Employment Application

Notice At Collection

We collect certain categories of personal information about you to facilitate employment opportunities and for other reasons internal to Crystal Springs Trucking. Find out more information about the categories of information we collect and the manner in which it is used in our Privacy Policy.

Position

Position Applying For

Type of employment? Full Time Part Time

Desired Annual Salary

Desired Hourly Wage

Are you willing to work extended hours as business needs warrant; may include nights and weekends? Yes No

If hired, date on which you anticipate being able to start? Select month, year and then date.

Complete if position requires driving for work and/or operating a company vehicle

Do you have a current valid driver’s license? Yes No

Has your license ever been suspended or revoked? Yes No

If yes, explain

Do you have personal automobile insurance? Yes No

If no, explain

Have you ever been denied personal automobile insurance or has it ever been terminated or suspended? Yes No

If yes, explain

Work History

Beginning with your current/most recent employment including internships, verified volunteer service and military service (if applicable), providing a full accounting of your work experience. Students would list all summer and part-time jobs.

#1

Employment Type

Employment Internship Verified Volunteer Service Military Service

Name of Current/Most Recent Employer/Company

Business/Industry Type

City

State

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontana NebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Position Held

Dates worked

Select month, year and then date.

Supervisor’s Name

Supervisor’s Phone Number

May we contact? Yes No

If no, explain

Reason for Leaving

If you were terminated, what reason did the employer give you for the termination decision?

Were you ever disciplined? Yes No

If so, for what?

When resigning, how much notice did you give?

If none, explain.

#2

Employment Type

Employment Internship Verified Volunteer Service Military Service

Name of Previous Employer/Company

Business/Industry Type

City

State

Position Held

Dates worked

Select month, year and then date.

Supervisor’s Name

Supervisor’s Phone Number

May we contact? Yes No

If no, explain

Reason for Leaving

If you were terminated, what reason did the employer give you for the termination decision?

Were you ever disciplined? Yes No

If so, for what?

When resigning, how much notice did you give?

If none, explain.

#3

Employment Type

Employment Internship Verified Volunteer Service Military Service

Name of Previous Employer/Company

Business/Industry Type

City

State

Position Held

Dates worked

Select month, year and then date.

Supervisor’s Name

Supervisor’s Phone Number

May we contact? Yes No

If no, explain

Reason for Leaving

If you were terminated, what reason did the employer give you for the termination decision?

Were you ever disciplined? Yes No

If so, for what?

When resigning, how much notice did you give?

If none, explain.

Education

#1

Type

High School College Grad/Professional Trade

Name

Course

Diploma GED Associates Bachelors Masters Doctors Other

Major

Completed

Yes No

#2

Type

High School College Grad/Professional Trade

Name

Course

Diploma GED Associates Bachelors Masters Doctors Other

Major

Completed

Yes No

#3

Type

High School College Grad/Professional Trade

Name

Course

Diploma GED Associates Bachelors Masters Doctors Other

Major

Completed

Yes No

Add Education

Supervisor References

List two (2) supervisors who we can contact. These can be the same or different as noted in work history.

Name

Title

Company

Phone Number

Email Address

Name

Title

Company

Phone Number

Email Address

By signing, I certify that:

All the information on this application, my resume, or any supporting documents I may present during any interview is and will be complete and accurate to the best of my knowledge. I understand that any falsification, misrepresentation, or omission or any information may result in disqualification from consideration for employment, or, if employed, disciplinary action, up to and including immediate dismissal.
I understand that, in accordance with federal regulations, my employment also depends on providing proof of identity and eligibility to work in this country.
I understand and agree that as a condition of employment and to the extent permitted by federal, state and local law, I will be required to sign a confidentiality, restrictive covenant, and/or conflict of interest statement.
I understand that I will have the right to terminate my employment with Crystal Springs Trucking and/or its affiliates at any time without notice and for any reason. I understand that Crystal Springs Trucking and/or its affiliates has this same right.

CLEAR

Applicant Signature

Date

By providing my signature electronically above (via mouse or touchscreen) and hitting the “Submit” button below, I am acknowledging my intent to sign this application, that this will constitute my signature on this application, and that this signature through electronic means has the same validity and meaning as my handwritten signature.

Note to Applicants:

Smoking is prohibited in all indoor areas of the Company.
Massachusetts Applicants: I understand that it is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Maryland Applicants: I understand that under Maryland Law, an employer may not require or demand, as a condition of employment, prospective employment or continued employment, that any individual submit to or take a lie detector or similar test. An employer who violates this law is guilty of a misdemeanor and subject to a fine not exceeding $100.