LINEAR CONTROLS, INC. Application for Employment

Today's Date

Date

Full Name*

First NameLast Name

Middle Name

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Area Code:*

Phone Number - 7 digit*

Are you 18 Years or Older?*

YesNo

Position Desired:*

Drivers License Number:

Licensed State:

Type of Drivers License:

OperatorCommercial OperatorClass

Class License:

Do you have any restrictions on your license?

YesNo

Please explain restrictions on License

Vehicle License Plate Number:

Vehicle Year:

Vehicle Make:

Vehicle Model:

Emergency Contact Name:*

Emergency Contact Phone:*

Are you related to, know of, or referred by an employee of Linear Controls?*

YesNo

If so, Who are you related to, know of or referred by that is employed by Linear?

Have you ever filled out an application with us before?*

YesNo

Provide approx. date if you've filled out an application with us before.

Have you ever been employed with us before?*

YesNo

If you've been employed w/ Linear provide approx. date:

Are you currently employed?*

YesNo

May we contact your present employer?*

YesNo

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?*

YesNo

On what date would you be available for work?

Are you available to work: Choose One*

Full-TimePart-TimeShift WorkTemporary

Choose time of day:

MorningEvenings

Are you currently on a "lay-off" status & subject to recall from another company?*

YesNo

Can you travel if the job requires it?*

YesNo

Will you work overtime if asked?*

YesNo

If you are not able to work overtime if asked please explain:

Have you ever been arrested and/or convicted of a felony or misdemeanor? (convictions will not necessarily disqualify an applicant from employment)*

YesNo

If you have been arrested and/or convicted of a felony or misdemeanor please explain:

Name of High School:*

City & State of High School:*

Yr Attended High School From:*

Yr Attended High School To:*

Did you Graduate?*

Name of University or Trade School:

City & State of University or Trade School:

Mth/Yr Attended University or Trade School From:

Mth/Yr Attended University or Trade School To:

Graduate / Degree ?

Personal/ Professional Ref. Name: (no family members)*

Phone Number to Reference #1:*

Best Time to call 1st Reference?

Occupation of 1st Reference?

Personal/ Professional References:

Phone Number to Reference #2:

Best Time to call 2nd Reference?

Occupation of 2nd Reference?

Personal/ Professional References:

Phone Number to Reference #3:

Best Time to Call Reference #3?

Occupation of Reference #3?

Most Recent Name of Previous Employer*

Month Started*

Year Started*

Month Ended

Year Ended

Phone Number

Please enter a valid phone number.

Street Address

City, State, & Zip*

Annual Salary

Hrly Rate*

Position*

Supervisor

Reason for Leaving:*

Lay OffDischargedResignedStill Employed

Explain Reason for Leaving:*

If still currently employed put reason you are looking for other employment.

2nd Most recent Employer

Month Started

Year Started

Month Ended

Year Ended

Phone Number

Please enter a valid phone number.

Street Address

City, State, & Zip

Annual Salary

Hrly Rate

Position

Supervisor

Reason for Leaving:

Lay OffDischargedResigned

Explain Reason for Leaving:

3rd Most Recent Employer

Month Started

Year Started

Month Ended

Year Ended

Phone Number

Please enter a valid phone number.

Street Address

City, State, & Zip

Annual Salary

Hrly Rate:

Position

Supervisor

Reason for Leaving:

Lay OffDischargedResigned

Explain Reason for leaving:

4th Most Recent Employer

Month Started

Year Started

Month Ended

Year Ended

Phone Number

Please enter a valid phone number.

Street Address

City, State, & Zip

Annual Salary

Hrly Rate

Position

Supervisor

Reason for Leaving:

Lay OffDischargedResigned

Explain Reason for leaving:

5th Most Recent Employer

Month Started

Year Start

Month Ended

Year End

Phone Number

Please enter a valid phone number.

Street Address

City, State, & Zip

Annual Salary

Hrly Rate

Position

Supervisor

Reason for leaving:

Lay OffDischargedResigned

Explain Reason for leaving:

Most recent 6th Employer

Month Start

Year Start

Month End

Year End

Phone Number

Please enter a valid phone number.

Street Address

City, State, & Zip

Annual Salary

Hrly Rate

Position

Supervisor

Reason for leaving:

Lay OffDischargedResigned

Explain Reason for leaving:

List of any special training:

Additional List of any special training:

Hobbies:

Full Name*

Today's Date*

Date

Signature*

1. I certify that this application was completed by me and that all of the information furnished on this application and during the application process is true, complete and correct to the best of my knowledge.

2. I understand that any misrepresentation or omission of facts called for on this application or during the application process, not limited to medical or employment information, may result in termination of the application process or my dismissal from current employment at any time regardless of when the false answer or omission is discovered.

3. I authorize the Company to conduct any necessary investigations or inquiries regarding my background to the extent permitted by federal, state and local law. I agree to complete the requisite authorization forms for the background investigation. I hereby release all parties from any liability in connection with the provision and use of such information.

4. I understand that if offered employment, I am to abide by all rules and regulations of the Company and its affiliated entities.

5. I recognize that this employment application is not an offer of employment. I agree that if I am hired by the Company, I will be an at-will employee, meaning that either the Company or I may end the employment relationship at any time with or without cause.

6. I understand and agree that, except for employment-at-will status, if hired my wages, hours, working conditions, job assignment(s), and compensation rate(s) will be subject to change by the Company.

7. I understand that the Company may share the information contained in this application with other Company employees for employment and administrative purposes and hereby consent to such transfer.

8. I consent to any and all of the following pre-employment processes, which are required by the Company and I further understand that the offer of employment is contingent upon my successfully completing all applicable preemployment testing: Background Check

a. Background Check

b. General Physical Examination (consistent with federal and state law)

c. Drug screen (DOT and Non-DOT applicants)

d. Previous Employer Drug and Alcohol History (DOT applicants, 49 CFR 382.413)

e. Motor Vehicle Report (MVR) (review of past driving record)

9. I agree and understand that this application for employment in no way obligates the Company to employ me.

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