Anchor Sign, Inc.

Application for Employment


Today's Date:    / / (MM/DD/YYYY)
Social Security Number:    (###-##-####)

Name:        
                     (First Name), (Middle Name), (Last Name)

Address:    
                     (Street Address), (City), (State & Zip)

Home Phone #:    - -
Other Phone #:    - -

Email Address:        

Do You Have A Valid Driver's License? Yes No     State:    DL#:

Do You Have A Valid CDL License?       Yes No     State:    DL#:

Position Specific Information:

Position Applied For:   

Relevant Experience:   

Pay Desired:              $          Date You Can Begin:    / / (MM/DD/YYYY)

Education:
Education Completed: High School: College / Technical: Graduate / Other:
Name Of School/College:
Check Highest Level Completed: 1 2 3 4 1 2 3 4 5 6 7
Are You Currently a Student ?     If So Where ?

Previous Employers:
This Information Must Be Complete And Accurate In Order To Be Considered for Employment.

Most Recent Employer:
Are You Currently Working For This Employer? Yes No

May We Contact This Employer? Yes No

Employed From: / / To: / / (MM/DD/YYYY)

Address:

Job Title:

Duties: Salary: $ Per Hour Annually

Reason For Leaving:


Second Most Recent Employer:
Are You Currently Working For This Employer? Yes No

May We Contact This Employer? Yes No

Employed From: / / To: / / (MM/DD/YYYY)

Address:

Job Title:

Duties: Salary: $ Per Hour Annually

Reason For Leaving:


Third Most Recent Employer:
Are You Currently Working For This Employer? Yes No

May We Contact This Employer? Yes No

Employed From: / / To: / / (MM/DD/YYYY)

Address:

Job Title:

Duties: Salary: $ Per Hour Annually

Reason For Leaving:

References:
Provide Only Individuals Who Are Familiar With Your Work History And Ability. Do Not List Relatives.
Name
Address & Phone Number:
Relation to You / Years Known:


Security Information:
List States & Counties Of Residence For The Past Ten Years:

Have You Used Any Names Or Social Security Numbers Other Than Given Above?

If So, Please List:

Have You Been Convicted Of A Crime In The Past Ten Years:
If so, please describe in the space provided below. (Conviction will not necessarily be a bar to employment. In accordance with Company policy and applicable federal and state laws, factors such as age at time of the offense, remoteness of offense, time since last conviction, and nature of the job sought and rehabilitation efforts will be taken into consideration. Use an extra sheet of paper if needed..
Incident:
City/State:
Charge:
Employment Information:
Can You, Upon Employment, Provide Genuine Documentation Establishing Your Identity And Eligibility To Be Legally Employed In The United States

Are You Currently, At Least, Seventeen (17) Years Of Age (Or Older)? (If no, you may be required to provide authorization to work.)

Can You Provide Proof Of Age?

Have You Ever Worked For Anchor Sign, Inc. Before?

If So, Provide Details Including Dates Of Employment and Position:
Applicant Information:
  1. I certify that all information included in this application is accurate to the best of my knowledge and understand that Anchor Sign, Inc. reserves the right to use this information in a background investigation which may be required of any employee. I also understand that any misrepresentation or omission of material facts in my application may be justification for refusal, or if employed, termination of employment from Anchor Sign, Inc.

  2. I authorize all persons, schools, companies, corporations, credit bureaus and law enforcement agencies to supply any information concerning my background and release them from any liability and responsibility arising from their doing so. I further understand that a routine inquiry and background check will be made which will provide information concerning character, criminal history, general reputation, personal characteristics, and mode of living and that upon written request additional information as to the nature and scope of the report, if any is made, will be provided.

  3. I understand and agree that:
    a) Anchor Sign, Inc. has a drug-free workplace policy, and that a substance screening may be required after an offer of employment is made and the commencement of employment may be contingent upon successful completion of the substance screening. The results will be held in strict confidence by Anchor Sign, Inc. except where release is required by law.
    b) At initial employment I may be expected to sign an employee non-compete agreement. This agreement protects any previous employer or other third party from disclosure of business information that may have been acquired illegally or with restrictions as to secrecy. Additionally, the agreement prohibits an employee from unfairly competing with Anchor Sign, Inc. during the course of employment or after termination of employment.

