Non-Driver’s Application for Employment Step 1 of 4 25% Application for Employment Rollet Bros Trucking 227 Hwy M PO Box 31 Perryville MO 63775 Phone: 800-942-5590 Fax: 573-547-2574 Today's date* MM slash DD slash YYYY Name* First Middle Last Social Security Number* E-Mail Address* Home Telephone Number*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Position Applied For* Are you available to work:* Full-Time Part-Time Temporary How did you learn about this opportunity?*If referral, please state the name Have you ever been convicted or pled guilty to a misdemeanor or felony?*A conviction record will not necessarily bar you from employment. Factors such as age, time of the offense, seriousness, and nature of the violation will be taken into account. Yes No Please explainDo you agree to a criminal background check prior to employment?* Yes No Have you ever been terminated from employment or asked to resign by an employer?* Yes No Please provide company name and detailsMay we contact your current employer?* Yes No N/A Are you at least 18 years old?* Yes No Are you legally eligible to be employed in the United States?* Yes No Have you ever worked for this company before?* Yes No Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY SkillsPlease describe any special skills, experience, and/or training.*EducationDo you have a high school diploma or GED certificate?* Yes No Name of High School Attended Name of College Attended (if applicable) College Address Total College Semester HoursMajor Degree Earned Employment HistoryDescribe in detail all positions that you have had during the last ten (10) years, starting with the most recent employment. If more than one position or classification has been held with a given organization, list each position or classification as a separate period of employment.Employment History List*Name of Employer:Date Employed From:Date Employed To:Supervisor's Name and Title:Job Title:Street Address:City:State:Zip:Monthly Salary:Reason for Leaving: References*NameAddressPhone Number CertificationI certify that the information provided herein is true and complete. I understand that intentional or inadverent misrepresentation or omission of information on this application may result in the rejection of my application or subsequent dismissal from employment.Signature*Date* MM slash DD slash YYYY We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.PhoneThis field is for validation purposes and should be left unchanged.