“R” Delivery, Inc.
Fax 866-610-9607
Office 815-735-4259
Application for Employment: 2 pages.
Applicants full
name:________________________________________________________
Street:____________________________________________________________________
City:
Home phone: _________________________Cell
Phone:____________________________
Date of Birth________________________ Social Security #_________________
Addresses: (past 3 locations):
City_____________ State______________ Zip______________ Dates_______
City_____________ State______________ Zip______________ Dates_______
City_____________ State______________ Zip______________ Dates_______
Attach a sheet if more space is necessary.
Drivers
License # ____________________________State____Type_________ Expires__________
Drivers License # ____________________________State____Type_________ Expires__________
Job Experience: (Last 4 jobs, list the most
recent first)
Employer________________________________________________________________
Contact
name ______________________________ Phone #________________________
City___________________________
State ________________Zip Code______________
Date of Employment: Starting
____________________Ending______________________
Employer________________________________________________________________
Contact
name ______________________________ Phone #________________________
City___________________________
State ________________Zip Code______________
Date of Employment: Starting
____________________Ending______________________
Employer________________________________________________________________
Contact
name ______________________________ Phone #________________________
City___________________________
State ________________Zip Code______________
Date of Employment: Starting
____________________Ending______________________
Employer________________________________________________________________
Contact
name ______________________________ Phone #________________________
City___________________________
State ________________Zip Code______________
Date of Employment: Starting
____________________Ending_______________________
“R” Delivery, Inc.
Fax 815-495-2014
Office 815-495-3500
Accident Record:
Last
accident date_____________Nature of accident____________ Result___________
Last
accident date _____________Nature of accident____________ Result
___________
Have you been Charged with or Convicted of a felony? Yes or NO
Explain ________________________________________________________________
Health: Can you do the following? Ask for details if necessary.
Can you
lift heavy weights? Yes or No
Can you climb? Yes or No
Do you take prescription medication? Yes or No Explain__________________________
Do you smoke? Yes or No
References: (No Relatives Please.)
Name ____________________________________Phone#
_________________________
Your relationship to the reference______________________________________________
Name
____________________________________Phone# _________________________
Your
relationship to the reference______________________________________________
Name
____________________________________Phone# _________________________
Your
relationship to the reference______________________________________________
Reminder:
Attach
your Department of Motor Vehicles Report and Medical Examination Report.
Please
attach any additional information which describes your skills and
experiences that improve your ability to work in a customer service
driving position.
“R” Delivery staff will be checking references and
performing background checks.
Signature of Applicant: _______________________________________________________
Thank
you. Have a Great Day!