Employment ApplicationPage 1 of 9Name*FirstMiddleLastStreet AddressCityStateZIP CodeEmail address*PhonePhonePosition Applied ForDate AvailableDesired SalaryAre you a US Citizen?YesNoIf no, are you authorized to work in the US?YesNoHave you ever worked for this company?YesNoIf so, when?NextEducationHigh SchoolAddress:FromToGraduate?YesNoDegreeCollegeAddress:FromToGraduate?YesNoDegreeOtherAddress:FromToGraduate?YesNoDegreeList any foreign languages you can speak, read, and/or write?Describe any specialized training, apprenticeship , skills, and extra-curricular activities.List any professional, trade, business or civic activities and offices held.BackNextBusiness ReferencesNameCompanyRelationshipPhoneAddressNameCompanyRelationshipPhoneAddressNameCompanyRelationshipPhoneAddressBackNextBusiness ReferencesCompanyAddressJob TitleFrom:To:Reason For Leaving:PhoneSupervisorResponsibilitiesStarting SalaryEnding SalaryMay we contact your previous supervisor?YesNoCompanyAddressJob TitleFrom:To:Reason For Leaving:PhoneSupervisorResponsibilitiesStarting SalaryEnding SalaryMay we contact your previous supervisor?YesNoCompanyAddressJob TitleFrom:To:Reason For Leaving:PhoneSupervisorResponsibilitiesStarting SalaryEnding SalaryMay we contact your previous supervisor?YesNoBackNextMilitary ServiceHave you ever served in the military?*YesNoBranchFromToRank at DischargeType of Discharge:Other than honorable, please explain:Describe any job related training received in the United States Military:BackNextDrug Testing ConsentI,First, MI, Lastunderstand that as a part of the pre-employment process as required by North Georgia Turf, Inc., I must submit to a urinalysis drug screening. I do hereby voluntary consent to the sampling and submission for testing of my urine for the purpose of screening for the presence of illegal drugs. I understand that a negative result from this screening is a condition of employment. I also understand that refusal to supply the necessary samples in a reasonable and timely manner or producing a positively confirmed test result for the presence of illegal drugs may result in my being denied employment. I understand that a refusal to submit to a drug screen or a confirmed positive test result indicating the presence of illegal drugs may bar me from securing employment with North Georgia Turf, Inc. I authorize disclosure of the drug screen results by and between the testing laboratory and North Georgia Turf, Inc. I understand that the results of the urinalysis will be available to me as soon as possible after receipt by North Georgia Turf, Inc. I understand that North Georgia Turf, Inc. will select the testing laboratory and the cost of the urinalysis will be furnished by North Georgia Turf.Retype your name as above to sign:*Date*BackNextDriver's Application for EmploymentAre you applying to be a driver?*YesNoAccident Record- For the past three years or more (attach a sheet if more space is needed.) If none, write none.Driving RecordDateNature of Accident (Head-on, Rear-end, Etc.)FatalitiesInjuriesHAZMAT SpillLast AccidentNatureFatalitiesInjuriesSpill InfoNext PreviousNatureFatalitiesInjuriesSpill InfoTraffic Convictions- and forfeitures for the past three years (other than parking violations). If none, enter none in first field.LocationStateLicense NumberTypeExpiration DateLocationStateLicense NumberTypeExpirationLocationStateLicense NumberTypeExpirationLocationStateLicense NumberTypeExpirationExperience and Qualifications- DriverClass of EquipmentType of EquipmentDatesAprox MileageStraight TruckYesNoSelectVanTankFlatDumpReferFromToMilesTractor & Semi TrailerYesNoSelectVanTankFlatDumpReferFromToMilesTractor 2 TrailersYesNoSelectVanTankFlatDumpReferFromToMilesTractor 3 TrailersYesNoSelectVanTankFlatDumpReferFromToMilesMotor Coach, School BusYesNoSelectVanTankFlatDumpReferFromToMilesOtherSelectVanTankFlatDumpReferFromToMilesList any other experiences, courses, and/or training that would help you in your work for this companyBackNextSupporting DocumentsResumeOther Supporting DocumentBackNextApplication Verification I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application shall be considered active for a time period not to exceed 45 days. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means the employee may resign at any time and the employer may discharge employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I also understand that I am required to abide by all rules and regulations of the employer.Type full name to sign*Date* I authorize you to make such investigations of my personal, employment, financial, or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connections with my application. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the company. I understand that the information I provided regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:Type full name to sign*Date*BackSendThis field should be left blank