Job descriptions and applications

 

Job descriptions

The first step an employer should take before beginning the employment application and hiring process is writing a comprehensive job description for the position needing to be filled.  This will allow the employer to pinpoint the exact qualifications required for the position and will assist greatly in the hiring process.

Misrepresentation of job

Tennessee makes it unlawful “to induce, influence, persuade or engage workers to change from one [workplace to another] by means of false or deceptive representations, false advertising or false pretenses concerning the kind and character of the work to be done, or amount and character of the compensation to be paid for such work, or the sanitary or other conditions of the employment, or as to the existence or nonexistence of a strike, or other trouble pending between employer and employees.”  Thus, when hiring new employees, employers should be careful not to misrepresent the nature and responsibilities of the job.

Once a job description has been prepared, an employer can begin the process of advertising the available position and screening qualified applicants. 

Job application

The first step in the candidate screening process is the employment application.  It is important that the application only request information pertinent to the job at hand.  Employers are advised not to request any information that would provide the employer with the age of the applicant, such as the applicant’s birth date or graduation dates pertaining to any education institutions the applicant may have attended.  If such information is provided, it could lead to claims of age discrimination by the applicant if he or she was not chosen for the position.

Four employment applications have been provided in this manual.  All four seek legally permissible information.  Before inserting any additional information into any of these forms, employers are strongly encouraged to obtain legal counsel.  While the information solicited by these applications is lawful for an employer to obtain, how an employer uses the information must also comply with various legal requirements. See Background and reference checks for more information.

Employers who adopt a drug-free workplace program in accordance with Tennessee’s Drug-Free Workplace Act must include notice of drug and alcohol testing on vacancy announcements for positions for which drug or alcohol testing is required.  For more information on Tennessee’s Drug-Free Workplace Act, please see Appendix B, Tennessee drug-free workplace program.

The Tennessee Non-Smokers Protection Act requires employers to notify applicants that smoking is prohibited as required by law.  One way to ensure that applicants receive this notice is to include it on job postings and applications.

Job description


Job Title:______________________________________________________________________

Date of this Description:__________________________________________________________

Job Summary:__________________________________________________________________


ESSENTIAL FUNCTIONSof the job (listed in order of importance):

1.

2.

3.

4.

5.


MARGINAL JOB FUNCTIONS:

1.

2.


Skills Required to Perform the Duties of the Job:

1.        

2.                    


Educational Requirements Needed to Perform the Duties of the Job:

1.        

2.        


physical Requirements of the Job:

1.        

2.        


Licensing or Other Special Certifications Required:

1.        

2.        




Job Description Approved by:_____________________________________________________

                                                                                   

Signature/Title:_____________________________             Date:_________________________


***THIS COMPANY RESERVES THE RIGHT TO MODIFY, INTERPRET, OR APPLY THIS JOB DESCRIPTION IN ANY WAY THE COMPANY DESIRES. THIS JOB DESCRIPTION IN NO WAY IMPLIES THAT THESE ARE THE ONLY DUTIES, INCLUDING ESSENTIAL DUTIES, TO BE PERFORMED BY THE EMPLOYEE OCCUPYING THIS POSITION. THIS JOB DESCRIPTION IS NOT AN EMPLOYMENT CONTRACT, IMPLIED OR OTHERWISE. THE EMPLOYMENT RELATIONSHIP REMAINS “AT-WILL.”  THE AFOREMENTIONED JOB REQUIREMENTS ARE SUBJECT TO CHANGE TO REASONABLY ACCOMMODATE QUALIFIED DISABLED INDIVIDUALS.***

 

 

 

At-will employment application

 

(PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE)
THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACTbut merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of sex, race, color, religion, age, marital status, national origin, citizenship, disability, veteran status, or any other status protected under state and federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a medical examination, which may include providing body substance samples. The company may prohibit smoking on its premises where required by state law. This application will remain active for six months.

PERSONAL INFORMATION 

Name Last First Middle                     Social Security # 


Home Phone                                 Work Phone

Please list below your current address and your two other most recent addresses:  Current Street City State Zip Since (Mo/Yr) 

Street City State Zip Since (Mo/Yr) 
Street City State Zip Since (Mo/Yr) 
EDUCATION
High School Attended 
City, County & State
Did you earn a Diploma?
Undergraduate College Attended 
City, State
Areas of Study
Degree/Certificate/Diploma
Graduate School Attended 
City, State
Areas of Study
Degree/Certificate/Diploma
Trade, Business or Other School 
City, State
Areas of Study
Degree/Certificate/Diploma





EMPLOYMENT INFORMATION
Position Applied For:
Date You Can  Start Work:
Desired Salary: $
Do You Prefer: oFull-Time oPart-Time
Can You Work: oWeekends oEvenings


Please answer all of the following questions. When necessary, note question number and use an extra paper to provide explanations:

1) Are you at least 18 years of age and legally eligible for work in the United States? oYES oNO
2) Will you work overtime when necessary? oYES oNO
3) Have you received a description of the job or been made aware of the essential functions of the job you are applying for : oYES oNO
4) Do you understand the job requirements? oYES oNO (If no, please explain)
5) Are you on layoff and subject to recall? oYES oNO
6) Are you currently bound by a noncompetition or trade secret agreement? (If yes, please explain) oYES oNO
7) Have you ever been discharged or asked to resign from a job? (If yes, please explain) oYES oNO
8) Have you ever been convicted of or pled guilty to a felony? (If yes, please explain) oYES oNO

EMPLOYMENT HISTORY

MAY WE CONTACT YOUR PRESENT EMPLOYER? oYES oNO
Please list below your last three employers beginning with the most recent:

Most Recent Employer  


City
State
Zip Code
Phone

Position Held Dates From/To    
Pay Rate Upon Leaving  $  
Superivsor


Duties Reason for Leaving 








 
Next Most Recent Employer
City
State
Zip Code
Phone 

Position Held Dates From/To
Pay Rate Upon Leaving  $
Supervisor

Duties Reason for Leaving 
Next Most Recent Employer
City
State
Zip Code
Phone 

Position Held Dates From/To
Pay Rate Upon Leaving  $
Supervisor

Duties Reason for Leaving 
Next Most Recent Employer
City
State
Zip Code
Phone 

Position Held Dates From/To
Pay Rate Upon Leaving  $
Supervisor

Duties Reason for Leaving 








JOB-RELATED SKILLS
Please answer the following questions if the position you are applying for requires driving a motor vehicle:

1. Do you have a valid driver’s license? oYES oNO  (If YES: Driver’s License Number)_________________________________________ 
Date of Issue:___________________________   

2. Have you been convicted of or pled guilty to any traffic-related offense within the past five years? oYES oNO   

3. Have you had your driver’s license suspended or revoked or had your driving privileges modified by a court of law?   oYES oNO   

4. Please list all states from which you hold or have held a driver’s license: 

Please use this space to list any special skills you may have that relate to the position applied for:   

Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization, and any other relevant information.  
1.   
2.   
3.

APPLICANT’S CERTIFICATION AGREEMENT

1. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.  
2. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate termination of employment, regardless of when or how discovered.  
3. I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.  
4. I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.  
5. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.    
_______________________________  
Signature Date

At-will employment application

 

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, marital or veteran status, disability, or any other legally protected status.

 

(Please Print)
Position Applied for:

 

Date of Application:
How Did You Learn About Us?

 

o  Advertisement           o  Friend        o  Walk-In
o  Employment Agency             o  Relative     o  Other______________________________

 



Last Name                                                                                          First Name                                                                        Middle Name

Address                                                                                                                 City                                                State                            Zip Code

Telephone Number(s)
Social Security Number

 




If you are under 18 years of age, can you provide required proof of your eligibility to work?    oYes     oNo

 

Have you ever filed an application with us before?  oYes     oNo               If Yes, give date                             
Have you ever been employed with us before?oYes     oNo        If Yes, give date            

 

Are you currently employed?   oYes     oNo
May we contact your present employer?         oYes     oNo

 

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment.    oYes     oNo

 

On what date would you be available to work?                               
Are you available to work:       oFull Time   oPart Time    oShift Work     oTemporary

 

Are you currently on “layoff” status and subject to recall?               oYes     oNo
Can you travel if a job requires it?        oYes     oNo

 

Have you been convicted of a crime within the last 7 years?   oYes     oNo
                  Conviction will not necessarily disqualify an applicant from employment.

 

If Yes, please explain                                                                                                                        
                                                                                                                                                         

 

                                                                                                                                                         
This application will remain active for six months.

 


We may prohibit smoking on company property where required by state law.

 


Education

Name and Address of School

 


Course of Study

 

# of Years
Completed

 

Diploma
Degree

 


Elementary

 

School



High
School

 




Undergraduate

 

College



Graduate
Professional

 




Other

 

(Specify)




Indicate any foreign languages you speak, read, and/or write

          
FLUENT

 

WELL
FAIR

 


SPEAK

 




READ


WRITE

 




Describe any specialized training, apprenticeship, skills and extra-curricular activities.

 


_______________________________________________________________________________________________________________________________________________________________________________________________________________

 




Describe any job-related training received in the United States military.

_______________________________________________________________________________________________________________________________________________________________________________________________________________





Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations that indicate race, color, religion, gender, national origin, disabilities, or other protected status.

 


1.

 

Employer

Dates Employed
Work Performed

 



From
To

 



Address



Telephone Number(s)

Hourly Rate/Salary


Starting

 

Final

Job Title

 




Reason for Leaving

 




2.
Employer

 


Dates Employed

 

Work Performed

From

 

To

Address

 




Telephone Number(s)

 


Hourly Rate/Salary

 




Starting
Final

 



Job Title



Reason for Leaving


3.

 

Employer

Dates Employed
Work Performed

 



From
To

 



Address



Telephone Number(s)

Hourly Rate/Salary


Starting

 

Final

Job Title

 




Reason for Leaving

 




4.
Employer

 


Dates Employed

 

Work Performed

From

 

To

Address

 




Telephone Number(s)

 


Hourly Rate/Salary

 




Starting
Final

 



Job Title



Reason for Leaving


If you need additional space, please continue on a separate sheet of paper.

 



List professional, trade, business, or civic activities and offices held.
You may exclude memberships that would reveal gender, race, religion, national origin, age, ancestry, disability, or other protected status:

 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Additional Information

 

Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.

 

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Specialized Skills:  

 

Software (list):
_______________________________________________________________________________________

 

_______________________________________________________________________________________
State any additional information you feel may be helpful to us in considering your application.

 

______________________________________________________________________________________________________________________________________________________________


References

1.


2.


3.

 


_________________________________________(         )________________

 

Name                                                                                                                                          Phone #
________________________________________________________________________________________

 

Address
_________________________________________(         )________________

 

Name                                                                                                                                          Phone #
________________________________________________________________________________________

 

Address
________________________________________________________________________________________

 

_________________________________________(         )________________
Name                                                                                                                                          Phone #

 

________________________________________________________________________________________
Address

 

________________________________________________________________________________________

*WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

 




FOR PERSONNEL DEPARTMENT USE ONLY

  Position(s) Applied For Is Open:       oYes  o   No

Position(s) Considered For:                                                                               Date                          

NOTES:_______________________________________________________________________
_____________________________________________________________________________

 

_____________________________________________________________________________
_____________________________________________________________________________

 



Applicant’s Statement

 


I certify that answers given herein are true and complete to the best of my knowledge.

 


I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

 


This application for employment shall be considered active for a period of time not to exceed six months.

 


Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.

 


I hereby understand and acknowledgethat, if hired, my employment relationship withthis organization would be of an “AT WILL” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time and for any or no reason. It is further understood that this “AT WILL” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.

 


In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.

 





____________________________________                _________________________
Signature of Applicant                                                         Date

 






*WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

 



FOR PERSONNEL DEPARTMENT USE ONLY

Arrange Interview        oYes     oNo

                                                                                  ____________________________
  INTERVIEWER                                                                     DATE

 


  Employed     oYes     oNo                     Date of Employment_________________________

 


                                          Hourly Rate/

 

  Job Title                               Salary _____________  Department__________________________

           By                                                                                                                             
                                   NAME AND TITLE                                                                                  DATE

 











*WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*


 

At-will employment application

 

        FOR OFFICE USE ONLY
Work

 

Location _______
Position _______

 


Rate _______

 

Date _______


(An Equal Opportunity Employer)

 

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, or any other legally protected status.  We will give this application every consideration. However, in accepting it, the Company makes no commitment of employment to the applicant.  We maintain a non-smoking facility where required by law.  This application will remain active for six months.

WE ARE AN AT-WILL EMPLOYER, MEANING THAT EITHER THE EMPLOYER OR THE EMPLOYEE MAY END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.
                                     BASIC INFORMATION: Please print in ink.

 

  Position Applied For:

  Date of Application:
  How Did You Learn About Us?

 

o  Advertisement                  o  Friend         o  Walk-In
o  Employment Agency        o  Relative      o  Other______________________

 


Last Name                               First Name                                                      Middle Name

 



  Address                                                                      City                                 State            Zip Code

  Telephone Number(s)

 

  Social Security Number



Salary requirements:                                                     Date Available:                                

Have you been convicted of a felony within the last 7 years?              oYes     o No
If yes, please explain:                                                                                                                                                                                                                                                                                                                                                                                                                       

 


Are you a United States Citizen or are you lawfully authorized to work in the United States?

 

oYes     o No


*WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

EMPLOYMENT HISTORY:  Start with your present or most recent job. Include any job-related military service assignments, self-employment, summer and part-time jobs.

 



1
Company

 

Address
        Telephone

 




Dates               From                To
  Employed

 

Starting                                Leaving
Salary

 

        Supervisor
  Your Duties:

 


  Reason for Leaving:

 


2

 

Company
Address

 

        Telephone


  Dates             From                To

 

  Employed
Starting                                Leaving

 

Salary
        Supervisor

 

  Your Duties:

  Reason for Leaving:

3
Company

 

Address
        Telephone

 




  Dates             From                To
  Employed

 

Starting                                 Leaving
Salary

 

        Supervisor
  Your Duties:

 


  Reason for Leaving:

 


4

 

Company
Address

 

        Telephone


  Date               From                To

 

  Employed
Starting                      Leaving

 

Salary
        Supervisor

 

  Your Duties:

  Reason for Leaving:

If presently employed, why do you desire to change your position?_______________________

 

______________________________________________________________________________

If you are now employed, may we contact your present employer?   oYes     o No


*WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

 


REFERENCES: (not former employers or relatives)
                           Name

 


                         Address

 

Phone Number





EDUCATION:

 

   School
             Name and

 

               Address
              of School

 

        Course of
           Study

 

Circle Last
      Year

 

Completed
  Did You

 

Graduate
     List

 

Diploma
or Degree

 

     High
                    

 

              
1  2  3  4

 

oYes
o No

 


   College

 



1  2  3  4

 

oYes
o No

 


    Other

 

  (Specify)

1  2  3  4

 

o Yes
o No

 



If you did not graduate, why did you leave school or college?_____________________________
______________________________________________________________________________

 


Are you planning to pursue further studies?    oYes     oNo                    

 

                                                                        If yes, oDay  OR  oNight School
If so, when, where, and what courses?___________________________________________________________________________________________________________________________________________________________________________________________________________

 


INTERESTS:Use this space below to describe interest in the                                industry and job-related skills and aptitudes that you feel qualify you for a position with our Company.  If you need more space, please continue on a separate sheet.

 


______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

    *WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

ACKNOWLEDGMENT

 

Please Read Before Signing:
The facts set forth in my application for employment are true and complete.  I understand that if employed, false or misleading statements on this application shall be considered immediate cause for dismissal.  In making this application for employment I authorize you to make and/or investigate a report whereby information is obtained through social networking websites and personal interviews with my neighbors, friends, or others with whom I am acquainted.  This inquiry, if made, may include information as to my character, general reputation, personal characteristics, and mode of living.  This inquiry, if made, also may include information concerning any and all employment discrimination claims and/or accusations brought against me, including, but not limited to, charges and/or accusations brought against me that relate to harassment and/or discrimination involving race, sex, age, religion, disability, and/or national origin.

 


I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of any such investigation or report that is made.

 


I understand that, if the Company employs me, EITHER THE Company or I can terminate my employment with or without cause at any time and for any or no reason.  I also understand that no official of the Company other than the Chief Executive Officer has any authority to enter into an agreement for employment for any specific period of time or to make any agreement contrary to the foregoing.

 


 

 

Signature of Applicant                                                                         Date
          

 





                       *WE ARE AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

At-will employment application

The Company is an equal opportunity employer and will not discriminate against any applicant on the basis of any characteristic that is protected by state or federal law.

 


THE COMPANY IS AN AT-WILL EMPLOYER, MEANING THAT EITHER THE EMPLOYER OR EMPLOYEE CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.  WE MAINTAIN A NON-SMOKING FACILITY WHERE REQUIRED BY LAW.

 


Position Applied For:_______________________________ 
Date of Application:____________

 

Date You Can Start:_______________________________ 
           Please note that this application will                only remain active for six months, after which
                                                                                                                                                                the applicant will need to reapply.

 


Name:______________________________________________ 
Social Security #:_____________

 

            Last                             First                            Middle

Present Address:________________________________________________________________
                                    Street                                                   City                 State              Zip

 


Permanent Address:_____________________________________________________________

 

                                    Street                                                   City                 State             Zip

Telephone #: Home (_____)___________________ 
   Work  (_____)______________________

Are you 18 years or older?   oYes     o No

Are there any hours or days of the week you cannot work?    oYes     o No
              If so, when?____________________________________________________________

 


Salary Desired____________________

 


Type of Employment: oFull-time     oPart-time

 


Are your employed now?   oYes     o No  

 

            May we contact your present employer?    oYes     o No

Did you ever apply to this Company before?   oYes     o No   Where?____________________

            Under what name? _____________________________ 
 When?_____________________

EDUCATION:


NAME AND ADDRESS OF SCHOOL

 

NO. OF
YEARS

 

ATTENDED

DID YOU
  GRADUATE?

 


SUBJECT/

 

MAJOR
Elementary

 

School


High School

 




College

 




Specialized
Training

 




Are you lawfully entitled to be employed in the United States?    oYes     o No

 


Have you ever been convicted of a crime except a minor traffic violation?    oYes     o No

 

       {This question pertains only to convictions that have not been sealed or expunged}.
If so, please state citation, date and place where offense occurred:_____________________________________________________________________________________________________________________________________________________________________________________

 


Please provide any additional information such as special skills, training, management experience, equipment operation, or qualifications you feel will be helpful to us in considering your application:

 

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

  REFERENCES:  Three individuals not related to you, whom you have known for at least one year.

NAME

 


ADDRESS & TELEPHONE

 


RELATIONSHIP

 

YEARS
ACQUAINTED

 










Emergency Contact______________________________________________________________

 

                                    Name/Street/City/State/Telephone

CURRENT AND FORMER EMPLOYERS:(Most Recent One First)

DATE
MONTH/

 

YEAR
NAME, ADDRESS & TELEPHONE NO. OF EMPLOYER

 

SALARY:
STARTING/ENDING

 

LAST POSITION HELD/
RESPONSIBILITIES

 

REASON FOR LEAVING
From:

 



To:

 





From:

 



To:

 





From:


To:



From:

 



To:

 





From:


To:




*  *  *  *

Please read the following statement carefully before signing to indicate your understanding:

I understand that if I receive a conditional job offer, and prior to beginning employment, I may be requested to undergo a pre-employment medical examination. In the event that I have a disability that will affect my ability to take the test, I will so inform the Company prior to the administration of the test so that a reasonable accommodation can be made. The Company reserves the right to require medical documentation regarding the need for accommodation.

I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application may result in termination.

I understand and agree that, if hired, my employment is AT-WILL. THIS MEANS THAT, IF HIRED, EITHER THE COMPANY OR I CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON.

I authorize investigation of all statements contained in this application for any employment-related purpose. I release the listed references and all employers to provide you with any and all applicable information they may have. I hereby release these references and former employers from all liability for any information they may give to you, including but not limited to any defamation claims I may now have or will have against them.   ______________________________________________________
Date           Signature

 





*THE COMPANY IS AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*



For Employer Use Only

Interviewed By:________________________ Date:_________________ Hired:   oYes   o No

Starting Date:____________________Position:_______________ Wage:______________

*THE COMPANY IS AN AT-WILL, EQUAL OPPORTUNITY EMPLOYER*

 

Driving history form

 

DRIVING HISTORY


If the position you seek requires you to drive a vehicle as part of your job duties, please answer the following questions:


Do you have a valid driver’s license?              Yes            No

If yes, list state, number, and expiration date: _________________________________________________________________________________________________________________________________


List all states from which you have held a driver’s license: _______________________________________________________________________________________________________________________


Has your driver’s license, permit, or privileges ever been suspended, revoked, or cancelled?    

          Yes                No

If so, list state(s), date(s), and reason(s): _______________________________________________________________________________________________________________________________________


Have you ever been denied a driver’s license, permit,

or privilege to drive by a government agency or employer:      Yes      No


If yes, list date(s), government agency(ies)/employer(s), and reason(s): ________________________________________________________________________________________________________________________________________________________________________________________________


Have you ever been charged with any traffic-related offenses?                 Yes        No

If yes, list all offense(s), date(s), location(s), and result(s): _______________________________________________________________________________________________________________________ ___________________________________________________________________________________


If the position you seek requires you to operate a commercial motor vehicle, please provide the names of all employers for whom you operated a commercial motor vehicle during the past 10 years: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Note:  Be sure that these employers, addresses, dates of employment, and reasons for leaving are identified in the employment history section of the application.


During the previous two years, have you:

1)     Had a driving related alcohol test result

        of 0.08 alcohol concentration or greater?                                                    Yes      No

2)     Had a verified positive controlled substance test result?                                Yes      No

3)     Refused to take an alcohol or drug test?                                                       Yes      No

Note:  Questions regarding driving history are ONLY appropriate when driving a vehicle is required for the job.