Hometown Hauling
PO Box 469

Fairdale, KY 40118

501 Downes Terrace

Louisville, KY 40214

Application For Employment

Hometown Hauling is an equal opportunity employer and does not discriminate against

otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex,

marital status, national origin, disability or handicap, or veteran status.

Hometown Hauling is an At-Will Employer

Personal Information

/
DATE
Name
Last First Middle Maiden
Present address
Number Street City State Zip
How long / Social Security No. ______– _____ – ______
Telephone ( )
How many hours can you work weekly? Can you work nights?
Employment desired qFULL-TIME ONLY qPART-TIME ONLY qFULL- OR PART-TIME
When available for work?______
EDUCATION
HISTORY / NAME OF SCHOOL / LOCATION
Complete mailing address / YEARS COMPLETED / MAJOR & DEGREE

HIGH SCHOOL

COLLEGE
Specialty Date Entered Discharge Date
Bus. Or Trade School
Professional School
Driver’s license
number State of issue ______Expiration date ______
q Operator q Commercial (CDL) qChauffeur
Have you had any accidents during the past three years? / How many?
Have you had any moving violations during the past three years? / How Many?
Work Experience / Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name. Attach additional sheets if necessary.
Name of employer
Address / Name of last supervisor / Employment dates / Pay or salary
City, State, Zip Code
Phone number / From
To / Start
Final
Your last job title
Reason for leaving (be specific)
Name of employer
Address / Name of last supervisor / Employment dates / Pay or salary
City, State, Zip Code
Phone number / From
To / Start
Final
Your last job title
Reason for leaving (be specific)
Name of employer
Address / Name of last supervisor / Employment dates / Pay or salary
City, State, Zip Code
Phone number / From
To / Start
Final
Your Last Job Title
Reason for leaving (be specific)

Military Experience

HAVE YOU EVER BEEN IN THE ARMED FORCES? q Yes q No
ARE YOU NOW A MEMBER OF THE NATIONAL GUARD? q Yes q No
Specialty Date Entered ______Discharge Date ______
Please list two references, other than relatives:
Name / Name
Position / Position
Company / Company
Address / Address
Telephone ( ) / Telephone ( )

THE RIGHT TO HAVE ERRONEOUS INFORMATION CORRECTED: If you believe there is an
error in the records, you have the right to have the error corrected.
THE RIGHT TO REBUT DISPUTED INFORMATION: You may rebut disputed information.
THE RIGHT TO REPORT FAILURES TO CORRECT ERRONEOUS INFORMATION: You can report failures to correct erroneous information.
Please review your rights as outlined in the Summary of Your Rights Under the Fair Credit Reporting Act

TO BE READ AND SIGNED BY APPLICANT

THIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME, AND THAT ALL ENRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I AUTHORIZE YOU TO MAKE SUCH INVESTIGATIONS AND INQUIRIES OF MY PERSONAL, EMPLOYMENT, CRIMINAL, FINANCIAL OR MEDICAL HISTORY AND OTHER RELATED MATTERS AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. I HEREBY RELEASE EMPLOYERS, SCHOOLS OF PERSONAL LIABALITY IN RESPONDING TO INQUIRIES IN CONNECTION WITH MY APPLICATION. IN THE EVENT OF EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION GIVEN IN MY APPLICATION OR INTERVIEW(S) MAY RESULT IN DISCHARGE. I UNDERSTAND, ALSO, THAT I AM REQUIRED TO ABIDE BY ALL RULES AND REGULATIONS OF THE COMPANY, AS PERMTTED BY LAW.

Applicant Signature ______Date ______

Implemented August 2009