Black & White Transportation - Communication Careers

Last Name

First Name

Street Address

Mailing Address (if different)

City

State

Zip

Primary Phone

Other Phone

Email Address

Are you a U.S. citizen or otherwise authorized to work in the U.S. on an unrestricted basis?

How did you hear of this opening?

Do you have reliable transportation to/from work?

Have you ever applied for employment with or ever been employed by Black & White Transportation?

If Yes, when/where?

Do you have any experience working with computers?

Do you have any phone experience or knowledge of city streets that may help you in your work for us?

Type of employment you are seeking

Are you willing to work swing shifts?

What days and hours are you available to work?

If hired, date you can start work

Starting salary/hourly rate desired

Are you at least 18 years of age?

Are you presently employed?

May we contact your current employer?

Education

High School

Years Completed

Major/Degree

College

Years Completed

Major/Degree

College

Years Completed

Major/Degree

Post College

Years Completed

Major/Degree

Other Training

Years Completed

Major/Degree

Employment History (Start with most recent employer)

Company Name

Telephone

Address

Date Started

Date Ended

Salary/Wage

Position Held

Name of Supervisor

May we contact?

Responsibilities

Reason for Leaving

Company Name

Telephone

Address

Date Started

Date Ended

Salary/Wage

Position Held

Name of Supervisor

May we contact?

Responsibilities

Reason for Leaving

Company Name

Telephone

Address

Date Started

Date Ended

Salary/Wage

Position Held

Name of Supervisor

May we contact?

Responsibilities

Reason for Leaving

In addition to your work history, are there other skills, qualifications or experience that we should consider?

References

List three references, not related to you, who have known you for more than one year.

Name

Telephone

Years Known

Address

Name

Telephone

Years Known

Address

Name

Telephone

Years Known

Address

Have you ever been convicted of a felony? (This will not necessarily affect your application.)

If yes, please describe conditions:

Have you failed or refused a DOT pre-employment test in the previous two years?

If yes, please describe conditions:

Please read:

I certify that all information provided by me on this application is true and complete to the best of my knowledge and that I have withheld nothing that, if disclosed, would alter the integrity of this application.

I authorize my previous employers, schools, or persons listed as references to give any information regarding employment or educational record. I agree that this company and my previous employers will not be held liable in any respect if a job offer is not extended, or is withdrawn, or employment is terminated because of false statements, omissions, or answers made by myself on this application. In the event of any employment with this company, I will comply with all rules and regulations as set by the company in any communication distributed to the employees.

In compliance with the Immigration Reform and Control Act of 1986, I understand that I am required to provide approved documentation to the company that verifies my right to work in the United States on the first day of employment. I have received from the company a list of the approved documents that are required.

I understand that employment at this company is “at will,” which means that either I or this company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I hereby acknowledge that I have read and understand the above statements.

Full Name/Signature

Driver's License/State ID Number

(In lieu of a signature, please enter your driver's license or state issued ID number in the box above to signify that you agree to the statements above.)