AN EQUAL OPPORTUNITY EMPLOYMENT APPLICATION Please Print Date: Name: Last First Middle Home Phone: Cell Phone: Social Security #: Present Email : No. Street City State Zip Mailing (If Different) No. Street City State Zip Employment Desired Position Applying For How did you hear about this position? Applying For Full-Time Work Part-Time Work Are you available to work on weekends? Are you able to work overtime, if necessary? Are there any days/times you are unable to work? If hired, what date can you start work? Desired Pay Rate: Per: Personal Information Have you ever applied to or worked at Tennessee Tractor LLC? If yes, when? Do you have any friends or relatives employed by our Company? If yes, please state name and relationship Are you at least 18 years old? If hired, can you present evidence of U.S. citizenship or proof of your legal right to work and live in this country? Have you ever served in the U.S. Armed Forces? If so, have you obtained any special skills as a result of your service? If yes, please explain
Are you able to perform the essential functions of the job for which you are applying? If no, please describe the functions that cannot be performed (Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential job functions. Hire may be subject to passing a medical examination and a skills and agility test.) Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? If yes, please state the nature of the offense(s), when and where convicted: (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the date of the offense, the surrounding circumstances, and the relevance of the offense to the position applied for may be considered.) Are you currently employed? If so, may we contact your current employer? If yes, with whom are you employed with? Education, Training and Experience School High School College/ University Vocational/ Business Health Care Name & City, State Yrs Completed Did you graduate? Degree/Diploma Do you speak, write or understand any foreign language(s)? If yes, what language(s)? Do you have any other experience, training, qualifications or skills which you feel make you a especially suited to work at Tennessee Tractor LLC? If so, please explain:
Employment History List all present and past employment starting with your most recent employer. (Last 10 years is sufficient). You must complete this section even if you are attaching a resume. Account for all periods of unemployment. Supervisor: Dates of Employment From Supervisor Dates of Employment From Supervisor Dates of Employment From
Supervisor Dates of Employment From Supervisor Dates of Employment From References Please list three people not related to you who have knowledge of your work performance within the last 3 years. Name Occupation No. of Years Acquainted Name Occupation Name Occupation No. of Years Acquainted No. of Years Acquainted
Please Read Carefully, Each Paragraph, and Sign Below I hereby certify that I have not withheld any information and that the answers given by me during the application process (including this written application) are true and correct to the best of my knowledge. I further certify that I have personally completed this application. I understand that any omission or misstatement of fact during the application process shall be grounds for rejection of my application for employment or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize Tennessee Tractor LLC and/or its agent to thoroughly investigate my references, work record, education, and other matters related to my suitability for employment and further, authorize the references I have listed to disclose to the company any information to my work records. I will execute all appropriate documentation and authorization, as required by the Federal Fair Credit Reporting Act. In addition, I hereby release the company, my former employers, and all other persons/entities from any and all claims, demands, or liabilities arising as a result of this employment investigation or disclosure. I hereby agree to submit to binding arbitration all disputes and claims arising out of the submission of this application. I further agree, in the event that I am hired by the company, that all disputes that cannot be resolved by informal internal resolution which might arise out of my employment with the company, whether during or after that employment, will be submitted to binding arbitration. By agreeing to binding arbitration, I understand and acknowledge that the decision of the arbitrator will be final and nonappealable and that I give up the right to have a jury decide any dispute covered by this agreement. I agree that such arbitration shall be conducted under the National Rules for the Resolution of Employment Disputes of the American Arbitration Association, that the arbitration shall take place in Alamo,TN, and that the arbitrator shall apply the applicable statute of limitations. This application contains the entire agreement between the parties with regard to dispute resolution, and there are no other agreements as to dispute resolution either oral or written. I understand that nothing contained in the application, or conveyed during any interview which may be granted during my employment, if hired, is intended to create an employment contract between me and the company. In addition, I understand and agree that if I am employed, my employment, wage rate, and other terms and conditions of employment are at will, for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Tennessee Tractor LLC, and that no promises or representations contrary to the foregoing are binding on the company, unless made in writing and signed by me and the company's president. Applicant Signature Date
I understand and agree that: 1. Any misrepresentation or omission of fact in my application may be justification, if employed, for immediate termination or disqualification from employment 2. Tennessee Tractor LLC may provide you with a locker, desk, work area or the use of voicemail or e-mail. These remain the property of Tennessee Tractor LLC and may be searched at any time without notice. If requested by the management at any time, I agree to submit to a search my person or of any locker, desk, work area, voicemail, or e-mail that may be assigned to me, and herby waive all claims for damages on account of such examination. 3. I authorize my physician or hospital to release any information which may be necessary to determine my ability to perform the duties of a job that I am being considered for following a conditional offer of employment with Tennessee Tractor LLC I consent to take a complete physical and medical examination by a qualified physician at the discretion of my employer, which may or may not include a thorough blood and urine testing. Additional information/criteria from the Medical Evaluation Report must be submitted to the company's physician in three days or less, or the applicant may be disqualified. I also understand that information discovered as a result of these tests and examinations may prevent my being hired; or if hired may subject me to immediate dismissal, and I release from liability any person giving or receiving such information. 4. Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory: overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment. I have read and understand the above completely. Applicant Signature Date
MOTOR VEHICLE RECORD (MVR) POLICY It is the policy of Tennessee Tractor LLC to obtain and review the Motor Vehicle Record (MVR) on each prospective driver before an offer for employment is extended to the individual. Management will review the Motor Vehicle Record to determine if the applicant holds a valid driver's license and their driving record is within the parameters set by the company's driving policy. Management will conduct an annual review of each employee's driving performance, where driving is a part of his or her job. Based upon the outcome of the annual review, the driving exposure, and the losses experienced during the past year. As company policy, MVR's are checked every three years on all employees where driving is a part of their job description, annually on drivers under the age of 25, and annually on drivers identified during the annual driving review. If the employee's driving record does not meet the criteria set by management, driving privileges may be revoked, or other disciplinary action may be taken. Applicant's Printed Name Applicant's Signature Date Driver's License Number Issuing State