Employment - The Riley Express Transportation

Applicant Information

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Are you a U.S. citizen?

Yes

No

Have you ever been convicted of a felony?

Yes

No

*If you answered yes to the above question, please provide a statement of explanation*

If selected for employment, are you willing to submit to a pre-employment drug screening test?

Yes

No

If selected for employment, are you willing to submit to a national background check?

Yes

No

Please indicate your Desired Pay

Employment Desired:

Do you have valid chauffeur's license?

Yes

No

Shift Availability

Please Include All Days and Hours

Education

References

Reference 1

Reference 2

Reference 3

Please List 3 (Include Name and Phone Number)

Employment History

Job Title

Dates Employed

End Date

Employer Phone Number

Pay Rate

Employer Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

ACKNOWLEDGEMENT AND AUTHORIZATION

I certify that all answers given herein are true and complete to the best of my knowledge.(Required)

I authorize investigation on all statements contained in this application for employment as may be necessary in arriving at an employment decision.(Required)

In the event of employment. I understand that false or misleading information given in my application or interview(s) may result in discharge.(Required)

Signature

Date