Apply for Driver - Tri Axle

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Summary
Title:Driver - Tri Axle
ID:1005
Location:Milton, PA
Department:Transportation
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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
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Application Information
If HRI, INC. Employee Referral, provide Name:
If referred by a HRI, INC. employee, please provide employee's full name.
If other, please specify:
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Application for Employment - for review
PERSONAL INFORMATION
Yes   No
Yes   No
Yes   No
Yes   No
EMPLOYMENT DESIRED
Full Time   Part Time   Seasonal
Yes   No
Yes   No
EDUCATION

Give record of all High Schools, Colleges, Universities and Vocational/Technical Schools you have attended.

School 1

Yes   No

School 2

Yes   No

School 3

Yes   No

School 4

Yes   No

School 5

Yes   No
EMPLOYMENT HISTORY

Give your full employment record, starting with your current or most recent employment

Employer 1

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Employer 2

Yes   No

Employer 3

Yes   No

Employer 4

Yes   No

Employer 5

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EXPERIENCE AND QUALIFICATION

Accident History

Yes   No

If yes, please list below

Accident 1

Accident 2

Accident 3

Traffic Convictions and Forfeitures (5 years)

Yes   No

If yes, please list below

Traffic Conviction or Forfeiture 1

Traffic Conviction or Forfeiture 2

Traffic Conviction or Forfeiture 3

Section 383.21 FMOSR states "No person who operates a commercial motor vehicle shall at any time have more than one driver's license". I certify that I do not have more than one motor vehicle license, the information for which is listed below.


REFERENCES

Please provide three references (not relatives).

Reference 1

*
*
*
*

Reference 2

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*
*
*

Reference 3

*
*
*
*
AUTHORIZATION

I swear/affirm that the statements and information I have provided in this Application for Employment are true, correct, and complete to the best of my knowledge.

I certify that I have answered all questions to the best of my ability and have not withheld any information that would unfavorably affect my application for employment. I acknowledge that misrepresentation or omissions may be the cause for my rejection for employment or may result in my subsequent dismissal if I am hired. I specifically, acknowledge that the employer will use my driver record abstract(s) required pursuant to Section 6-114 of the Pa Vehicle Code for the purposes identified and for no other purpose.

I hereby consent to have HRI Inc. contact anyone it deems appropriate to investigate or verify any information I have provided or to discuss my background, past performance, or suitability for employment. I expressly consent to any discussions regarding the foregoing by any person contacted. I knowingly and voluntarily waive all rights to bring any actions for defamation, invasion of privacy, or similar cause of action against anyone providing such information. This affidavit is filed in compliance with Section 607 of the Fair Credit Reporting Act.

I understand that employment at HRI Inc. is "at-will" which means that either I or HRI Inc. can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis. I understand that no leader, supervisor, manager, or executive of HRI Inc., other than the President, has the authority to create an employment contract other than an at will employment contract and the President may only do so in writing that is signed by both the President and the employee in question. I represent and warrant that I am not subject to any covenant or other restriction, including non-compete and/or non-solicitation agreements, that would preclude me from accepting employment at HRI Inc. and performing all duties associated with the position for which I am applying.

Equal Opportunity Employment
We are an Equal Opportunity employer and do not discriminate on the basis of race, ancestry, color, religion, sex, age, marital status, sexual orientation, national origin, medical condition, disability, veteran status, or any other basis protected by law.

The information provided will be used for research, reporting, statistical purposes and to monitor legal compliance. To help us comply with these government requirements, please complete the following information.

Completion of this form is voluntary and will not affect your opportunity for employment or terms or conditions of employment if hired. We appreciate your cooperation.
Gender:
Female
Male
I Choose Not to Respond
Race/Ethnicity:
American Indian or Alaska Native (Not Hispanic or Latino)
A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains tribal affiliation or community attachment
Black or African American (Not Hispanic or Latino)
A person having origins in any of the Black racial groups of Africa
Hispanic or Latino
A person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race
Asian (Not Hispanic or Latino)
A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
White (Not Hispanic or Latino)
A person having origins in any of the original peoples of Europe, North Africa, or the Middle East
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino)
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands
Two or More Races (Not Hispanic or Latino)
All persons who identify with more than one of the above races
I Choose Not to Respond
Veteran Status: (Please check all that apply)
Vietnam Era Veteran
A person who 1) Served on active duty for a period of more than 180 days, and was discharged or released therefrom with other than a dishonorable discharge, if any part of such active duty occurred; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases; or 2) Was discharged or released from active duty for a service-connected disability if any part of such active duty was performed; a. in the Republic of Vietnam between February 28, 1961, and May 7, 1975; or b. between August 5, 1964, and May 7, 1975, in all other cases.
Disabled Veteran
1) A veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who but for the receipt of military retired pay would be entitled to compensation) under laws administered by the Secretary of Veterans Affairs; or 2) A person who was discharged or released from active duty because of a service-connected disability.
War/Campaign/Expedition Veteran
A veteran who served on active duty in the U.S. military, ground, naval or air service during a war or in a campaign or expedition for which a campaign badge has been authorized.
Armed Forces Service Medal Veteran
A veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order No. 12985. To identify the military operations that meet this criterion, check your DD Form 214, Certificate of Release or Discharge from Active Duty.
Recently Separated Veteran
Any veteran during the three-year period beginning on date of such veteran's discharge or release from active duty in the U. S. military, ground, naval or air service.
I Choose Not to Respond

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
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