Date of Application
*
MM
DD
YYYY
Name
*
First Name
Last Name
Middle Initial
*
Your Address
*
Street Address, Suite, City, State, Zip, Country
Pay Expected
*
Primary Phone Number
*
Alternate Phone Number
Email
*
Date Available to Start
*
How did you hear about Ted Collins?
*
Have you ever applied for employment with us before?
*
Yes
No
If yes, what month and year?
Besides absence for religious observances, are you available full time?
*
Yes
No
If not, how many hours are you available?
Will you work overtime if asked?
*
Yes
No
Do you have a valid New York State drivers license?
*
Yes
No
Do you have a valid New York State Commercial License (CDL)?
*
Yes
No
If so, what class?
A
B
C
Are you 18 years or older?
*
Yes
No
What was the date of your last physical?
*
MM
DD
YYYY
Do you hold a valid medical certificate?
*
Yes
No
Are you a U.S. Citizen or permanent resident alien?
*
Yes
No
Position Desired
*
Special Skills/Equipment Operation
*
Other Experience/Qualificiations
*
High School Name & Location
Years Completed
College Name & Location
Years Completed
Degree
Course of Study
Notes/Comments
Company Name
Phone Number
Address
Street Address, Suite, City, State, Zip, Country
Employment Dates
Supervisor
Pay
Job Description
Reason for Leaving
Company Name
Phone Number
Address
Street Address, Suite, City, State, Zip, Country
Employment Dates
Supervisor
Pay
Job Description
Reason for Leaving
Company Name
Phone Number
Address
Street Address, Suite, City, State, Zip, Country
Employment Dates
Supervisor
Pay
Job Description
Reason for Leaving
May we contact your previous employer(s)?
*
Yes
No
If not, state the employer and reason why.
Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court?
*
If yes, please describe in full detail.
Name
Relationship
Phone Number
Name
Relationship
Phone Number
Today's Date
*
MM
DD
YYYY
