Application for Employment - Lucky Enterprises

Lucky Enterprises Inc.

"COURIER - TAXI - FREIGHT"
SERVICING THE MIDWEST

309-788-8182

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About Us

Name:

First

Middle

Last

Present Address:

Street

City

State

ZIP

How long:

Telephone:

Email:

Social Security:

If Under 18, please list age:

Position applied for/salary desired:
(please be specific)

(1) (2)

Days/Hours available to work:

No Pref		Mon		Tue		Wed
Thur		Fri		Sat		Sun

Employment Desired:

Full Time Part Time

Work Availability

Type of school	Name of School	Location (complete mailing address)	No. of years complete	Major and Degree
High School:
College:
Bus/Trade School:
Professional School:

If Yes, please explain the number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:
Have you ever been convicted of a crime:		Yes No

Do you have a driver's license :	Yes No
What is your means of transportation to work:
Driver's Lic. No:		State of Issue:
Driver's Lic. Type:		Operator Chauffeur Commercial (CDL)
Expiration Date:
Have you had any accidents during the past three years?			Yes No
If so, how many?
Have you had any moving violations during the past three years?			Yes No
If so, how many?

Please list two references other than relatives or previous employers.
Name:		Name:
Position:		Position:
Company:		Company:
Address:		Address:
Telephone:		Telephone:

Have you ever been in the armed forces:		Yes No
Are you now a member of the National Guard or Reserves?		Yes No
Specialty:	Date Entered:	Discharge Date:

Name of Employer:
Address:
Phone:
Name of last supervisor:		Last Job Title:
Employment Dates:		To:
Starting Pay/Salary:		Final:
Reason for Leaving:
List the jobs you held, duties performed, skills used/learned, advancements or promotions while you worked at this company.

Name of Employer:
Address:
Phone:
Name of last supervisor:		Last Job Title:
Employment Dates:		To:
Starting Pay/Salary:		Final:
Reason for Leaving:
List the jobs you held, duties performed, skills used/learned, advancements or promotions while you worked at this company.

Name of Employer:
Address:
Phone:
Name of last supervisor:		Last Job Title:
Employment Dates:		To:
Starting Pay/Salary:		Final:
Reason for Leaving:
List the jobs you held, duties performed, skills used/learned, advancements or promotions while you worked at this company.

Name of Employer:
Address:
Phone:
Name of last supervisor:		Last Job Title:
Employment Dates:		To:
Starting Pay/Salary:		Final:
Reason for Leaving:
List the jobs you held, duties performed, skills used/learned, advancements or promotions while you worked at this company.

By signing and submitting this form, I certify that the facts in this application are true and complete and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no representation of the company has any authority to enter into any agreement for employment for any specified period of time, or make any agreement contrary to the foregoing unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or the use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.
Date:		Signature: