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Answer all questions – Leave no blank spaces

Read and carefully complete all portions of this application. We will not process incomplete applications or those filled out incorrectly.

Personal Information

We consider qualified applicants without regard to age, race, religion, color, sex, developmental disability, physical condition, sexual orientation, national origin or any other area protected by federal, state, and local laws. Your application will not be processed unless the DISCLOSURE AND RELEASE AUTHORIZATION section of this form is completed.

Date of Application
Position Applying For
Legal Name
Date of Birth
List any other last name by which you have been known

When?

Home Phone
Cell Phone
Emergency Contact
Phone
Email
Do you possess the legal right to work in the U.S.?
 Yes No
Type of Work Desired?
 Full-Time Part-Time
Have you ever applied for employment here previously?
 Yes No
If yes, when?
May we contact your present employer?
 Yes No
Are you willing to travel?
 Yes No
Percentage?
Date you can start?
Desired starting salary?
Five-Year Address History
Present Address
Past Address
Past Address
Past Address
Past Address

Add Address

Where did you learn about H.O. Wolding?

Select type and enter source name in the field below.

Select One
Source Name
Education
High School
Degree

 Yes No

2-Year College
Degree
 Yes No
4-Year College
Degree
 Yes No
Technical School
Degree
 Yes No
Other (Describe)
Degree
 Yes No
List any additional skills, courses, qualifications, certifications, experience or honors
Employment Record

LIST PAST FIVE YEARS Begin with present or most recent job and work backwards, listing ALL full/part - time employers for the past five years. Account for ALL TIME including military service, school, self - employment and unemployment. Use extra sheet, if necessary. Military periods must be accompanied by DD214. (Member 4 copy). You must complete ALL information : name, address and phone number. Explain any employment gaps in the ADDITIONAL COMMENTS box at the end of this section.

Current Employer
From
To
Check One
 Employed Unemployed Self-Employed
Supervisor Name
Can we contact this employer?
 Yes No
Company Name
Phone
Address
Position Held
Rate of Pay
Reason for Leaving
Responsibilities
Second Last Employer

From
To
Check One
 Employed Unemployed Self-Employed
Supervisor Name
Can we contact this employer?
 Yes No
Company Name
Phone
Address
Position Held
Rate of Pay
Reason for Leaving
Responsibilities
Third Last Employer

From
From
From
 Employed Unemployed Self-Employed
Supervisor Name
Can we contact this employer?
 Yes No
Company Name
Phone
Address
Position Held
Rate of Pay
Reason for Leaving
Responsibilities
Fourth Last Employer

From
From
From
 Employed Unemployed Self-Employed
Supervisor Name
Can we contact this employer?
 Yes No
Company Name
Phone
Address
Position Held
Rate of Pay
Reason for Leaving
Responsibilities
Fifth Last Employer

From
From
From
 Employed Unemployed Self-Employed
Supervisor Name
Can we contact this employer?
 Yes No
Company Name
Phone
Address
Position Held
Rate of Pay
Reason for Leaving
Responsibilities

Add Employer

Technician Education / Training
Are you an experienced tractor-trailer technician?
 Yes No
How many years/months experience?
List tractor/trailer types with which you have experience.
List any certifications you have earned.
Please answer all questions
Have you been convicted of anything other than minor traffic violations?
 Yes No
Are you 18 years of age?
 Yes No
Are you physically capable of moving freight weighing up to 100 pounds per piece from floor level to shoulder level for a distance of no more than 53 feet?
 Yes No
Are you able to pass a urine-sampled drug-screen?
 Yes No
If applying for a technician position, can you work nights and weekends?
 Yes No
Do you have transportation to and from work?
 Yes No
Do you have any job-related military training?
 Yes No
Do you have any tools you own that you would use on the job site?
 Yes No
Do you possess basic computer skills and if applicable, how many words per minute can you type?
 Yes No
Are you skilled with Microsoft Office Suite products?
 Yes No
Driving Experience

If none, leave blank

Straight Truck
Types of Equipment
From
To
Approx. # of Miles
Tractor and Semi-Trailer
Types of Equipment
From
To
Approx. # of Miles
Military Service Record
Have you ever served in the U.S. armed forces?
 Yes No
Branch
 Army Navy Air Force Marines National Guard Reserves
From
To
Current duty status
 Active Inactive Discharged
Highest rank achieved
Rank at discharge
Type discharge

(You will need to provide a copy of your DD214 (Discharge Certificate) if military service occurred within the past 10 year)

MOTOR VEHICLE LICENSE OR PERMIT

List ALL Drivers Licenses held, past & present

State
License Number
Type
Expiration Date
Current License
 Yes No
State
License Number
Type
Expiration Date
Current License
 Yes No
State
License Number
Type
Expiration Date
Current License
 Yes No
References

No relatives

First Reference
Second Reference
Third Reference
Any other comments
Voluntary Equal Employment Opportunity Survey

Your cooperation by providing the survey information below on a VOLUNTARY BASIS is greatly appreciated. The information obtained is kept strictly confidential and may be used only in accordance with provisions of applicable laws, executive orders, and regulations, including those that require the information to be reported to the federal government for civil rights enforcement. When reported, data will not identify a specific individual. This information helps H.O. Wolding, Inc. (H.O.W) comply with mandatory government recordkeeping and reporting requirements. Submission of this information is voluntary and is not required as a condition of employment, nor will it affect any decisions regarding your employment.

