Sugar House Movers & Storage - Bekins Van Lines

PERSONAL IDENTIFICATION

Name: *

Address:

City:

State:

Zip Code:

Home Number: *

Cell Number:

Email Address:

Date Available For Work:

WORK PREFERENCE

Salary or pay you expect: *

Kind of work desired:

Describe your prior experience:

Describe any formal schooling:

List any licenses or certificates:

List any special skills you may have:

AVAILABILITY FOR WORK

Type of Work

Part Time Full Time

Monday

Yes No

Tuesday

Yes No

Wednesday

Yes No

Thursday

Yes No

Friday

Yes No

Saturday

Yes No

Sunday

Yes No

Holidays

Yes No

Will you work overtime on occasion if necessary?

Yes No

Do you plan to work elsewhere or attend school & work here too?

Yes No

Do you have any continuing obligations which might affect your work schedule?

Yes No

GENERAL QUESTIONS

Are you Presently Employed?

Yes No

Are you able to meet the attendance & work period time schedules required for the position you are seeking?

Yes No

Do you have to give advance notice to your present employer?

Yes No

Have you ever worked for or applied for work at this company before?

Yes No

If required, are you willing to take a physical at the expense of Sugar House if an offer of employment is made?

Yes No

Have you ever been discharged for cause?

Yes No

Are you willing to take a drug test at company expense?

Yes No

Have you ever been refused a surety bond or ever had one cancelled?

Yes No

Do you have any condition that would make you unable to perform all of the physical or mental requirements of the position you are seeking?

Yes No

Have you ever been convicted of a felony?

Yes No

Do you have any condition that would make you unable to perform all of the physical or mental requirements of the position you are seeking?

Yes No

If employed, can you provide proof of U.S. citizenship? Or if an alien, proof of identity AND authorization to work in the United States?

Yes No

Are you a minor (under 18 years of age)?

Yes No

EDUCATION AND TRAINING

GRADE AND HIGH SCHOOL

Name of last school:

Location:

Average Grade:

Date Left

Special courses (typing, etc.)

Did you graduate?

Yes No

Highest year completed:

COLLEGE OR UNIVERSITY

Name:

Location:

Years Attended:

Degree:

Major subject:

Scholarship Average:

Date Left:

OTHER (Graduate, Trade School, Correspondence School, Etc.)

Name:

Location:

Length of course:

Subject:

Scholarship average:

Was course completed?

Yes No

When:

EMPLOYMENT HISTORY AND U.S. MILITARY SERVICE RECORD (Give a complete account of your full time employment. BEGIN ON THE FIRST LINE WITH YOUR PRESENT OR MOST RECENT POSTION AND WORK BACKWARDS)

Employer:

Address:

Telephone Number:

Employed From:

Employed To:

Starting Pay:

Leaving Pay:

Supervisor Name:

Do you authorize us to contact this employer for a reference?

Yes No

Main duties:

What did you like about this job?

What did you dislike about this job?

Why did you leave?

Employer:

Address:

Telephone Number:

Employed From:

Employed To:

Starting Pay:

Leaving Pay:

Supervisor Name:

Do you authorize us to contact this employer for a reference?

Yes No

Main duties

What did you like about this job?

What did you dislike about this job?

Why did you leave?

Please note that ANY information provided herein that is not 100% accurate will be grounds for dismissal.

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