Tri State Truck Center, Inc
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Employment Application
Pre-employment Questionnaire
An Equal Opportunity Employer

Your Email
Position Applying For
Date
First name      Middle Int.
Last name
Social Security No.
Address
City
State           ZIP
Area Code   Phone
Is there another day time telephone where you can be reached
Are you 18 Years Old or Older Yes    No
Are you a Citizen of the U.S. or otherwise authorized to work in the U.S. Yes    No
Are you employed now Yes    No
May we contact your present employer Yes    No
Date you can start
Are you willing to relocate Yes    No
Are you available to travel Yes    No
If so, what percentage
Salary needed
Were you employed by us before Yes    No
If yes, when?
Are you related to any Holbrook Granite employee Yes    No
If so, to whom
Education
High School
Diploma/G.E.D.
Trade/Technical School
Course of Study
Apprenticeships
Certifications
College
Course of Study
Degrees
Do you have teaching certification Yes    No
If yes, what type
Subjects of special study
or research work
Additional Comments:
Work Experience
Company/Address
Dates of Employment
Job Title
Reason for Leaving
Salary
 
Company/Address
Dates of Employment
Job Title
Reason for Leaving
Salary
 
Company/Address
Dates of Employment
Job Title
Reason for Leaving
Salary
 
Company/Address
Dates of Employment
Job Title
Reason for Leaving
Salary
Additional Experience Comments:
Work References
Name
Phone Number
Business
Years Acquainted
 
Name
Phone Number
Business
Years Acquainted
 
Name
Phone Number
Business
Years Acquainted
Miscellaneous
Have you ever been convicted
of a felony or misdemeanor
other than a minor traffic violation?		 Yes    No
If yes, give details
Are your presently under
arrest for a pending felony charge?		 Yes    No
If yes, give details
In case of an emergency notify


Applicant's Certification and Agreement
Please Read Your Form Carefully Before Submitting.

By submitting this electronic form, I authorize investigation of all areas contained in this application, including reference checks and completion of a criminal records check. I understand that misrepresentation or omission of facts called for is cause for dismissal.

An employee may request reasonable accommodation to a disability, in order to facilitate the performance of assigned work.



 National Toll Free: (800) 395-8494
Main: (508) 753-1200
Alignment Center: (508) 845-2498

Hours of Operation
Open 24/5 Monday-Friday
Saturday: 6:30am to 3:00pm
Closed Sunday
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