TraPac Employment Application REV 0421

TraPac, LLC
P.O. Box 1178, Wilmington, CA 90748-1178
APPLICATION FOR EMPLOYMENT
PRE-EMPLOYMENT QUESTIONNAIRE
LAST NAME
FIRST
MIDDLE
DATE
STREET ADDRESS
CITY
HOME TELEPHONE NUMBER
STATE
ZIP CODE
ALTERNATE TELEPHONE NUMBER
POSITION DESIRED
ANNUAL SALARY EXPECTED
HAVE YOU EVER APPLIED FOR EMPLOYMENT WITH TraPac, //&?
DATE AVAILABLE TO WORK
IF YES, WHEN?
HOW WERE YOU REFERRED TO TraPac, //&?
NAMES OF PERSONS KNOWN TO YOU EMPLOYED BY TraPac, //&
EDUCATION
NAME AND ADDRESS
COURSE OF STUDY
# YRS
COMPLETED
DID YOU
GRADUATE?
DEGREE/CERTIFICATION
COLLEGE
HIGH SCHOOL
BUSINESS/
TRADE OR
TECHNICAL
OTHER
COURSES OR
TRAINING
MILITARY SERVICE
BRANCH
RANK
DUTY ASSIGNMENTS
EDUCATIONAL/WORK SKILLS ACQUIRED
ARE YOU PRESENTLY IN:
NATIONAL GUARD
RESERVES
WORK HISTORY
LIST BELOW ALL PRESENT AND PAST EMPLOYMENT STARTING WITH YOUR MOST RECENT EMPLOYER. YOU MUST COMPLETE THIS SECTION EVEN IF ATTACHING A RESUME.
1.
COMPANY NAME
TELEPHONE NUMBER
ADDRESS
DATES OF EMPLOYMENT
FROM
SALARY
POSITION
NAME OF SUPERVISOR
MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?
2.
REASON FOR LEAVING
YES
TELEPHONE NUMBER
ADDRESS
DATES OF EMPLOYMENT
FROM
SALARY
POSITION
MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?
3.
YES
NO
COMPANY NAME
TELEPHONE NUMBER
ADDRESS
DATES OF EMPLOYMENT
FROM
SALARY
NAME OF SUPERVISOR
MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?
YES
NO
TELEPHONE NUMBER
ADDRESS
DATES OF EMPLOYMENT
FROM
SALARY
POSITION
MAY WE CONTACT THIS EMPLOYER FOR A REFERENCE?
TO
REASON FOR LEAVING
COMPANY NAME
NAME OF SUPERVISOR
TO
REASON FOR LEAVING
POSITION
4.
NO
COMPANY NAME
NAME OF SUPERVISOR
TO
TO
REASON FOR LEAVING
YES
NO
Please list computer experience and any other training, qualifications or skills that you feel make you especially suited for work at TraPac, LLC.
REFERENCES
1.
NAME
2.
NAME
3.
NAME
List three persons not related to you, whom you have known at least one year, and who have knowledge of your work performance.
ADDRESS
TELEPHONE NUMBER
YEARS
ACQUAINTED
ADDRESS
TELEPHONE NUMBER
YEARS
ACQUAINTED
ADDRESS
TELEPHONE NUMBER
YEARS
ACQUAINTED
PERSONAL
ARE YOU ABLE TO PERFORM ESSENTIAL FUNCTIONS OF THE JOB FOR WHICH YOU ARE APPLYING, EITHER WITH OR WITHOUT REASONABLE
ACCOMODATION?
YES
IF NO, DESCRIBE THE FUNCTIONS THAT CANNOT BE PERFORMED.
NO
(Note: We comply with the ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.
Hire will be subject to successful completion of pre-employment physical exam.)
HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENSE (FELONY OR SERIOUS MISDEMEANOR)?
