Employment Opportunities

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Full Name

Home Address: Street

City

Zip Code

CELL PHONE #

HOME PHONE #

Texas Driver's License Number

Social Security Number

Date Of Birth

How many Traffic tickets/ auto accidents have you had in the last three years?

What were the violations?

Have you been convicted of a felony or pleaded " No Contest" to a felony?

Will you take a pre-employement drug test?

Do you agree to random testing?

Are you married?

How many dependats do you have?

Does your spouse work?

Where does he/she works?

Are you currently employed?

Where?

Name last three places you worked and length of time you were employed

Whom can we talk abou your job performance?

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Name three personal references, their phone numbers and their relation to you

Name

Phone

Relation

Name

Phone

Relation

Name

Phone

Relation

Are you in good health?

Is there any reason you should not be involved in strenuous activity?

If yes, why?

Do you take prescribed medication on a regular basis?

If yes, what do you take and why do you take it?

Have you had any medical operations?

If yes, for what and why?

Have you graduated from High School?

Which one and what year?

Have you been to college?

Which one?

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Do you have a degree?

Have you ever been in the Military?

What branch?

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What did you do in military?

What kind of discharge did you receive?

Are you in Reserves?

Have you had Route Sales Experience?

Where?

Do you know anyone that works here?

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How much money do you need to make weekly to meet your obligation?

Would you be willing to "ride" with a supervisor on a route one day without pay to determine whether or not you like route sales and whether or not we think you're suited for the job?

In the event of an emergency who should we notify?

What is their relation to you?

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What is their address?

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I certify that the information provided above is true and accurate to the best of my knowledge. Any deliberate falschools/ misrepresentations may result in the immediate termination of my employement.

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Printed Name

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“We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.”