Clerical / Shop Application - Wille Transport, INC.

Date*

Name

First

Last

Address

Phone Number

Email address*

What is your age and Date of Birth?

Social Security Number

Desired Position*

Date you can start*

Desired Salary*

Are you currently employed*

YES

If so, may we inquire your present employer?*

YES

Have you ever applied with Wille Transport before?*

YES

If yes, when?

Name of High School and number of years attended

Did you graduate?

YES

Name of College and number of years attended

Did you graduate?

YES

Name of Trade/Business/Correspondence School and number of years attended

Did you graduate?

YES

Subjects of Special Studies or Research

What languages, besides English, do you speak fluently?

U.S. Military / Rank

Special Membership in National Guard or Reserves

How were you referred to this organization?

Have you ever been involuntarily discharged from employment?

YES

If so, when and under what circumstances

If hired, can you provide documents to prove that you are authorized to work in the United States?

YES

Is there any information we would need about your name or the use of another name for us to be able to check your work record? (please specify)

Have you ever been convicted of any crimes, excluding minor traffic violations? If yes, list nature, date and place

Previous Employment 1: Please include Name of Employer, Position, Supervisor, Phone Number, Dates worked, and Ending Salary

Description of Duties and your reason for leaving

Previous Employment 2: Please include Name of Employer, Position, Supervisor, Phone Number, Dates worked, and Ending Salary

Description of Duties and your reason for leaving

Previous Employment 3: Please include Name of Employer, Position, Supervisor, Phone Number, Dates worked, and Ending Salary

Description of Duties and your reason for leaving

Are you able to lift 50lbs?

Yes

Do you have any injuries or conditions that would prevent you from doing your job?

Yes

Special Skills (list all pertinent skills and equipment that you can operate)

Certifications earned / Special training (ex. welding, first responder) and years of experience

Reference 1: (Please include at least three professional references) name, years acquainted, and contact information

Reference 2: name, years acquainted, and contact information.

Reference 3: name, years acquainted, and contact information.

In Case of Emergency please contact: (provide and name, address, and phone number)

Applicant Name and Date

SIGNATURE: “I certify that the facts contained in this application are true and complete to the best of my knowledge and understanding that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed herein to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.”

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