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Employment Application

Please email completed form to

ALL APPLICANTS WILL BE SUBJECT TO BACKGROUND CHECK AND DRUG TESTING BEFORE EMPLOYMENT.

Personal Information:

Full Name (First, Middle, Last): _______________________________________________________

Address (Street, Apt. No.) : __________________________________________________________

(City, State, Zip): __________________________________________________________

Phone Number: ________________________________ Are you 18 years or older? __ Yes __ No

Are you a United States Citizen or an alien authorized to work in the United States? __ Yes __ No

Employment Desired:

Position applying for: _______________________________________________________________

Date you can start: _____________________ Salary Desired: _______________________

Are you employed now? __ Yes __ No

If yes, may we contact your present employer? __ Yes __ No

Have you ever applied at STOBER Drives in the past? __ Yes __ No If yes, when? _________

Referred by: ______________________________________________________________________

Education:

High School:

Name: _______________________________________________________________

Location: _____________________________________________________________

Number of Years Attended: ____________________________ Did you graduate? __Yes __ No

College or Trade School:

Name: _______________________________________________________________

Location: _____________________________________________________________

Number of Years Attended: ____________________________ Did you graduate? __Yes __ No

Subject Studied: __________________________________________________

General:

Subjects of Special Interest or Research Work: ___________________________________________

_________________________________________________________________________________

Special Skills: _____________________________________________________________________

Activities of Interest (Social, Athletic, etc.): _______________________________________________

_________________________________________________________________________________

US. Military Service: __________________________ Years of Service: ____________________

Are you presently in the National Guard or Reserves? __ Yes __ No

Employment History: (List your last three employers, starting with the most recent one first.)

Employer 1:

Name: _______________________________________________________________

Location: _____________________________________________________________

Start/End Date: ________________________ Reason for leaving: ________________________

Job Responsibilities: _____________________________________________________________

Employer 2:

Name: _______________________________________________________________

Location: _____________________________________________________________

Start/End Date: ________________________ Reason for leaving: ________________________

Job Responsibilities: _____________________________________________________________

Employer 3:

Name: _______________________________________________________________

Location: _____________________________________________________________

Start/End Date: ________________________ Reason for leaving: ________________________

Job Responsibilities: _____________________________________________________________

Which of these jobs did you like best and what did you like most about it? _____________________________________________________________________________

References: List three people, not related to you, whom you have known for at least one year.

Reference 1:

Name: _______________________________________________________________

Address: _____________________________________________________________

City, State, Zip: ________________________________________________________

Phone Number: ________________________ Years Acquainted: __________

Reference 2:

Name: _______________________________________________________________

Address: _____________________________________________________________

City, State, Zip: ________________________________________________________

Phone Number: ________________________ Years Acquainted: __________

Reference 3:

Name: _______________________________________________________________

Address: _____________________________________________________________

City, State, Zip: ________________________________________________________

Phone Number: ________________________ Years Acquainted: __________

I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand 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 above to give you any and all information concerning my previous employment and any pertinent information they may have and hereby 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 or without cause.

Signature: _______________________________________________________

Date: _______________________________________________________

Form No. 9021IN