EMPLOYMENT FORM Step 1 of 4 25% Date* Date Format: MM slash DD slash YYYY Name* First Name Middle Name Last Name Address Street Address City State Zip Home PhoneCell PhoneEmployment Desired Position applying for:Are you applying for ?Full TimePart TimeWhat shifts are you available? 1st Shift 2nd Shift 3rd Shift If hired, on what date can you start work? Date Format: MM slash DD slash YYYY Salary desired Personal InformationHave you ever applied to or worked for Total Transportation & Distribution, Inc. before?YesNoIf yes, when?Do you have any friends or relatives working for Total Transportation & Distribution, Inc. or Westset Logistics, Inc?YesNoIf yes, state name(s) and relationship:Name Name RelationshipAre you at least 18 years of age?YesNoIf hired, can you present proof of your legal right to live and work in this country?YesNoIf hired, would you have reliable means of transportation to and from work?YesNoAre you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?YesNoIf no, describe the functions that cannot be performed: Education, Training and ExperienceSchoolName and AddressNo. of years completedDid you graduate?Degree or Diploma List any training, license/or certificates you have that may help to qualify you for the position you are applying, include trade, vocational, military, etc. Indicate type of training, where acquired, dates and whether you completed it successfully. Employment History List below all present and past employment starting with your most recent employer (last five years is sufficient). Account for all periods of unemployment. Attach additional sheets if necessary. You must complete this section even if attaching a resume. Name of EmployerTelephone No.Your Supervisor's NameMay we contact this employer for a reference?AddressYour Position and DutiesReason for Leaving (be specific)Dates of Employment: FromTo References List below three persons not related to you who have knowledge of your work performance within the last three years.First NameLast NamePhoneAddressOccupationNo. of Years Acquainted Upload ResumeAcknowledge Each Paragraph and Submit Below.Consent* I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.Consent* I hereby authorize Total Transportation & Distribution, Inc. to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize the references I have listed to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure.Consent* I understand that employment at Total Transportation & Distribution, Inc. is at will, which means that I can voluntarily terminate employment at any time or that the company can terminate my employment at any time with or without cause or with or without prior notice.Consent* I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment. If hired, is intended to create an employment contract between me and the company. I also understand that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company’s designated representative.Consent* In keeping with our commitment to the communities in which we do business, Total Transportation and Distribution Inc., is an equal employment opportunity employer. This means that employment decisions are based on merit and business needs, and not on race, color, citizenship status, national origin, ancestry, sex, sexual orientation, age, religion, creed, physical or intellectual disability, physical handicap, medical condition, including genetic characteristics, marital status, veteran status or any other consideration made unlawful by federal, state or local laws. Company policy also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics. The Company is committed to compliance with all applicable laws providing equal employment opportunities. This commitment applies to all persons involved in the operations of the Company and prohibits unlawful discrimination by any employee of the Company.