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BLUE LINE TRUCKING, INC. P.O. BOX 424 REESE, MI 48757 fax 989-868-3529 APPLICATION FOR EMPLOYMENT

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, OR THE PRESENCE OF A NON-JOB RELATED MEDICAL CONDITION OR HANDICAP.

PERSONAL HISTORY:                                                                          PHONE___________________________________________________________

POSITION(S) APPLIED FOR _____________________________________________  RATE OF PAY EXPECTED ________________________________

NAME ______________________________________________________________  SOCIAL SECURITY NO. ______________________________________
ADDRESS ____________________________________________________________________________________HOW LONG?____________________________ PREVIOUS ADDRESS ___________________________________________________________________________HOW LONG?___________________________ DATE OF BIRTH ________________________________________ (REQUIRED FOR TRUCK DRIVERS) CAN YOU PROVIDE PROOF OF AGE?______________ CDL #_________________________________________________DO YOU HAVE THE LEGAL RIGHT TO WORK IN THE UNITED STATES? _____________ HAVE YOU WORKED FOR THIS COMPANY BEFORE? ___________WHEN? ______________________________RATE OF PAY? ________________ POSITION ______________________________REASON FOR LEAVING? ____________________________________________________________________ ARE YOU NOW EMPLOYED? _______________________ IF NOT, HOW LONG SINCE LEAVING LAST EMPLOYMENT? __________________________ PHYSICAL HISTORY: DO YOU HAVE ANY PHYSICAL CONDITION WHICH MAY LIMIT YOUR ABILITY TO PERFORM THE JOB APPLIED FOR? IF YES, WHAT CAN BE DONE TO ACCOMMODATE YOUR LIMITATIONS? WOULD YOU BE WILLING TO TAKE A PHYSICAL EXAMINATION? _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ EDUCATION: LAST GRADE COMPLETED? HIGH SCHOOL________________________
COLLEGE ___________________________
GED ____________________________
LIST ANY SCHOOL CURRENTLY ATTENDING ____________________________________________________________________________________________
OTHER TRAINING______________________________________________________________________________________________________________________
EXPERIENCE: LIST ANY ACCIDENTS OR TICKETS IN THE LAST 3 YEARS _______________________________________________________________________________________________________
LIST ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY _______________________________________________________________________________________________________
LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION _______________________________________________________________________________________________________
LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN) _______________________________________________________________________________________________________
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision.
I hereby release employers, schools or persons from all liability in responding to inquiries in connection with my application. 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 company, as permitted by law.
_________________________ ____________________________________________ date applicant’s signature


EMPLOYMENT HISTORY Please include company name, supervisor, length of employment, and a number to contact them. ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________