Yes No


   Yes       No   

If the answer to either A, B, or C is “Yes,” please attach statement giving details

A maximum file size of 5 MB is allowed. Only extensions of .jpg,.jpeg,.gif,.png,.doc,.docx,.xls,.xlsx and .pdf will be accepted






Driving/Equipment Experience (If applicable)


Type of Equipment Start Date End Date Approx. # of Miles/Hours (Total)





A maximum file size of 5 MB is allowed. Only extensions of .jpg,.jpeg,.gif,.png,.doc,.docx,.xls,.xlsx and .pdf will be accepted


Dates Nature of Accident Fatalities Injuries
Traffic Convictions & Forfeitures for Past 3 Years (Other than Parking Violations)


Location Date Date Penalty







I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions or misrepresentations are discovered, my application may be rejected and if I am employed, may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause and with or without notice, at any time, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than the head of the company, and then only when in writing and signed by the head of the company, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing.

It is also agreed and understood that under the Fair Credit Report Act. Public Law 91-508 that this investigation may include an investigating Consumer Report, including information and complete such examinations as may be required to complete the employment file.

860.872.2330

PO Box 331   |   77 Meadow Brook Rd.   |   Ellington, CT 06029

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