  4. I understand that this employment application and any other company documents published for employees or job applications are not contracts of employment and that if I am hired, I will be an at-will employee and I may voluntarily leave employment or I may be terminated by my employer, at any time for any reason. I understand that any oral or written statements to the contrary do not alter my at-will employment status.

  5. I understand that all benefits offered by Anchor Sign, Inc. to its employees can be modified or decreased at any time, at the company's sole discretion.

  6. I understand that any policy items that appear in any policy manuals, Employee Handbooks, or other related documents at the discretion of the company, may be withdrawn, revised, or replaced at any time.

  7. I understand that Anchor Sign, Inc. only offers full time employees fringe benefits, and that eligibility for the these fringe benefits will not begin until after I have completed six (6) full months of employment.

I understand that this company has a policy not to refuse to hire a qualified individual with a disability because of that person's need for a reasonable accommodation as required by the ADA.

I represent and warrant that I have read and fully understand the foregoing and seek employment.

Applicant’s Signature: Date:

Driver's Application for Employment


Today's Date:    / / (MM/DD/YYYY)
Social Security Number:    (###-##-####)

Name:        
                     (First Name), (Middle Name), (Last Name)

Address:    
                     (Street Address), (City), (State & Zip)

Date of Birth :    / / Req'd For All Drivers
Phone #:    _ _

Addresses For the Past 3 Years:

How many address have you had ?

Previous Address:   

Previous Address:   

Previous Address:   


Previous Employers For The Past 3 Years:
Please list All of the employers you have worked for in the past three years (from today’s date) and indicate if you were subject to the Federal Motor Carrier Safety Regulations (FMCSR’s) and/or Drug Screening Programs while you were employed. Also, please explain any gaps in employment. Please use a separate sheet if needed.
Number of Employers in the past three years ?:

Previous Employer 1:

Name: Phone - -

Address:

Subject to FMCSR's while there ? Yes No Subject to drug & alcohol testing reqmts? Yes No

Employed From: / / To: / / (MM/DD/YYYY)

Reason For Leaving:

Previous Employer 2:

Name: Phone - -

Address:

Subject to FMCSR's while there ? Yes No Subject to drug & alcohol testing reqmts? Yes No

Employed From: / / To: / / (MM/DD/YYYY)

Reason For Leaving:

Previous Employer 3:

Name: Phone - -

Address:

Subject to FMCSR's while there ? Yes No Subject to drug & alcohol testing reqmts? Yes No

Employed From: / / To: / / (MM/DD/YYYY)

Reason For Leaving:

Previous Employer 4:

Name: Phone - -

Address:

Subject to FMCSR's while there ? Yes No Subject to drug & alcohol testing reqmts? Yes No

Employed From: / / To: / / (MM/DD/YYYY)

Reason For Leaving:

Experience And Qualifications – Driver:
List the states and license numbers of All drivers’ licenses that you have held within the past 3 years with information on any endorsements that were added to your license – If applicable.
Number of licenses that you have held within the past three years ?:
State:
License Number:
Type (i.e. CDL):
Expiration Date:
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?
If you answered “Yes” to the above question provide the relevant details:
Has any driver’s license, permit, or privilege ever been suspended or revoked?
If you answered “Yes” to the above question provide the relevant details:

 

Drug and Alcohol Testing Information
As a prospective employer we must ask any applicant for a driving position with our Company the following questions:
Anchor Sign, Inc. requires all Drivers who operate Commercial Motor Vehicles to undergo alcohol and/or controlled substances testing and receive a negative result prior to driving for the Company. Do you consent to such testing? Yes No
Have you ever tested positive, or refused to test, on an employment_related drug and/or alcohol test administered by an employer to which you applied, but did not obtain safety sensitive work (I.e. driving a commercial motor vehicle) in the past 2 years? Yes No

Please Note: DOT Regulations prohibit our hiring you to perform a “safety sensitive function” (I.e. driving a commercial motor vehicle) if you refuse to consent to such testing; if you had a positive test, or a refusal to test, until and unless you provide documentation that shows you successfully completed the return_to_duty process in accordance with the DOT regulations.

