Application

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Position Info
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Employment
Emergency Contact
Agreement

Date

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Phone Number

Email Address

Are you at least 18 years of age?

Military Status

Specific Position Applied For

Was this position advertised?

Where

When

Will you be able to perform the essential functions of the position for which you have applied?

What accommodation to this condition would make it possible for you to do this job?

On what date would you be available for work?

This job could require you to travel Monday through Friday on a statewide basis. Are you prepared to be gone overnight on this arrangement?

What other companies have you applied to recently?

A valid driver’s license is required, please specify the type of license:

Operators
Commercial (CDL)

Prior to employment, applicant will be asked to furnish Drivers License # & authorize release of state driving record.

Have you had a motor vehicle accident or moving violation in the past 5 years?

Please explain:

List any trade licenses you may have:

Are you prepared to provide the craft tools as required for your trade?

List any craft training programs in which you have participated:

Have you attended High School, Vocation / Technical School or College?

Please specify:

Are you currently employed?

Are you subject to recall?

Previous Employment

Please provide information for the last 10 years.

Employer

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Start Date

End Date

Job Title

Wage / Rate

Benefits

Reason For Leaving

Employer

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Start Date

End Date

Job Title

Wage / Rate

Benefits

Reason For Leaving

Employer

Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Start Date

End Date

Job Title

Wage / Rate

Benefits

Reason For Leaving

If you need additional space to provide complete information for the last 10 years, please upload a separate document.

Drop your file here or click here to upload

Upload files must be in one of the following file types: doc, docx, pages, or pdf.

During the past two years, have you ever 1.) Tested positive or 2.) refused to test on any pre-employment drug and alcohol test administered by an employer that you applied, but did not obtain employment for safety sensitive transportation work covered by DOT drug and alcohol testing rules?

Who should be notified in case of emergency?

Emergency Contact Name

Emergency Contact Address

Address Line 1

Address Line 2

City

State / Province / Region

Zip / Postal Code

Emergency Contact Phone

Agreement

"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 shall be grounds for dismissal, and I agree to hold my employer harmless in the event of my dismissal based thereon.

I authorize investigation of all statements contained herein and to do background checks to give you all information concerning my previous employment and any pertinent information they may have, confidential or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

I realize that under certain provisions of Iowa law, pre-employment drug testing could be a condition of my employment. I also acknowledge that the employer may require drug testing at a subsequent time providing that proper advance notice of testing is provided.

I also recognize that I could be offered employment subject to appropriate medical examination and that such a report could nullify my ultimate employment by this employer. I agree to submit to physical examination if required.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the method of payment of my wages and salary, be terminated at any time without prior notice. If employment is obtained under this application, I will comply with all rules and policies of my employer."

I request disclosure of the nature and substance of all information on me in the credit bureau's files, including the sources of the information (except investigative sources) and identification of the receipts of all reports furnished within the last six months (or last two years if furnished for employment purposes).

Signature

Date Signed

Note

This application will be current for 30 days or until position is filled.

Message

Voltmer, Inc. does not discriminate in hiring or employment on the basis of age, race, color, sex, religion, national origin or handicap.

VOLTMER, INC. IS AN EQUAL OPPORTUNITY EMPLOYER

Previous Employment

Who should be notified in case of emergency?

Agreement

Note

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