YES
NO
IF YES, STATE THE NATURE OF THE CRIME, WHEN AND WHERE CONVICTED AND DISPOSITION OF THE CASE.
(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, the surrounding circumstances and
the relevance of the offense to the position applied for, however, may be considered.) DOES NOT APPLY TO AUSTIN, TEXAS APPLICANTS
IF HIRED, CAN YOU PRESENT EVIDENCE OF YOUR U.S. CITIZENSHIP OR PROOF OF YOUR LEGAL RIGHT TO LIVE AND WORK IN THE U.S.?
YES
NO
ARE YOU LICENSED TO DRIVE?
IF HIRED, WOULD YOU HAVE A RELIABLE MEANS OF TRANSPORTATION TO AND FROM WORK?
YES
YES
NO
NO
ARE YOU WILLING TO WORK OVERTIME, IF REQUIRED?
YES
NO
WHAT FOREIGN LANGUAGES DO YOU SPEAK FLUENTLY
READ
WRITE
PLEASE READ CAREFULLY, INITIAL EACH PARAGRAPH AND SIGN BELOW
______
INITIAL
______
INITIAL
______
INITIAL
I HEREBY CERTIFY THAT I HAVE NOT KNOWINGLY WITHHELD ANY INFORMATION THAT MIGHT ADVERSELY AFFECT MY CHANCES OF EMPLOYMENT
AND THAT THE ANSWERS GIVEN BY ME ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I FURTHER CERTIFY THAT I, THE
UNDERSIGNED APPLICANT, HAVE PERSONALLY COMPLETED THIS APPLICATION. I UNDERSTAND THAT ANY OMISSION OR MISSTATEMENT OF
MATERIAL FACT ON THIS APPLICATION OR ON ANY DOCUMENT USED TO SECURE EMPLOYMENT SHALL BE GROUNDS FOR REJECTION OF THIS
APPLICATION OR FOR IMMEDIATE DISCHARGE IF I AM EMPLOYED, REGARDLESS OF THE TIME ELAPSED BEFORE DISCOVERY.
I AUTHORIZE PRESENT AND FORMER EMPLOYERS, AND INDIVIDUALS I HAVE LISTED AS PERSONAL REFERENCES, TO FURNISH INFORMATION
ABOUT MY EMPLOYMENT RECORD, INCLUDING A STATEMENT FOR THE REASON FOR THE TERMINATION OF MY EMPLOYMENT, WORK
PERFORMANCE, ABILITIES, AND OTHER QUALITIES PERTINENT TO MY SUITABILITY FOR EMPLOYMENT, HEREBY RELEASING THEM FROM ANY AND
ALL LIABILITY FOR DAMAGES ARISING FROM FURNISHING THE REQUESTED INFORMATION.
I UNDERSTAND THAT NOTHING CONTAINED IN THE APPLICATION, OR CONVEYED DURING ANY INTERVIEW WHICH MAY BE GRANTED OR 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 IS 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 THE COMPANY, 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 DESIGNATED
REPRESENTATIVE.
BY ENTERING MY PRINTED NAME, I REPRESENT AND WARRANT WITHOUT RESERVATION THAT I HAVE THE LEGAL RIGHT, POWER AND AUTHORITY
TO AGREE TO ALL TERMS CONTAINED IN THIS ONLINE APPLICATION.
APPLICANT'S SIGNATURE
DATE
WE ARE AN EQUAL OPPORTUNITY EMPLOYER AND DO NOT DISCRIMINATE IN HIRING OR EMPLOYMENT ON THE BASIS OF RACE, COLOR, RELIGION,
POLITICAL BELIEFS, NATIONAL ORIGIN, ANCESTRY, PREGNANCY AND MEDICAL CONDITION, PHYSICAL HANDICAP, MARITAL STATUS, SEX OR AGE.
NO QUESTION ON THIS APPLICATION IS INTENDED TO SECURE INFORMATION TO BE USED FOR SUCH DISCRIMINATION.
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