Application for Employment Uso para el empleo - DTR · Application for Employment Uso para el...

Application for Employment

Uso para el empleo

FORM # P001a 2447 E. Hwy 356 Irving, Texas 75060

Personal Information \ Información Personal Date \ Fecha:

Drivers License Number:

CDL [ ] YES [ ] NO

Name \ Nombre

Social Security Number:

Seguro Social:

Address \ Dirección

Home Phone: Teléfono de Casa #

City, State, Zip Code Ciudad, Estado, Código postal

Other Number: Teléfono Cellular #

Have you ever applied for employment with us?

¿Usted ha solicitado trabajo con Dallas Trailer Repair Co. anteriormente?

[ ] yes [ ] no If Yes: Month: Year:

Have you ever been employed with us? ¿Has trabajado con Dallas Trailer Repair Co. anteriormente?

[ ] yes [ ] no If Yes: Month: Year:

Do you have relatives employed with us? ¿Es usted relacionado con cualquier persona empleada aquí?

[ ] yes [ ] no Name \ Nombre: Relation \relacionado cómo:

Are you legally eligible for employment in the United States?

¿Es usted legalmente elegible para el empleo en los Estados Unidos?

[ ] yes [ ] no Are you over the age of 18? [ ] yes [ ] no

¿Es usted mayor de 18 años? [ ] sí [ ] no

Apart for religious observance, are you available for full time work?

¿Aparte de observancia religiosa, está usted disponible para el trabajo a

[ ] yes [ ] no

Have you ever been convicted of a felony?

¿Has estado condenado por un crimen?

[ ] yes [ ] no

* Conviction will not necessarily disqualify an applicant for employment *

* Trabajado horas extra si se te pide *

Will you work overtime if asked? ¿Trabajará horas extras si en necesario?

[ ] yes [ ] no

Position Desired? ¿qué posición está usted solicitando?

Pay Expected ¿La Paga Esperó?

$

Other Special Training or Skills (languages, machine operation, etc.)

¿Hay habilidades o entrenamiento especiales que usted tenga? (idiomas, operación de máquina, etc.)

How did you learn about us? ¿Cómo supo de nosotros?

[ ] FRIEND AMIGO [ ] OTHER

OTRO

[ ] RELATIVE PARIENTE

[ ] WALK-IN CAMINÓ ADENTRO

[ ] ADVERTISEMENT ANUNCIO

[ ] EMPLOYMENT AGENCY AGENCIA DE COLOCACIÓN

Military

Did you serve or are you serving in the United States armed forces? [ ] yes [ ] no What Branch?

Describe any relevant training?

Are you still in Reserve for service which could effect your attendance? [ ] yes [ ] no How?

EMAIL ADDRESS:


Uso para el empleo

FORM # P001a

Employment Experience / Experiencia del Empleo Dates Employed Fechas Empleadas

Work Performed Trabajas Realizado

1 Employer Patron

From To

Address direccion

Telephone # telefono

Job Title Titulo del trabajo

Hourly Rate / Salary Salarios Cada hora / Sueldo

Supervisor

Starting Comienzo

Final Extremo

Reason For Leaving? Razon de irse?



2 Employer Patron

From To

Address direccion




Supervisor

Starting Comienzo

Final Extremo




3 Employer Patron

From To

Address direccion




Supervisor

Starting Comienzo

Final Extremo




4 Employer Patron

From To

Address direccion




Supervisor

Starting Comienzo

Final Extremo


Please do not contact the following employers (Indicate why) Please circle corresponding number: 1 2 3 4

No entre en contacto con por favor a patrones siguientes (indique porqué)circundan por favor número correspondiente: 1 2 3 4

SIGNATURE DATE

Waiver Box: By Signing, you give us permission to contact the above noted Previous employers; you give these previous employers permis-sion to disclose information about you; you waive your right to legally pursue any person who discloses such information as a result of our background examination.


Uso para el empleo

FORM # P001a 2447 E. Hwy 356 Irving, Texas 75060

Education Name & Address of School Completed Diploma or Degree

Elementary [ ] Yes / Si [ ] No

High School [ ] Yes / Si [ ] No

College [ ] Yes / Si [ ] No

Graduate Professional [ ] Yes / Si [ ] No

Technical [ ] Yes / Si [ ] No

Other [ ] Yes / Si [ ] No

Languages Fluent Good Fair

Speak

Write

Read

Please Indicate any foreign languages which you can speak, write or read.

