Social Security No (last 4 digits only):
List your addresses of residency for the past 3 years.
Are you legally eligible for employment in the United States?:
Driver Experience and Qualifications
A.) Have you ever been denied a license, permit or privilege to operate a motor vehicle?
B.) Has any license, permit or privilege ever been suspended, revoked or canceled?
C.) Have you ever been convicted of driving under the influence of alcohol or drugs or any related offense?
D.) Have you ever had any non-DUI traffic convictions in the past 3 years?
E.) Have you ever been involved in any Motor Vehicle accidents in the past 3 years?
If the answer to either A, B, C, D or E is YES, please set forth in detail the acts, circumstances, and dates of such denial, revocation, suspension or conviction:
List ALL work experience in the past 10 years, beginning with the most recent.
If you have a resume file, upload it here. Only ".doc", ".docx", ".pdf" and ".rtf" files are accepted.
|COMPLETING THE FOLLOWING FIELDS IS VOLUNTARY AND IS NOT A REQUIREMENT FOR EMPLOYMENT:
|How you were referred to VCNA Prairie, Inc. :
I understand in filling out this application that VCNA Prairie, Inc. is in no way obligated to offer me employment. I certify that the facts set forth in my application for employment are true, correct and complete. I agree that any misrepresentation or false statement of this application shall be considered grounds for rejecting this application, rescinding a tentative job offer or immediate discharge if discovered after hire. I authorize VCNA Prairie, Inc. to investigate any of the information contained on this application, including the examination of past employment records, references and other facts stated on the application. I waive any rights which I may have to receive written notice from any former employer listed on this application regarding the release to VCNA Prairie, Inc. of any information concerning any disciplinary action taken against me by said former employers. I understand that I will be required to successfully complete a post-offer medical examination as a condition of employment, including drug and alcohol testing, and I agree to take such examination.
I agree, if hired, to submit, at any reasonable time during my employment, and without notice, to a drug and/or alcohol-screening test. I understand that refusal to take a requested drug and/or alcohol screening test may result in discharge. I further understand that, if employed, a positive test result may also result in immediate discharge.
I agree, if hired, to wear or use protective clothing or devices as required and to fully comply with all relevant safety rules. If hired, I agree to conform with all rules and regulations.
I also recognize and accept the right of VCNA Prairie, Inc. to unilaterally modify, amend, or eliminate any policies, handbooks, rules or procedures in its sole discretion at any time.
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.
[ You must agree to terms in order to submit application