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Your Information
First name*
Middle*
Last Name*
Address
(Last 3 Years)
Home Phone*
Are you at least 21 years of age?*
Position desired?*
Expected Pay*
Are you legally eligible for employment in the United States?*
When would you be available to begin work?*
Are there any limitations to the days and/or hours that you are available to work?*
Please explain limitations*
Employment Record
(employment for at least the past 3 years and/or commercial driving experience for the past 10 years must be shown)
Drivers Licenses
Must include at least one
DRIVING EXPIRENCE
Accident Record
(include all within the past 3 years)
Traffic Convictions
(include all within the past 3 years)
Have you ever been denied a license, permit or privilege to operate a motor vehicle?*
Has any license, permit or privilege ever been suspended or revoked?*
Education
OTHER SKILLS OR TRAINING: (explain)
This certifies that I completed this application and that all entries on it are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the employee may resign at any time and the Employer may discharge the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interviews may result in my discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. North Coast Mercantile is an Equal Opportunity Employer.*