 

Accident Record For The Past 10 Years:
Provide Information On All Accidents You Have Been Involved In the Past 10 Years. Please use a separate sheet if needed. If None, Type “None”. 

Number of Accidents You Have Been Involved In the Past 10 Years ?:

Date:
Type of Accident You Were In:
Were There Any Fatalities:
Were There Any Injuries:

 

Traffic Convictions For The Past 10 Years:
Provide Information On All Traffic Convictions You Have Been Involved In the Past 10 Years. Including: Speeding Tickets, Traffic Tickets, Accidents, Suspensions, etc. . If None, Type “None”. 

Number of Accidents You Have Been Involved In the Past 10 Years ?:

Date:
Type of Conviction:
Were There Any Fatalities:
Were There Any Injuries:

 

Driving Experience:
Provide Information On Any Previous Driving Experience You Have. If None, Write “None”.
Number of Accidents You Have Been Involved In the Past 10 Years ?:
Class of Equipment:
Type of Equipment:
Date
From:
Date
To:
Approximate Number of Miles
List States Operated In Over The Last Five Years:
List Any Courses Taken That Would Help You As A Driver:

 

 

Background Check / Motor Vehicle Record Check Authorization:

TO BE READ AND SIGNED BY THE APPLICANT:

In connection with your employment or application for employment, consumer reports may be requested from USIS Commercial Services/Hire Right, government agencies or from any previous employer whether listed or not in this application.  These reports may include the following types of information: names and dates of previous employers, reasons for termination of employment, work experience, accidents, academic history, professional credentials, safety performance, driving history and information related to the testing for drug/alcohol use, the results of such testing or any other information related to the completing of a substance abuse program.. 

Such reports may also contain any of the following public record information concerning your driving record, safety performance record, worker’s compensation claims, credit, bankruptcy proceedings, criminal records etc. from Federal, state and other agencies which maintain such records; as well as information from USIS/Hire Right concerning previous driving record requests made by others from such state agencies and state provided driving records.

Release: I authorize Anchor Sign, Inc. and USIS/Hire Right and any party or agency connected with USIS/Hire Right to furnish the above_mentioned information.  By signing below I certify that I have read and fully understand this release, that prior to signing I was given the opportunity to ask questions and to have those questions answered to my satisfaction, and that I executed this release voluntarily and with the knowledge that the information being released could affect my being hired, my employment and my eligibility for promotion. 

I also understand that, pursuant to the federal Fair Credit Reporting Act (FCRA), Anchor Sign, Inc. will provide me with a copy of any such report if the information contained in such report is, in any way, to be used in making a decision regarding my fitness for employment with Anchor Sign, Inc. I further understand that such report will be made available to me prior to any such decision being made, along with the name and address of the reporting agency that produced the report.

My signature below shall authorize Anchor Sign, Inc. to procure a consumer report as part of the pre_employment/post_employment background investigation. I understand that if I am hired, this authorization shall remain on file and shall serve as an ongoing authorization for Anchor Sign, Inc. to procure additional consumer reports at any time during my employment period with Anchor Sign, Inc.

Applicant’s Signature: Date:

Applicant Authorization:

TO BE READ AND SIGNED BY THE APPLICANT:

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize Anchor Sign, Inc. to make such investigations and inquiries 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 any former or current employers, schools, health care providers and other persons from any and all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in either my application or interview(s) may result in discharge.  I understand, also, that I am required to abide by all rules and regulations established by Anchor Sign, Inc.

Please Note:  Anchor Sign, Inc. may require an applicant to provide information in addition to the information required by the Federal Motor Carrier Safety Administration.
Applicant’s Signature: Date: