1222 Bennington Street * East Boston, MA * * FAX: APPLICATION FOR EMPLOYMENT

Transcription

1 CAPITOL WASTE SERVICES, INC Bennington Street * East Boston, MA * * FAX: PERSONAL INFORMATION NAME: LAST, FIRST, MIDDLE APPLICATION FOR EMPLOYMENT DATE OF APPLICATION: TELEPHONE NO.: CELL PHONE NO.: ADDRESS FOR PAST 3 YEARS (please use back if you have more than 3 addresses in the past 3 years) Street: City State: How Long? Street: City State: How Long? Street: City State: How Long? Are you prevented from lawfully becoming employed in this country because of VISA or immigration status? YES (Proof of citizenship or immigration status will be required upon employment.) NO Have you worked for this company before YES NO If YES, what year? Is there any reason you may not be able to fully perform the duties of the position you are applying for? YES NO If YES, please explain. Are you now employed? YES NO If no, what is your last day worked?. Do you have or have you ever had any felony within the last five (5) years? YES NO If YES, please list convictions and year of convictions. Have you ever violated any of the DOT rules and/or regulations on drug or alcohol use? YES NO If yes, please list violation and year of violation.

2 EMPLOYMENT HISTORY All DRIVER APPLICANTS TO DRIVE IN INTERSTATE COMMERCE MUST PROVIDE THE FOLLOWING INFORMATION ON ALL EMPLOYERS DURING THE PROCEEDING 3 YEARS. List complete mailing address, street number, city, state and zip code. Applicants to drive a commercial motor vehicle* in interstate commerce shall also provide an additional 7 years information on those employers for who the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. ) EMPLOYER: Reason for Leaving: EMPLOYER: Reason for Leaving: *Includes vehicles having a GVWR of 26,001 lbs. or more, vehicle designed to transport 15 or more passengers or any size vehicle used to transport hazardous materials in a quantity requiring placarding.

3 EMPLOYER: Reason for Leaving: EMPLOYER: Reason for Leaving: EMPLOYER: Reason for Leaving:

4 EMPLOYER: Reason for Leaving: EMPLOYER: Reason for Leaving: ACCIDENT RECORD for the past 3 years (attach a sheet if more space is needed) if none, write none. DATES NATURE OF ACCIDENT FATALITIES INJURIES

5 TRAFFIC CONVICTIONS and forfeitures for the past 3 years (other than parking violations) if none, write none. If additional pages are required please use back of form. LOCATION DATE CHARGE PENALTY EXPERIENCE & QUALIFICATIONS DRIVER DRIVER S LICENSE STATE LICENSE NO. TYPE EXPIRATION DATE Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes NO If yes, attach a statement giving details. Has any license, permit or privilege ever been suspended or revoked? Yes NO If yes, attach a statement giving details. DRIVING EXPERIENCE: CLASS OF EQUIPMENT TYPE OF EQUIPMENT FROM TO APPROX. NO OF TOTAL MILES PACKER TRASH RECYCLING STRAIGHT TRUCK TRACTOR & SEMI-TRAILOR TRACTOR TWO TRAILERS MOTORCOACH OTHER List states operated in for last five (5) years: List special courses or training that will help you as a driver: Do you hold any safe driving awards and if so from whom? Yes NO.

6 CAPITOL WASTE SERVICES EDUCATION EDUCATIONAL BACKGROUND NAME & LOCATION OF SCHOOL CIRCLE HIGHEST GRADE COMPLETED HIGH SCHOOL GED COLLEGE TRADE, BUSINEES OR GRADUATE SCHOOL REFERENCES: Please give the names of three (3) persons you are NOT related to, whom you have known at least one (1) year. NAME ADDRESS TELEPHONE NO. Employees are subject to random, post accident and reasonable suspicion drug and alcohol testing. Testing is conducted in accordance with the US Department of Transportation regulations. An employee who tests positive shall be subject to discharge. Since our employees come into contact with children at schools, libraries and other facilities, as well as the Municipalities elderly population certain Cities/Towns require Capitol Waste to conduct criminal background checks through the Commonwealth of MA Criminal History Systems Board. Employee Work Assignment: Per the Collective Bargaining Agreement between the Union and Capitol Waste Services... The staffing need of any job covered by this Agreement and the job duties of any classification contained herein shall be determined by the Employer. Nothing contained in this Agreement shall constitute a guarantee of an particular job or duty with any particular classification nor shall it constitute a guarantee of any particular duties as part of any particular classification. Employees of Capitol Waste Services are represented by Teamsters Local 25. A complete copy of the Union Agreement is available by contacting Teamsters Local 25 and/or the Capitol Waste Services Shop Steward.

7 CAPITOL WASTE SERVICES PAGE 4 OF 4 AUTHORIZATION I CERTIFY THAT THE FACTS CONTAINED IN THIS APPLICATION ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND UNDERSTAND THAT, IF EMPLOYED, FALISFIED STATEMENTS ON THIS APPLICATION SHALL BE GROUNDS FOR DISMISSAL. I AUTHORIZE INVESTIGATION OF ALL STATEMENTS CONTAINED HEREIN AND THE REFERENCES AND EMPLOYERS LISTED ABOVE TO GIVE YOU ANY AND ALL INFORMATION CONCERNING MY PREVIOUS EMPLOYMENT AND ANY PER- TINENT INFORMATION THEY MAY HAVE, PERSONAL OR OTHERWISE, INCLUDING THE AUTHORIZATION TO CON- DUCT A CRIMINAL BACKGROUND CHECK AND RELEASE THE COMPANY FROM ALL LIABILITY FOR ANY DAMAGE THAT MAY RESULT FROM UTILIZATION OF SUCH INFORMATION. I ALSO UNDERSTAND AND AGREE THAT NO REPRESENTATIVIVE OF THE COMPANY HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIED PERIOD OF TIME, OR MAKE ANY AGREEMENT CON- TRARY TO THE FOREGONE, UNLESS IT IS IN WRITING AND SIGNED BY AN AUTHORIZED COMPANY REPRESENTATIVE. SIGNATURE: DATE: YOUR COMPLETED APPLICATION WILL REMAIN ACTIVE FOR SIX (6) MONTHS In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veternan status, non-job related disability, or any other protected group status. CAPITOL WASTE SERVICES, INC.