Work at WRTD

Kindly fill the below form to submit your application to WRTD:

Name *

First

Last

Date of Birth *

Present Address *

Telephone Number and Area Code *

Email Address *

If hired, can you present evidence of your legal right to work in the US?

• Yes
• No

List any other names that you have used in the past 10 years

List all addresses for the past 10 years

Have you ever been fired or asked to resign by an employer? *

• Yes
• No

If yes, explain:

What position are you applying for? *

Minimum salary / wage requirement:

Social Security Number *

How were you referred to our company? *

• Banner
• Flyer
• Print Ad
• On-line Ad
• Radio/TV Ad
• State Employment Agency
• Job Fair
• Community Organization
• Employee Referral-Name
• Other

If employee referral/other, please specify:

Have you ever worked for our company? *

• Yes
• No

In what position?

When?

If hired, what date are you available to start work? *

Are you applying for: *

• Full-time
• Part-time

Are you able to work: *

• Days
• Evenings
• Weekends

Name and location of Elementary and Junior High/Middle School *

Highest grade completed in Elementary and Junior High/Middle School *

Name and location of High School and/or G.E.D. *

Highest grade completed in High School and/or G.E.D. *

Name and location of College *

Degree/Certificate earned *

Did you graduate? *

• Yes
• No

Degree *

Major *

Name and location of Trade, Business, Correspondence or Graduate School

Degree/Certificate earned

Did you graduate?

• Yes
• No

Degree

Major

List any other training or educational programs of note

List any academic honors or other special recognition you have received

List any extracurricular activities and school offices of note:

Previous Employer 1 name

Dates employed (mo/yr)

Beginning salary/pay rate

Ending salary/pay rate

Employer Address

Employer Phone

Supervisor's name & title

Position(s) held

Briefly explain your job duties & responsibilities including supervisory experience

May we contact the employer?

• Yes
• No

Was this position covered under the Federal Motor Carrier Safety Regulations (FMCSR)?

• Yes
• No

Previous Employer 2 name

Dates employed (mo/yr)

Beginning salary/pay rate

Ending salary/pay rate

Employer Address

Employer Phone

Supervisor's name & title

Position(s) held

Briefly explain your job duties & responsibilities including supervisory experience

May we contact the employer?

• Yes
• No

Was this position covered under the Federal Motor Carrier Safety Regulations (FMCSR)?

• Yes
• No

Previous Employer 3 name

Dates employed (mo/yr)

Beginning salary/pay rate

Ending salary/pay rate

Employer Address

Employer Phone

Supervisor's name & title

Position(s) held

Briefly explain your job duties & responsibilities including supervisory experience

May we contact the employer?

• Yes
• No

Was this position covered under the Federal Motor Carrier Safety Regulations (FMCSR)?

• Yes
• No

Identify and explain any employment gaps, or periods of unemployment of 30 days or longer *

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. *

• Choice 1

Submit