Employment Application

Applicant’s Affidavit

1- The information I am presenting in this application is complete, true and correct to the best of my knowledge. I understand that any falsification, misrepresentation, or omissions could result in the denial of my application, withdrawal of any offer of employment, or immediate discharge.

2- I understand that in connection with the application process, the company and its representatives may contact my former employers, educational institutions, references, and other relevant third parties to obtain additional information related to the information given by me in this application. I hereby request, release, and consent to the release and disclosure of such information. I further release and hold harmless the company, their officers, employees and agents, and any other parties inquiring about, investigating, furnishing, communicating, reviewing, or evaluating such information from any and all potential claims, damages, liabilities, and / or actions of any kind arising from such activities, whether known or unknown to me presently, that I may have, now or in the future.

3- If employed, I agree to conform to the rules and regulations of the company and understand that I will be an employee-at-will, and my employment may be terminated at any time by me or the company, with or without notice, for any reason.

    Position Requested

    Referral Source

    Personal Information

    Address for last seven (7) years of residency:

    1

    2

    3

    4

    Work Experience - Include up to 10 years of employment ; Write explanation for any gap in employment exceeding thirty (30) calendar days use section(s) additional notes on Page 4 or additional info on Page 5:

    1

    Dates Employed

    Hourly Rate/Salary

    2

    Dates Employed

    Hourly Rate/Salary

    3

    Dates Employed

    Hourly Rate/Salary

    4

    Dates Employed

    Hourly Rate/Salary

    5

    Dates Employed

    Hourly Rate/Salary

    6

    Dates Employed

    Hourly Rate/Salary

    7

    Dates Employed

    Hourly Rate/Salary

    Education

    High School

    College/University

    Graduate/Professional

    Grade/Years Completed

    Diploma/Degree

    Course of Study

    References - List three school, work, or personal references who we may contact. Do not list relatives or former supervisors

    OPERATOR INFO ONLY

    Availability: The program runs 24 hours a day and 7 days a week and On-Time Performance Required

    Example of various shifts start and runs approx 8hrs up to 14 hrs : 2:00am, 4:45am, 12:45pm and Monday through Sunday

    Are you able available to work any shift or days assigned?

    Indicate mode of transportation to get to and from to work :

    Additional Information

    Summarize special skills and qualifications acquired from employment or other experience. Also, provide any additional information you feel may be helpful to us in considering your application for employment.

    Equal Opportunity Employer Disclosure

    Our company is an equal opportunity employer and will consider all applicants for all positions equally without without regard to their race, sex, age, color, religion, national origin, veteran status or any disability as provided in the Americans with Disabilities Act. All hiring decisions are made without prejudice or discrimination.


    Office Use Only

    Division: CHALLENGER TRANSPORTATION INC.