Careers

Date
*Position(s) Applied For:
*First Name
*Last Name
Middle
*Date of Birth
*Address
*City
*State
*ZIP
*Phone
Previous Address (Go Back 3 Years)
City
State
ZIP
How long at this address?
Previous Address (Go Back 3 Years)
City
State
ZIP
How long at this address?

Next

Can you legally be employed in the United States?	Yes No
Do you have proof of age? (Required of commercial drivers)	Yes No

Have you ever been employed by this company before?	Yes No
If yes, when:
What was your rate of pay?
If yes, position held:
Reason for leaving?
Currently employed?	Yes No
If yes, may we contact your present employer?	Yes No
If not, how long since you were last employed?
What pay rate are you expecting?
How did you hear about this company?
After reviewing the job description, for what reasons might you be unable to perform the duties of the position for which you are applying? You may explain.

Next

Please give the following information regarding your current and previous employers. Start with the most recent. Use additional sheets if necessary and please explain any employment gaps.

Employer
Contact
Phone
Address
City
State
ZIP
Date From
Date To
Position
Salary
Reason for Leaving
Employer
Contact
Phone
Address
City
State
ZIP
Date From
Date To
Position
Salary
Reason for Leaving
Employer
Contact
Phone
Address
City
State
ZIP
Date From
Date To
Position
Salary
Reason for Leaving
Employer
Contact
Phone
Address
City
State
ZIP
Date From
Date To
Position
Salary
Reason for Leaving
Please use this space for comments, additional information, or to explain periods of time between employers.

Next

State:
License No.:
Type:
Expiration Date:
State:
License No.:
Type:
Expiration Date:
State:
License No.:
Type:
Expiration Date:

Tractor & Semi-Trailer
Equipment Type:
For How Long?:
Total Miles: (Approx.)
Tractor w/ Two Trailers
Equipment Type:
For How Long?:
Total Miles: (Approx.)
Straight Truck
Equipment Type:
For How Long?:
Total Miles: (Approx.)
Other
Equipment Type:
For How Long?:
Total Miles: (Approx.)
In what states have you operated in the past three years?
Have you ever had your license revoked or suspended?	Yes No
If so, when and where?
Why? (please explain)
Have you ever been convicted of a felony?	Yes No
If so, when and where?
Why? (please explain)
Have you tested positive for a pre-employment or random Drug or Alcohol test in the past two years?	Yes No

Next

(List most recent first - attach additional sheets if necessary)

Date:
Injuries?	Yes No
Fatalities?	Yes No
Vehicle Type:
Describe:
Date:
Injuries?	Yes No
Fatalities?	Yes No
Vehicle Type:
Describe:
Date:
Injuries?	Yes No
Fatalities?	Yes No
Vehicle Type:
Describe:

(List most recent first - attach additional sheets if necessary)

Date:
Where?
Violation:
Penalty:
Date:
Where?
Violation:
Penalty:
Date:
Where?
Violation:
Penalty:

Next

Please provide the following information about completed education, starting with the most recent.

School or University
Years Completed
Field of Study
Graduate?	Yes No
When
School or University
Years Completed
Field of Study
Graduate?	Yes No
When

Have you ever served in the military?	Yes No
When
Please list any training you have received that you think will benefit you in the position for which you are applying.

Please provide three personal references. These references should not be people related to you nor former supervisors.

Name
Years Known
Phone Number
Name
Years Known
Phone Number
Name
Years Known
Phone Number

Next

By signing below, I certify that the answers and information provided on this form are true, accurate and complete to the best of my knowledge. I understand that if any answer is not true, accurate, or complete, I may not be hired, or if hired, I may be discharged.

I understand that this employer will investigate my work and personal history, character, and qualifications to verify all information given on this application, on related papers, and in interviews. Except for those that I have specifically noted, I authorize any firms, individuals, references, and schools named on the form to provide this employer with information regarding my work history, educational history, or character and to cooperate fully with the investigation of my qualifications. I authorize them to provide any information requested about me and I release them from all liability for damage in providing this information.

I understand that this employer may perform a background check in the areas of criminal history and presence on any sex offender, child abuse or adult abuse registries. By my signature below, I specifically authorize any private or public entities to provide this employer with information regarding my background, including, but not limited to, criminal history and whether my name is present on any child or adult abuse registries. I authorize these private or public entities to provide any information this employer requests about me and release them from all liability in providing this information.

I understand that this employer follows an "employment at will" policy, which means that they or I may terminate my employment at any time and for any reason consistent with applicable state or federal law. I understand that this application is not a contract of employment. I acknowledge that no oral representation has been made. If I am hired, I agree to conform to the rules and expectations provided to me by this employer.

I understand that this application is considered current for 90 days. If I want to be considered for employment after that time, I must renew my application in writing.

Mead Lumber is a drug free workplace. Pre-employment tested is required. All employment offers are contingent upon a negative drug screen.

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