Personal References /

1. Reference

Address

Telephone

2. Reference

Address

Telephone

3. Reference

Address

Telephone

4. Reference

Address

Telephone

I attest that I have answered these questions contained herein truthfully. ~ Atestiguo que he contestado a estas preguntas contenidas adjunto verazmente.

Signature: Date:

This information is used to satisfy the Affirmative Action requirements of Section 503 of the Rehabilitation Act or necessitated by another federal law or regulation.

APPLICATION FOR EMPLOYMENT P E R S O N A L I N F O R M A T I O N

Name Soc ia l Secur i ty Number FIRST MIDDLE LAST

Present Address STREET CITY STATE ZIP

Permanent Address

Email Address Phone Number(s) ( ) - / ( ) - If you are under 18, can you furnish a work permit? � Yes � No DAYTIME EVENING

Driver’s License Number State Issued Class (IF REQUIRED BY YOUR POSITION)

E M P L O Y M E N T D E S I R E D Position Applied For: Salary Desired: Type: � Full Time � Part Time � Temporary � Seasonal Date you can start: / /

Are you employed now? � Yes � No If so, may we contact your current employer? � Yes � No

Have you ever applied for a position or worked at eEmployers Solutions, Inc. before? � Yes � No If yes, When? Where? Are you on lay-off and subject to recall? � Yes � No Will you travel if job requires it? � Yes � No

Will you relocate if the position requires it? � Yes � No Will you work overtime if required? � Yes � No

Are you able to meet the attendance requirements of the position? � Yes � No

Have you ever been denied a bond required for employment or denied a security clearance? � Yes � No

Have you been convicted of a felony in the past seven (7) years? � Yes � No (A conviction does not constitute an automatic bar to employment unless relevant to the type of employment.)

If yes, please explain:

E D U C A T I O N Type of

Education Status Name & Location of School # of years

Completed Did you

graduate? Subjects Studied

Currently Attending

Aca

dem

ic

Last Completed

Currently Attending

Tra

de,

Bus

ines

s O

r O

ther

Last Completed

V O L U N T A R Y A F F I R M A T I V E A C T I O N I N F O R M A T I O N

We comply with government regulations including Affirmative Action. In an effort to comply with requirements regarding government record keeping and other legal obligations, we ask that you complete this data survey. Your cooperation is appreciated. Please be advised that your survey is considered confidential information that will not be used in any employment matters. Sex: r Male r Female Race/Ethnic Group: r Hispanic or Latino r Black or African American r White r American Indian/Alaskan Native rAsian r Pacific Islander/Native Hawaiian r Two or more races SPECIAL NOTICE TO VIETNAM VETERANS, DISABLED VETERANS AND INDIVIDUALS WITH PHYSICAL OR MENTAL HANDICAPS OR DISABILITIES: Government contractors subject to the Vietnam Era Veterans Readjustment Act of 1974 and the Rehabilitation Act of 1973 are required to take affirmative action to employ and advance in employment qualified disabled veterans and veterans of the Vietnam Era, and qualified handicapped individuals. PLEASE CHECK IF ANY OF THE FOLLOWING ARE APPLICABLE: r VIETNAM ERA VETERAN r DISABLED VETERAN r HANDICAPPED INDIVIDUAL

S K I L L S A N D Q U A L I F I C A T I O N S :

Summarize special skills and qualifications acquired from employment or other experiences that may qualify you to work with our Company FORMER EMPLOYERS: List below, your last two employers, starting with the most recent one first.

Dates Worked Name & Address of Previous Employer Salary Job Title Reason for Leaving From

To

From

To

FORMER SUPERVISORS: List below, three supervisors for whom you have worked at some point during the last five years. Name Address Phone Number Years Acquainted

( ) ( ) ( ) FOREIGN LANGUAGE: List any foreign language skills that you have and check the box(s) that best describes your capabilities.

Language Speak Read Write � Fluent � Good � Fair � Fluent � Good � Fair � Fluent � Good � Fair

C O N D I T I O N S O F E M P L O Y M E N T

Ø I give the Company the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability the Company and its representatives for seeking such information and all other persons, corporations or organizations for furnishing such information.

Ø It is understood and agreed upon that any mis representation or omission by me in this application will be sufficient cause for cancellation of this application and/or separation from the Company's service if I have been employed. Furthermore, I understand that just as I am free to resign at anytime, the Company reserves the right to terminate my employment at any time, with or without cause and without prior notice. No supervisor or other representative of the company (except the President of eEmployers Solutions, Inc.) has the authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the above.

