Last Name *

First Name *

Middle Initial

Street Address

City

State/Province

ZIP / Postal Code

Phone *

Email Address *

Position applied for *

Salary desired

Are you authorized to work in the U.S.? *YesNo

Have you ever been convicted of a felony? *YesNo

If Yes Explain

Emergency phone number (other than your own)

Social Security Number

Birth Date *

Driver's License Number *

Class

Have you previously applied for a position with The Trash Man? *YesNo

Are you willing to work overtime? *YesNo

When can you start? *

Have you had any accidents in the past 5 years?YesNo

Have you had any moving violations in the past 5 years?YesNo

WORK EXPERIENCE

Please list your work experience for the past five years beginning with your most recent job held.

Company Name

Street Address

City

State/Province

Phone

Supervisor Name

Dates of Employment

From

To

Reason for leaving (be specific)

Were you subject to Federal Motor Carrier Safety Regulations?YesNo

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Company Name

Street Address

City

State/Province

Phone

Supervisor Name

Dates of Employment

From

To

Reason for leaving (be specific)

Were you subject to Federal Motor Carrier Safety Regulations?YesNo

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Company Name

Street Address

City

State/Province

Phone

Supervisor Name

Dates of Employment

From

To

Reason for leaving (be specific)

Were you subject to Federal Motor Carrier Safety Regulations?YesNo

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Company Name

Street Address

City

State/Province

Phone

Supervisor Name

Dates of Employment

From

To

Reason for leaving (be specific)

Were you subject to Federal Motor Carrier Safety Regulations?YesNo

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Company Name

Street Address

City

State/Province

Phone

Supervisor Name

Dates of Employment

From

To

Reason for leaving (be specific)

Were you subject to Federal Motor Carrier Safety Regulations?YesNo

List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

REFERENCES

Please list three professional references

Full Name

Relationship

Company Name

Street Address

City

State/Province

Phone

Years Known

Full Name

Relationship

Company Name

Street Address

City

State/Province

Phone

Years Known

Full Name

Relationship

Company Name

Street Address

City

State/Province

Phone

Years Known

Application for Employment