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APPLICATION FOR EMPLOYMENT
In compliance with Federal and State equal emploment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, non-job related disability, or any other protected group status. I authorize A.C. Schultes and its subsidiaries/affiliates, to use or disclose my information provided on this application during the normal course of my employment as needed by customers, vendors, federal, state or local governing agencies, doctors, benefit administrators or any other agencies that we conduct business with. I understand that I may revoke this authorization at any time by notifying A.C. Schultes in writing.
Minimum Job Requirements of A.C. Schultes Inc. Companies

* Must be 18 years of age.
* Must have driver's license (CDL preferred).
* Must be able to drive a truck with manual transmission.
* Must have steel toed shoes.
* Construction and mechanical training/experience is preferred.
* Must have your own form of transportation to and from the shop in Rocky Point, NC.
* Must be willing to live away.
* Must be able to lift 100 pounds.
Signature of above*
- Yes
Date of Application
Position's Applied For
Email*
Name of Applicant
First Middle Last
Current Address
Street Address City State ZIP Code
Social Security Number
Phone Number (Home)
Phone Number (Cellular)
Date & Place of Birth
(Date, City, State)
Who reffered you?
Rate of pay expected
Are you currently employed?
- Yes
- No
If No, how long have you been unemployed?
Do you have the legal right to work in the United States?
- Yes
- No
Were you in the military?
- Yes
- No
Can you electric weld?
- Yes
- No
Have you ever been convicted of a felony?
- Yes
- No
If Yes, please explain below. Conviction of a crime is not an automatic disqualification from employment-all circumstances will be considered.
EMPLOYMENT HISTORY
All driver applicants driving in interstate commerce must provide the following information on all employers during the preceding three years. List complete mailing address, street number, city, state and zip code.

Applicants driving a commercial motor vehicle* in intrastate commerce shall also provide an additional seven years of information on those employers for whom the applicant operated such vehicle.

(NOTE: List employers in reverse order starting with the most recent.)

* Includes vehicles having GVWR of 26,001 lbs. or more, vehicles designed to transport 15 or more passengers, or any size vehicle used to transport hazardous materials in a quantity requiring placarding.
EMPLOYER
NAME
DATE (FROM)
Month
Day
Year
DATE (TO)
MM slash DD slash YYYY
POSITION
SALARY/WAGE
REASON FOR LEAVING
ADDRESS
Street Address City State ZIP Code
CONTACT PERSON
PHONE NUMBER
DID YOU DRIVE A VEHICLE REQUIRING A CDL?
- YES
- NO
EMPLOYER
NAME
DATE (FROM)
MM slash DD slash YYYY
DATE (TO)
MM slash DD slash YYYY
POSITION
SALARY/WAGE
REASON FOR LEAVING
ADDRESS
Street Address City State ZIP Code
CONTACT PERSON
PHONE NUMBER
DID YOU DRIVE A VEHICLE REQUIRING A CDL?
- YES
- NO
LIST MOTOR VEHICLE ACCIDENTS FOR THE PREVIOUS THREE YEARS (IF NONE, WRITE NONE)
LIST TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PREVIOUS THREE YEARS (OTHER THAN PARKING VIOLATIONS)
LIST OCCUPATIONAL INJURIES (WORK RELATED) FOR THE PREVIOUS FIVE YEARS (IF NONE, WRITE NONE)
EDUCATION
CIRCLE HIGHEST GRADE COMPLETED
- 1
- 2
- 3
- 4
- 5
- 6
- 7
HIGH SCHOOL
- 1
- 2
- 3
- 4
COLLEGE
- 1
- 2
- 3
- 4
DRIVING - EXPERIENCE AND QUALIFICATIONS
DRIVING LICENSES INFORMATION
STATE
LICENSE NO.
TYPE
EXPIRATION DATE
MM slash DD slash YYYY
Do you have a CDL?
- Yes
- No
If you have a CDL, please list vehicles and describe your experience.
If no, would you be willing to attain?
- Yes
- No
OTHER - EXPERIENCE AND QUALIFICATIONS
LIST ANY EQUIPMENT OPERATION EXPERIENCE YOU HAVE THAT IS NOT PREVIOUSLY NOTED ON THIS APPLICATION
LIST ANY OTHER CERTIFICATIONS, SPECIAL EQUIPMENT, TRAINING, TECHNICAL MATERIALS AND/OR COURSES NOT PREVIOUS NOTED ON THIS APPLICATION
TO BE READ AND SIGNED BY APPLICANT
This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiriesof my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, doctors or other persons from all liability in responding to inquiries in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interviews may result in discharge. I understand also, that I am required to abide by all rules and regulations of the Company, as permitted by law.
DATE
Applicant's Signature*
- Yes
PRE-EMPLOYMENT URINALYSIS NOTIFICATION
The Federal Motor Carrier Safety Regulations, Section 391.103 - pre-employment testing requirements, apply to applicants of this company.

391.103 Pre-employment test requirements.

(a) A motor carrier shall require an applicant who the motor carrier intends to hire or use to be tested for the use of controlled substances as a pre-qualification condition.

(b) An applicant shall submit to controlled substance testingas a pre-qualification condition.

(c) Prior to collection of a urine sample under 391.107 of this subpart, an applicant shall be notified that the sample will be tested for the presence of controlled substances.

As a condition of my employment, I agree to the urine sample collection and controlled substance testing.

The Medical Review Officer will maintain the results of the Urinalysis Test. Negative and positive results will be reported to the company.

I have read and understand the above conditions for the Pre-Employemtn Urinalysis Notification.
Applicant's Name*
Applicant's Signature*
- Yes
DATE
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