On-line Application (non driver)

Application Date		Position
SS #
Name
Address
City
State		Zip Code
Address Last 3 Yrs
City
State		Zip Code
Telephone #		Other #
Are you a United States Citizen?		Yes No
If not, do you have a visa permitting employment?		Yes   No
How did you hear about us?     Friend Newspaper Radio Are you presently employed?     Yes No Location desired:     Stoughton White Pine, TN Which shift do you prefer:     First Second Third Type of employment sought:     Full Time              Part Time Temporary            Summer Only
When can you start working?    Have you worked here before?  If so, when:   Have you ever applied at any subsidiary of Stoughton Trailers, Inc?  If so, when: During the past 2 years, how many work/school days have you been absent (not including vacation)?
Do you have a valid drivers license?		Yes No
License number:
License state:
Do you have a reliable source of transportation?  If so, what is it?
Have you ever been convicted of a crime, other than a traffic violation or misdemeanor?  If yes, please describe and indicate dates.
Please list any acquaintances or relatives employed by Stoughton Trucking Inc, that we could contact as a reference: Name and relationship: Name and relationship: Name and relationship:
Employment History List all employers in reverse starting with the most recent.
Employer		Job Title
Address
City
State		Zip Code
Supervisor		Telephone #
Employed From		Until
Duties
Reason ForLeaving
Employer		Job Title
Address
City
State		Zip Code
Supervisor		Telephone #
Employed From		Until
Duties
Reason ForLeaving
Employer		Job Title
Address
City
State		Zip Code
Supervisor		Telephone #
Employed From		Until
Duties
Reason ForLeaving
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Education and Training
School Name & Location  From  To  Major  Graduated?  # Years  GPA
If not a high school graduate, do you have your GED?		Yes No
For maintenance/shop jobs: Check the following skills, tools, and/or equipment that apply: Forklift Drills Hydralics Paint Cup Gun Inventory Rivet Gun Generators CDL Brake Press Electrical Auto CAD Shear Lathes Hand Tools Impact Wrench CNC Machines Overhead Cranes Grinder/Chipper
Have you ever been a member of the U.S. Military?		Yes No
If yes, what branch, how long, rank at discharge, and type of discharge?
Special skills, training, or experience aquired:
Please list references that Stoughton Trucking, Inc. may contact. Include only individuals familiar with your work ability.  Do not include relatives.
Name  Complete Address & Telephone  Occupation
May we contact your present employer?		Yes    No
Emergency contact
PRE-EMPLOYMENT DRUG SCREENING:   I agree to give urine specimens as required by the company and authorize the release of all medical history, physical examination, and specimen analysis information to my prospective employer. I understand that if I do not cooperate fully in the giving of a specimen, or if my specimen fails to pass drug screening, my employment application will be rejected. This certifies that I completed this application and that all entries and information on it are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given on my application or interview(s) may result in discharge.  I also understand that I am required to abide by all rules and regulations of Stoughton Trucking, Inc.  In accordance with the provisions of Section 804(b)(2)(a) of the Fair Credit Reporting Act, (Public Law 91-508),  as amended by the consumer Credit Reporting of 1996 (Title II, Subtitle D Chapter 1 of Public Law 104-208), you are being informed that a consumer report may be obtained on you for employment purposes. This report may include the following types of information: names and dates of previous employers, reason for termination of  employment, work experience, accidents, etc. I further understand that such reports may contain public record information concerning my driving record, worker's compensation claims, credit, bankruptcy proceedings, etc. from federal, state, and other agencies which maintain such records. I acknowledge the receipt of the above disclosure. I do not acknowledge the receipt of the above disclosure. Applicant's Initials Date    *Applying on-line does NOT replace the 'hard copy' employment application that is required.  In the event that you are hired by Stoughton Trucking, Inc.,  you WILL be required to fill out an official employment application.