RACE AND ETHNIC IDENTIFICATION (www.eeoc.gov) Race and ethnic designations as used by the Equal Employment Opport unity Commission do not denote scientific definitions of anthropological origins. Definitions of the race and ethnicity categories are as follows:

Hispanic or Latino: Person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin, regardless of race.  Yes No
White (Not Hispanic or Latino): Person with origins in any of the original peoples of Europe, the Middle East or North Africa.  Yes No
Black or African American (Not Hispanic or Latino): Person having origins in any of the black racial groups of Africa.  Yes No
Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): Person having origins in any of the peoples of Hawaii, Guam, Samoa or other Pacific Islands.  Yes No
Asian (Not Hispanic or Latino): Person having origins in any of the original peoples of the Far Eastern, Southeast Asia or the Indian Subcontinent, including for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Island, Thailand and Vietnam.  Yes No
American Indian or Alaska Native (Not Hispanic or Latino): Person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.  Yes No
Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.  Yes No
Signature

Type your name here, intending this to be your electronic signature
Date
DISCLOSURE AND RELEASE AUTHORIZATION

Carefully read and authorize with applicant signature. Please print name, sign and date below before faxing. If you have any questions regarding this form, please call H.O. Wolding, Inc. for clarification.

In connection with my application for employment with H.O. Wolding Inc., I understand that a consumer report which may contain public record information, may be requested from DAC Services, Tulsa, Oklahoma and/or other driving record sources. These reports may include the following information: names and dates of previous employers, reason for termination of employment, work experience, accident, etc. I further understand that such reports may contain public record information concerning my driving record, workers' compensation claims, credit, and bankruptcy proceedings, criminal records, etc., from DAC concerning previous driving record requests made by others from such state agencies and state provided driving record.

I AUTHORIZE, WITHOUT RESERVATION, ANY PARTY OR AGENCY CONTACTED BY DAC AND/OR OTHER DRIVING RECORD SOURCES TO FURNISH THE ABOVE MENTIONED INFORMATION.

I have the right to make a request to DAC and or other driving sources, upon proper identification, to request the nature and substance of all information in its files on me at the time of my request, including the sources of information; and the recipients of any reports on me which DAC and/or other driving sources, has previously furnished with in the two-year period preceding my request. I hereby consent to H.O. Wolding, Inc. obtaining the above information from DAC, and I agree that such information, which DAC and/or other driving record sources have to obtain, and my employment history with H.O. Wolding Inc., if I am hired, will be supplied by DAC to other companies, which subscribe to DAC Services.

I hereby authorize procurement of consumer report(s). If hired, this authorization information shall remain on file and shall serve as an ongoing authorization for H.O. Wolding Inc. to procure consumer reports at any time during my employment period.

I hereby authorize, without liability, any person/organization whose name I provided as a reference, or by whom I was previously employed or contracted, to furnish H.O.W any information regarding my performance, character, habits, ability, financial responsibility, job performance or other work-related characteristics, reasons for leaving my employment/lease and all information concerning my employment. I hereby release all such persons and organizations from any claims for damages of any kind, which may befall me by reasons of furnishing such information.

I attest that this application was completed by me and that all entries on it and information in it are true and complete to the best of my knowledge. Any false, misleading or incomplete statement of the information requested in this application and any supplemental material submitted shall be sufficient grounds for disqualification of this application or termination from employment, if this application results in employment.

I understand and agree that this application for employment in no way obligates H.O. Wolding, Inc. to employ this applicant. I also understand and agree that if I am hired, I am required to comply with all company policies, State and Federal regulations as they may apply.

Furthermore, I understand and agree that if hired, it will be considered "At Will" and H.O. Wolding, Inc. may suspend or terminate my employment without reason or cause at any time.

I attest I have read and understand the terms of this DISCLOSURE AND RELEASE AUTHORIZATION by placing my name at the bottom of said document and hereby authorize H.O.W and its employees, agents, and affiliates to obtain the information authorized in this DISCLOSURE AND RELEASE AUTHORIZATION document. If hired, this authorization form shall remain on file and serve as ongoing authorization for H.O. Wolding, Inc. to procure consumer reports anytime during my employment period.

Signature

Type your name here, intending this to be your electronic signature
Date