AM-RAIL CONSTRUCTION, INC. JOB APPLICATION INSTRUCTIONS: Please provide the information requested in the following pages as it applies to you at this time. It is important that you answer every question. If the question does not apply to you, please put N/A. At the time you submit this application, we will require a copy of your photo ID and social security card . This can be scanned and e-mailed to us at email@example.com or mailed to us at PO Box 581164, Tulsa, OK 74158. Thank you for your cooperation. AM-RAIL CONSTRUCTION, INC. JOB APPLICATION NAME:_________________________________________________ DAYTIME PHONE NUMBER:_________________________________ MAILING ADDRESS:_____________________________________ OTHER PHONE NUMER:_____________________________________ CITY AND STATE________________________________________ E-MAIL ADDRESS:__________________________________________ CURRENT PHYSICAL ADDRESS: _________________________________________________________________________________________ _________________________________________________________________________________________________________________ HOW LONG HAVE YOU BEEN AT THIS ADDRESS? ________________YEARS ____________MONTHS LANDLORD’S NAME AND PHONE NUMBER ______________________________________________________________________________ PREVIOUS ADDRESS: __________________________________________________________________________________________________ _________________________________________________________________________________________________________________ HOW LONG AT PREVIOUS ADDRESS? _____________YEARS _____________MONTHS LANDLORD’S NAME AND PHONE NUMBER _____________________________________________________________________________ WHAT POSITION ARE YOU APPLYING FOR?_______________________________ DESIRED WAGES___________________________ HAVE YOU BEEN GIVEN A COPY OF THE JOB DESCRIPTION FOR THIS POSITION TO READ? YES_________ NO_________ IF YOU ANSWERED YES, IS THERE ANY REASON THAT YOU COULD NOT PERFORM THE RESPONSIBILITIES OF THIS POSITION AS DESCRIBED IN THE JOB DESCRIPTION? YES______________ NO______________ IF YES, EXPLAIN____________________________________________________________________________________________ IS THERE ANY REASON THAT WOULD PREVENT YOU FROM BEING AT WORK DURING REGULAR HOURS OF WORK? YES_______________ NO_________________ IF YES, EXPLAIN____________________________________________________________________________________________ WHAT WAS THE HIGHEST GRADE LEVEL YOU FINISHED IN SCHOOL?______________________________________________________ WHAT COLLEGE LEVEL COURSES HAVE YOU COMPLETED?______________________________________________________________ _______________________________________________________________________________________________________________________ WHAT COLLEGE DID YOU ATTEND? HAVE YOU WORKED FOR AM-RAIL IN THE PAST? YES _____________ NO ______________ IF YES, PLEASE STATE DATES OF EMPLOYMENT ___________________________________________________________________ 1. NAME OF MOST CURRENT EMPLOYER________________________________________________________________________________ IMMEDIATE SUPERVISOR’S NAME_______________________________________________________________________________________ ADDRESS AND PHONE NUMBER ________________________________________________________________________________________ _______________________________________________________________________________________________________________________ START DATE_________________ END DATE_________________REASON FOR LEAVING________________________________________ 2. NAME OF PREVIOUS EMPLOYER _____________________________________________________________________________________ ADDRESS AND PHONE NUMBER ________________________________________________________________________________________ _______________________________________________________________________________________________________________________ START DATE_________________ END DATE_________________REASON FOR LEAVING________________________________________ _______________________________________________________________________________________________________________________ HAVE YOU APPLIED FOR EMPLOYEMENT AT AM-RAIL IN THE PAST? _____________________________________________________ HAVE YOU BEEN INJURED ON THE JOB IN THE PAST SEVEN YEARS? ______________________________________________________ IF YES, PLEASE EXPLAIN____________________________________________________________________________________________ ________________________________________________________________________________________________________________________ DRIVER’S LICENSE NUMBER__________________________________EXPIRATION DATE________________________________________ DESCRIBE ANYTHING ABOUT YOURSELF THAT YOU BELIEVE QUALIFIES YOU FOR THIS POSITION:_________________________ ______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ PROVIDE THE NAMES, CONTACT INFORMATION, AND RELATIONSHIP OF ANY PERSONS WE MAY CONTACT AS A REFERENCE FOR YOU AND ANY INFORMATION YOU PROVIDE IN THIS APPLICATION. REFERENCES CAN INCLUDE CURRENT OR FORMER EMPLOYERS, CURRENT OR FORMER TEACHERS, COLLEAGUES, AND OTHERS WHO KNOW YOU PROFESSIONALLY. NAME CONTACT INFORMATION RELATIONSHIP _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________ SIGNATURE:_________________________________________________________ DATE:______________________________________ THIS INFORMATION WILL BE VERIFIED. FA LSIFIED OR DECEPTIVE INFORMATION WILL BE CONSIDERED A REASON FOR NOT APPROVING THE APPLICATION. Am-rail construction, Inc. Job application Am-Rail Construction has a drug and alcohol policy. All new employees must undergo a drug test before reporting to an Am- Rail jobsite. We will inform you where to go for the drug test. The cost of the first drug test is the responsibility of the new employee, and will be deducted from your first pay check. After the first drug test, any random testing requested by Am-Rail will be paid for by Am-Rail. Refusal to take the test, or a positive reading, will result in the employee’s application being denied and/or immediate termination. Your signature below acknowledges that you have read, understood and approve the above policy.________________________ EMPLOYEE NAME:__________________________________________________ DATE:____________________________ EMPLOYEE SIGNATURE:_______________________________________________________ AM-RAIL CONSTRUCTION, INC. I, ______________________________________________(print name) do affirm that the forms of identification I am submitting with my application is genuine, legal, authentic and original. The picture identification I am submitting is not fraudulent. I understand that using fraudulent forms of identification could lead to my being prosecuted. Signature___________________________________________________ Date______________________________________ RELEASE A ND A UTHORIZA TION TO OBTA IN CONS UMER A ND/ OR INVESTIGA TE CONSUM ER REPORT I, the undersigned, hereby consent and release AM- Rail Construct ion, Inc., its affiliated companies, its subcontr actors, and/or its agents (collectively, herein after referred to as the “Company”) to procure consumer reports on me including, but not limited to information concerning my character and general reputation. These reports may be obtaine d through, but not limited to the following sources: motor vehicle reports, social security number verifications, present and former addresses, criminal and civil history/records, and any other public records. I hereby release any and all persons, business entities, third party agencies, and gover nmental agencies providing information, w hether public or private, from any and all liability, claims and/or demands, by me, my heirs or others making such claim or demand on my behalf for providin g consumer report(s) and/or investigative consumer report(s) authorized therein. I authorize without reservation the Railroads and other Businesses, for which the Company provides services, to access my inf ormation in order to determine if I am eligible to perform wor k on their property. Further, if I am selected as an employee, or an employee of an independent contractor, for the Company, I understand and auth orize that periodic investigations may be requested for the duration of my association with the Company. I under stand that this release and authorization shall remain in effect for the duration of my association with the Company. Additionally, I hereby authorize the Company to investigate any incidents of wor kplace misco nduct made against or involving me both during and after the term of my association with the Company. I understand and agree that any information provided by me that is found to be false, incomplete or misrepresented in any res pect in the Company’s sole judgment, will be cause to cancel fur ther consideration of my application for employment and/or contracting services whenever such discrepancies are discovered. Further, I understand that by requesting this information that no promise of employment is being made. I am willing that a ph otocopy of this a uthorization will be accepted with the same authority as the original. I HEREBY CERTIFY THAT THIS FORM WAS COMPLETED BY ME, A ND THA T THE INFORMA TION PROVIDED IS TRUE A ND CORRECT AS OF THE DAY HEREOF. Signature: ___________________________________________________ Date: _________________________ Please Print: Name: _______________________________________________________ *Date of Bir th: __________________ First Middle Last Social Security Number: _________ - ________ - _________ Gender (check one): [ ] Male [ ] Female Drivers License #: ___________________________________ Issuing State: _________ Daytime Phone Number: ________________________ Alternate Phone Num ber: ________________________ Other Names Used (alias, maiden, nickname): _________________________________________________________ Current Address: __________________________________________________________________________ _________ Street Number and Name City State -ZIP Dates Are you applying for a position in California, Minnesota, or Oklahoma?  Yes  No (if yes) Would you like a copy of any consumer reports requested sent to you?  Yes  No * Note: Date of Birth information is required for identification purposes only, and is in no manner used as qualifying for jo ining the Company. The Company does not discriminate on the basis of sex, religion, veteran status, age, or disability.
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