Job application form
Name *
First and last name
Your answer
Phone number *
Your answer
Email *
Your answer
Position Applying For? Person Referring you? *
Your answer
Are you legally eligible for employment in this country? *
Your answer
Drivers License Number. State - Class *
Your answer
Have you been convicted of a felony in the last seven years? If yes please explain. *
Your answer
Job History
Name, Address and Type of Business *
Your answer
Name and Phone number of supervisor *
Your answer
Date starting employment *
MM
/
DD
/
YYYY
Date ending employment *
MM
/
DD
/
YYYY
Name, Address and Type of Business *
Your answer
Name and Phone number for supervisor *
Your answer
Date starting employment *
MM
/
DD
/
YYYY
Date ending employment *
MM
/
DD
/
YYYY
Education
School Name and last year completed *
Your answer
Diploma or Degree Earned *
In accordance with the provisions of Section 31-17-103(l)(ii)(iii), Wyoming Statutes, 1977, et seq., this area is to be completed by all applicants seeking employment as a driver of a commercial motor vehicle. Please list the names and addresses of all previous employers for which you were a driver of a commercial vehicle during the last ten (10) years, the dates between which you drove for each employer and your reason for leaving each employer
Employers Name and Address
Your answer
Dates between which you drove
Your answer
Reason for Leaving
Your answer
Employers Name and Address
Your answer
Dates between which you drove
Your answer
Reason for Leaving
Your answer
Personal references
Name , Address and Telephone *
Your answer
Name , Address and Telephone *
Your answer
I understand and agree that any misrepresentation by me on this application will be sufficient cause for voiding this application or for separating me from the service of this company if I have become employed. I further understand that acceptance of and offer of employment does not create contractual obligation upon STAR to continue to employ me in the future. I Authorize STAR to investigate my work performance with my references and with my previous employers,and to investigate other such records, (e.g., motor vehicle operator records, criminal records etc.),pertinent to the job(s)for which I have Applied. I hereby release from liability STAR and its representatives for seeking such information and all other persons, corporations, or organizations for furnishing such information. I understand and consent to physical examinations, including drug and alcohol screenings, and other tests/evaluations,etc. that may be required to certify my suitability for the work for which I have applied, and I release from liability STAR and its representatives for any legitimate actions it takes relating to the results of such tests. I also understand that refusal to submit to the physical and drug screening will constitute voluntary withdrawal of my applications for employment. I also understand that STAR may refuse to hire me as a result of the examination, and I agree to hold STAR harmless for such refusal. If I become employed, I also agree to such physical examinations, including drug and alcohol screenings, and other tests/evaluations, etc. as reasonable may be required for any work which I may encounter while an employee of STAR. I further agree to hold STAR harmless for the consequences of such examinations, screenings, tests, etc.
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