Ø Reporting to work with impaired abilities; or the possession, consumption or distribution of drugs or alcohol on Company or Client premises and/or worksites, shall be grounds for disciplinary action, including discharge. A condition of employment includes a willingness on the part of the applicant or employee to agree to physical examination, and/or substance testing, if requested by the Company. We are committed to operating a drug free workplace. Violations of our drug and alcohol policy may result in dismissal.

Ø The Company is an Equal Opportunity Employer. The Company does not discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant's consideration for employment on a basis prohibited by local, state or federal law.

Ø Any controversy of any kind arising between the parties under this agreement or otherwise (or any agent, officer, director or affiliate of any party), including but not limited to common law, statutory, tort or contract claims, will be submitted to mediation and, failing settlement in mediation, to binding arbitration, in accordance with the rules of the American Arbitration Association. Arbitration shall be conducted in San Antonio, Texas. Each party will select one person to serves as arbitrator. Those arbitrators will in turn select a single arbitrator to hear the matter. Each party is responsible for its own costs and expenses and will share equally the cost and expenses of the Arbitrator. The arbitration will be subject to and governed by the provisions of the Federal Arbitration Act, 9 U.S.C., Section 1-et seq. The parties hereto stipulate and agree that this agreement involves matters affecting interstate commerce.

Ø This application is current for only 60 days. At the conclusion of this time, if I have not heard from the Company and still wish to be considered for employment, it will be necessary to fill out a new application.

I have carefully read the above Conditions of Employment and I understand and agree to the terms.

_______________________________________ ________________________________

Signature of Applicant Date

EMPLOYMENT BACKGROUND CHECK DISCLOSURE AND AUTHORIZATION

DISCLOSURE

Dallas Trailer Repair Co., Inc. / DTR Transportation Services (“Company”) may obtain information about you from [RED STAR BACK-

GROUNDS INC. 8000 IH 10 W. STE 600 SAN ANTONIO, TX 78230, 210-524-7707 AND WWW.REDSTARBACKGROUNDS.COM, or anoth-

er third-party consumer reporting agency, for employment purposes, including without limitation, for the purpose of evaluating you for employ-

ment, promotion, reassignment and retention as an employee, at any time prior to or during your employment, if applicable, and without giving

you any further notice. Thus, you may be the subject of a background check, also known as a “consumer report” and/or an “investigative con-

sumer report,” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These

reports may contain, without limitation, all or some of the following types of information about you: credit history, social security number verifi-

cation, address and alias history, personal references, professional references, employment history, educational history, licenses, certifica-

tions, motor vehicle records, driving records, criminal history, and civil court record history. Credit history will only be requested where such

information is substantially related to the duties and responsibilities of the applied-for position. You have the right to know whether a consum-

er report has been obtained about you; and you have the right to request a copy of any report obtained by Company, a copy of “A Summary

of Your Rights Under the FCRA,” and a complete and accurate written disclosure of the nature and scope of any investigative consumer re-

port obtained by Company. An investigative consumer report is information on an individual's character, general reputation, personal charac-

teristics, or mode of living is obtained through a personal interview with an information source. The nature and scope of the most common

form of investigative consumer report obtained for employment purposes is an interview with a reference, employer, coworker, supervisor, or

customer.

AUTHORIZATION

I acknowledge receipt of the Background Check Disclosure and A Summary of Your Rights Under the FCRA, and certify that I have read and

understand both documents. I hereby authorize Company to obtain background check information, including consumer reports and investiga-

tive consumer reports, about me from [RED STAR BACKGROUNDS INC.] or another third-party consumer reporting agency, for employment

purposes, including without limitation, for the purpose of evaluating you for employment, promotion, reassignment and retention as an em-

ployee, at any time prior to or during my employment, if applicable, and without giving me any further notice. To this end, I hereby authorize,

without reservation, any credit bureau, creditor, employer, coworker, supervisor, customer, institution, school, college, university, license or

certificate granting entity, state department of motor vehicles, state department of revenue, court, governmental agency, law enforcement

agency, information service bureau, insurance company, other record-keeping agency, person, administrator, organization, company, corpo-

ration, entity, and any other information source, to furnish any and all background information requested by [RED STAR BACKGROUNDS

INC., 8000 IH 10 W. STE 600 SAN ANTONIO, TX 78230, 210-524-7797 AND WWW.REDSTARBACKGROUNDS.COM], another third-party

acting on behalf of Company, and/or Company itself, and regardless of whether the requested information was received from another source.

