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APPLICATION FOR EMPLOYMENT

To Applicant:  We deeply appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications.  A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in possible future upgrading.

PERSONAL

DATE:  


NAME: (LAST) (FIRST)   (MIDDLE)
STREET ADDRESS:  APT# CITY ST ZIP

 PHONE NO.                                   E-MAIL ADDRESS   
              

POSITION(S) APPLIED FOR RATE OF PAY EXPECTED
$ PER     
WORK FULL-TIME PART TIME SPECIFY DAYS AND HOURS IF PART TIME DATE AVAILABLE
YES   NO   YES 

PREVIOUSLY EMPLOYED  BY US?  YES  NO 
 IF YES WHEN? 

WHY ARE YOU INTERESTED IN EMPLOYMENT WITH WESTERN BRANCH DIESEL?



LIST ANY FRIENDS OR RELATIVES WORKING FOR US        NAME(S)


LIST EXPERIENCES, SKILLS, OR QUALIFICATIONS THAT MAKE YOU QUALIFIED TO WORK WITH OUR ORGANIZATION.





ARE YOU OVER AGE 18?                      IF NO, ANY EMPLOYMENT OFFER IS SUBJECT OR VERIFICATION THAT YOU
     YES   NO                                 ARE OF MINIMUM LEGAL AGE.

HAVE YOU BEEN CONVICTED OF A CRIME IN THE PAST TEN YEARS, EXCLUDING MISDEMEANORS?   YES  NO             
IF YES, DESCRIBE IN FULL


IF JOB INVOLVES DRIVING, PLEASE LIST ALL ACCIDENTS AND TRAFFIC VIOLATIONS IN THE PAST FIVE (5) YEARS.


RECORD OF EDUCATION

SCHOOL NAME AND ADDRESS COURSE OF STUDY SELECT  YEAR COMPLETED DID YOU  GRADUATE LIST DIPLOMA OR DEGREE

  YES  
NO
COLLEGE OR OTHER        

YES  
NO

                                                                              

LIST BELOW ALL PRESENT AND PAST EMPLOYMENT,
BEGINNING WITH MOST RECENT

NAME AND ADDRESS OF COMPANY AND TYPE OF BUSINESS
FROM TO
MO YR MO YR
WEEKLY
STARTING SALARY		 WEEKLY ENDING SALARY


DESCRIBE THE WORK YOU DID
NAME OF  SUPERVISOR
 PHONE
REASON   FOR LEAVING
NAME AND ADDRESS OF COMPANY AND TYPE OF BUSINESS
FROM TO
MO YR MO YR
WEEKLY
STARTING SALARY		 WEEKLY ENDING SALARY


DESCRIBE THE WORK YOU DID
NAME OF  SUPERVISOR
 PHONE
REASON   FOR LEAVING
NAME AND ADDRESS OF COMPANY AND TYPE OF BUSINESS
FROM TO
MO YR MO YR
WEEKLY
STARTING SALARY		 WEEKLY ENDING SALARY


DESCRIBE THE WORK YOU DID
NAME OF  SUPERVISOR
 PHONE
REASON   FOR LEAVING


MAY WE CONTACT THE EMPLOYERS LISTED ABOVE?   YES   NO
IF NOT, INDICATE BY NO, WHICH ONE(S) YOU DO NOT WISH US TO CONTACT.


PLEASE READ THE STATEMENT  BELOW CAREFULLY

The facts set forth in my application for employment are true and complete.  I understand that if employed, false statements on this application shall be considered sufficient cause of dismissal.  Western Branch Diesel, Inc., is hereby authorized,  by THE SUBMISSION OF THIS ELECTRONIC APPLICATION, to make any investigation of my personal history through any investigative agencies.  I hereby waive and release any and all claims and causes of action of every kind whatever against Western Branch Diesel, Inc., and its officers and employees in connection with conducting an investigation concerning my background.

I understand that any job offer will be conditioned upon satisfactory results of a medical exam and drug test.  I also understand that any employment relationship with Western Branch Diesel, Inc., is "at will", which means the employee may resign at anytime and the employer may discharge the employee ant any time with or without cause.

I have carefully read all of the foregoing and fully understand its content.