RNI TRUCKING
140 West, 425 South ∙ PO Box 98 ∙ Roosevelt, Utah 84066
Phone: 435-722-2024 Fax: 435-722-1410 ∙ Email: adrion@rnindustries.com
NON-DRIVING POSITION APPLICATION
Qualified applicants receive equal consideration. No question is asked for the purpose of excluding any applicant due to
race, color, national origin, religion, age, sex, disability, or any other factor prohibiting by law or regulation.
(PLEASE PRINT)
POSITION(S) APPLIED FOR DATE OF APPLICATION
LAST NAME FIRST NAME MIDDLE INITIAL
ADDRESS CITY STATE ZIP
HOME PHONE: CELL PHONE: OTHER:
On what date would you be available for work?
What schedule are you available to work? FULL PART TEMPORARY
Are you currently employed? YES NO
May we contact your present employer? YES NO
Do you need to give advance notice to your present employer? YES NO
Are you eligible to work in the United States and can you provide proof if hired? YES NO
Proof of citizenship or immigration status will be required upon employment.
Are you able to perform the duties of the job for which you are applying with or
YES NO
without an accommodation?
Do you have a valid driver’s license? YES NO
Are you willing to take a drug/alcohol screening exam before and/or during
YES NO
employment as a condition of employment?
Will you work daily overtime on occasion if necessary? YES NO
Will you work extra days in the week if necessary? YES NO
Have you ever been convicted of any law violation, except a minor traffic violation?
YES NO
(A criminal record does not automatically bar employment)
Do you have any on-going obligations or other personal commitments that would
YES NO
affect your work schedule?
Have you ever worked for or applied for work with RNI Trucking, Chapman
YES NO
Construction, Dalbo, BHS, or Dawn Trucking before?
Have you ever been discharged for cause? YES NO
In the past three years have you been unemployed for any period of time? If yes,
YES NO
please list dates and explain below.
Explanation for answers given above:
_________________________________________________________________________________________
__________________________________________________________________________________________
EMPLOYMENT HISTORY(LIST MOST RECENT FIRST)
1. EMPLOYER JOB TITLE SUPERVISOR
FULL ADDRESS DATES EMPLOYED WORK RESPONSIBILITIES
START END
TELEPHONE NUMBER(S) HOURLY/RATE/SALARY REASON FOR LEAVING
STARTING FINAL
2. EMPLOYER JOB TITLE SUPERVISOR
FULL ADDRESS DATES EMPLOYED WORK RESPONSIBILITIES
START END
TELEPHONE NUMBER(S) HOURLY/RATE/SALARY REASON FOR LEAVING
STARTING FINAL
3. EMPLOYER JOB TITLE SUPERVISOR
FULL ADDRESS DATES EMPLOYED WORK RESPONSIBILITIES
START END
TELEPHONE NUMBER(S) HOURLY/RATE/SALARY REASON FOR LEAVING
STARTING FINAL
4. EMPLOYER JOB TITLE SUPERVISOR
FULL ADDRESS DATES EMPLOYED WORK RESPONSIBILITIES
START END
TELEPHONE NUMBER(S) HOURLY/RATE/SALARY REASON FOR LEAVING
STARTING FINAL
EDUCATION/TRAINING HISTORY
LOCATION YEAR
TYPE OF TRAINING DEGREE EARNED
CITY & STATE GRADUATED
OPERATOR APPLICANTS (PLEASE LIST HEAVY EQUIPMENT EXPERIENCE AND
EXPLAIN THE EXTENT OF YOUR EXPERIENCE.)
EQUIPMENT # OF YEARS EXPERIENCE/COMMENTS
REFERENCES
Give name, address, and telephone number of three references who are not related to you and are not
previous employers.
1. _____________________________________________________________________________
2. _____________________________________________________________________________
3. _____________________________________________________________________________
List job benefits, other than wages, you expect or want in order of importance:
1. _____________________ 2. _____________________ 3. ______________________
APPLICANT AGREEMENT
All information provided by me is true and correct to the best of my knowledge. I understand
omissions or misrepresentations may result in rejection of my application or, if employed, may result
in subsequent dismissal.
I hereby authorize any former employer, person, school, firm, or corporation listed hereon, including
RNI, to answer any and all questions related to employment and I agree to release from liability and
hold all persons harmless for giving any and all truthful information within their knowledge or records.
I understand this is a preliminary application and not a contract to employ me. Furthermore, in the
event I am employed, my employment shall be completely voluntary and may be terminated at will at
any time by either myself or the employer for any reason not expressly prohibited by law. I
understand that no one other than an acting company president has authority to enter into any
employment agreement to the contrary.
I agree to take a job-related physical examination or a drug/alcohol test, when requested, as a condition
of employment. I agree to comply with all company rules and policies as a condition of employment.
_______________________________ __________
SIGNATURE OF APPLICANT DATE
RNI TRUCKING AN EQUAL OPPORTUNITY EMPLOYER