I agree that a copy of this Authorization shall be as valid as the original.

First Name Middle Name Last Name Maiden / Other Names

Social Security # Driver’s License Number State Class County of Residence

Date of Birth Authorization Signature Date

For DTR Internal use only

SERVICES REQUESTED

MVR Education

Criminal Employment

Other Prof. Cred.

Applicant Screening Form

Full Name (First, Middle, Last): Maiden Name/Other Names Used: Date last used: Maiden Name/Other Names Used: Date last used: Social Security Number: Date of Birth: Sex: Male Female Drivers License Number: State of Issue: Have you been convicted of any felonies or misdemeanors since the age of 18 or do you have any action pending with a law enforcement agency? Include courts-martial, military tribunals, probation and deferred adjudication on misdemeanors and felonies. Do not include juvenile convictions or traffic citations. A conviction will not necessarily disqualify an applicant from employment. Yes No If yes, list all violations below, include dates and arresting agency. Attach additional pages if necessary. (A conviction will not necessarily bar an applicant from employment) ____________________________________________________________________________________________________________________________________________________________________________________________________________ All addresses for the last SEVEN years: (attach additional pages if necessary) 1. __________________________________________________________________________________________________ Street City County State Zip Years From – To 2. __________________________________________________________________________________________________ Street City County State Zip Years From – To 3. __________________________________________________________________________________________________ Street City County State Zip Years From – To 4. __________________________________________________________________________________________________ Street City County State Zip Years From – To 5. __________________________________________________________________________________________________ Street City County State Zip Years From – To . . Employment History (Show every employment – begin with last or present employer.) Show all employments, beginning with last or present employer. If self-employed, list at least 2 business. Check the appropriate boxes below. May your current employer(s) be interviewed? Yes No Dates (month/year) From: ____________ To: ______________

Check one: Employer self-employed Company Name: ___________________________________Phone:_________________________ Address:__________________________ City:______________ State:____ Zip:_________________ Job Title(s): _______________________________________________________________________ Name of Supervisor or Contact: Dept: ___________________________________________________ Reason for Leaving: ________________________________________________________________

Dates (month/year) From: ____________ To: ______________

Check one: Employer self-employed Company Name:_______________________________________Phone:_____________________ Address:__________________________ City:______________ State:____ Zip:________________ Job Title(s): ______________________________________________________________________ Name of Supervisor or Contact: Dept: __________________________________________________ Reason for Leaving: ________________________________________________________________

Professional Credentials 1. Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status 2. Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status 3. Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status 4. Issuing Authority Phone Issuing State License Type License Number Issue Date/Exp. Date Status Education 1. Institution Name and Address From - To (mo/yr) GPA/Class Standing Major Minor Type of Degree Date Degree Obtained or to be Obtained 2. Institution Name and Address From - To (mo/yr) GPA/Class Standing Major Minor Type of Degree Date Degree Obtained or to be Obtained 3. Institution Name and Address From - To (mo/yr) GPA/Class Standing Major Minor Type of Degree Date Degree Obtained or to be Obtained I hereby certify that all information provided in this authorization is true, correct and complete. Signed this______________ day of_________________________________, 20_____________ . Applicant Signature: ______________________________________________________________

www.redstarbackgrounds.com

8000 IH10 West, Suite 600, San Antonio, TX 78230

http://www.redstarbackgrounds.com/

References-Etc. Driving Record Authorization

Please fax the completed form to : (603) 297-1476

I, ___________________________________________________________________________________

Please print your full name

Hereby authorize References-Etc. to obtain and send a copy of my driving record to the address or fax

number I have provided. I certify that all information provided by me pursuant to this agreement is true

and accurate to the best of my knowledge and I have read, understand and agree to the terms of this

agreement.

Your Daytime Phone: ___________________________________________________________________

Your Signature: ________________________________________________________________________

Date: ________________________________________________________________________________


Uso para el empleo

FORM # P001a Page 4 2447 E. Hwy 356 Irving, Texas 75060

I attest that I have answered these questions contained herein truthfully. ~ Atestiguo que he contestado a estas preguntas contenidas adjunto verazmente.

Signature: Date:

BACKGROUND INQUIRY AUTHORIZATION

In order to be considered for employment with Dallas Trailer Repair Co., Inc. (the company) and it’s affiliated businesses; a personal background inquiry is conducted on all potential applicants. I hereby am informed and understand that this company shall obtain criminal history record information.

I understand that I may be disqualified from further employment consideration if I have been convicted of a felony or any offense involving moral turpitude or for not disclosing any conviction.

I understand that this criminal history record search may include local, state and nationwide law enforcement agency records and hereby expressly release any law enforcement agency, record holder or individual from any and all liability for releasing any and all information these agencies or individuals may provide. If there is a need for further clarifi-cation of my identity, I agree to provide additional information.

I confirm that I have been informed that I may review and confirm any negative criminal history data that had been deemed to adversely impact the decision to offer employ-ment. I understand I will be provided with the name of the reporting source, as well as the nature and substance of the criminal record information. The review and confirma-tion must be obtained from the providing agency.

I hereby affirm that all information I have provided in my employment application package is true and accurate to the best of my knowledge and understand that any deliberate falsification, misrepresentation or omission of fact may be grounds for the rejecting me as an employment candidate.

By signing this form you are indicating that you understand all of the above statements and that your criminal history record will be checked. The authorization and all attach-ments to the employment application package become the property of the company. The company reserves the right to accept or reject any applicant. All offers of employ-ment are conditional, upon review of your criminal history by management , and are retractable. All information, which becomes a part of this record, may be revealed to all persons who participate in the selection of employees. I further understand that all information gathered regarding my application will be the property of the company and will not be released to me.

The company is an Equal Opportunity Employer and will consider all applications without regard to race, color, national origin, religion, gender, martial status, veteran or mili-tary status or disability.

DISCLOSURE AND AUTHORIZATION FOR RELEASE OF MVR INFORMATION

As part of our driver controls, we may obtain motor vehicle reports (MVR’s) on your driving history. Before we seek such reports, we wish to have your written permission to obtain the information. You have the right, upon written request, to a copy of the MVR.

Under the provisions of the Fair Credit Reporting Act, 15 USC, §1681 et.seq., the Americans with Disabilities Act and all applicable federal, state and local laws, I hereby authorize and permit member companies of Dallas Trailer Repair Co., Inc., and all DBA’s of such, my employer and/or my employer’s insurance agent to obtain a MVR.

I agree that a copy of this authorization has the same effect as an original.

I hereby release and hold harmless any person, firm, or entity that discloses matters in accordance with this authorization, from liability that might otherwise result from the request for use of and/or disclosure of any or all of the foregoing information.

I understand and acknowledge that I may request a copy of my MVR after I have provided proper identification.

Member companies of Dallas Trailer Repair Co., Inc., and all DBA’s of such, my employer, and/or my employer’s insurance agent have the continuing right and authority to check and deliver my motor vehicle records on file with the state and other resource, including, without limitation, driving record, financial responsibility information and prior driving information as set forth above and to deliver such records to one another and the company.

Period of Active Status

This application will be active for one year. After that time, you will need to complete another application to be considered for employment,

Request for Verification of Prior Employment Part 1 of 2

2447 E. Hwy 356 Irving, Texas 75060

Date:

Name/Title:

Company:

Address:

RE: Employment Verification for:

Dear:

__________________________________ has applied for employment with Dallas Trailer Repair Co., Inc. Would you kindly provide us with a statement regarding your experience with this applicant during the applicant’s term of employment with your company? Please complete the information requested below, and fax it back to 972-721-1606 OR email to __________________________________________________ at your earliest convenience. Feel free to call me as well at 972-579-9027.

Of course, your reply will be held in the strictest of confidence. Thank you in advance for your assistance.

Sincerely,

____________________________________________

Name, Title

Dallas Trailer Repair Co, Inc.

Candidate’s Reference Release

I hereby authorize __________________________________________________________ to provide Dallas Trailer Repair Co., Inc. with the information requested in the attached Employment Verification Form. I hereby expressly release __________________________________ from any and all claims which may be related to or arise from the disclosure of the reference information provided by ______________________________________________________ pursuant to this authorization, including, but not limited to, claims for defamation, interference with contract, and negligence.

_______________________________________________________ ________________________________________________________

Candidate’s Signature Date

Return Form to:

Dallas Trailer Repair Co., Inc.

2447 East Hwy 356

Irving, Texas 75060

Phone: 972-579-9027

Email:______________________________________________

Internal FORM # P001a Page 5

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