Non Driver Application

Full Name*

First NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState

Zip Code

Have you resided at this address for at least 3 years?*

YesNo

If no, please list all residences for the past 3 years.*

If no, please type N/A.

Date of Birth*

MonthDayYear

Phone Number*

Area CodePhone Number

E-mail*

Have you ever been known by any other name? ie; maiden name, name change*

YesNo

If yes, please list name(s). *

If no, please type N/A.

Have you ever been convicted of a crime? A conviction does not automatically bar you from employment*

YesNo

Are there any pending charges against you?*

YesNo

If yes, please list City, County and State, month, year and nature of offense. *

If no, please type N/A.

Have you previously applied for a position at Cordes Inc?*

YesNoPrevious employee at Cordes Inc

If hired, can you furnish proof you are eligible to work in the U.S.?*

YesNo

Are you at least 21 years of age or older?*

YesNo

Position Applying For?

gravel trains, pneumatic tankers, flowboy

Have you been previously employed at Cordes Inc?*

YesNo

Start Date

MonthDayYear

End Date

MonthDayYear

Are you currently employed?*

YesNo

When are you available to start work?*

MonthDayYear

Please list current, or most recent employment first.

Start date*

MonthDayYear

Ending date*

MonthDayYear

Employer Name*

City, State*

Employer phone*

Area CodePhone Number

Position Held*

Reason for leaving*

Is this your current employer?*

YesNo

May we contact this employer at this time?*

YesNo

NEXT EMPLOYER

Start date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Employer phone

Area CodePhone Number

Position Held

Reason for leaving

NEXT EMPLOYER

Starting date

MonthDayYear

Ending date

MonthDayYear

Employer Name

City, State

Employer phone

Area CodePhone Number

Position Held

Reason for leaving

EDUCATION

Name & City/State of High School

Name & City/State of College

Did you graduate?

YesNo

It is agreed and understood that any misrepresentation given on this application shall be considered an act of dishonesty and reason for non-consideration or subsequent dismissal if hired. It is also agreed and understood that Cordes Inc. and its agents may investigate the applicant’s background to ascertain any and all information of concern to applicant’s record, whether same is of record or not, and applicant releases employers and persons named herein from all liability for any damages on account of his/her furnishing such information.

I understand that nothing contained in this application or in the granting of any interview is intended to create an employment contract between Cordes Inc. and myself, for either employment, authorization to drive, or for the providing of any benefits. I agree to furnish such additional information that may be necessary and complete such examinations as may be required to complete my application file. No promises regarding employment have been made to me, and no such promises exist unless specifically made by Cordes Inc. in writing. It is agreed and understood that if qualified, hired, or contract started, I may be on a probationary period during which time I may be disqualified without recourse. I understand employment with Cordes Inc. is on an “at-will” basis that allows me to quit, be fired, or lease agreement revoked at any time with or without notice and with or without cause. 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.

Choose ONE:*

I ACCEPTI DO NOT accept

Name*

First NameLast Name

By signing, I agree I have read the above statements *

Date*

Date

Non-Driver Application

General Information

EMPLOYMENT HISTORY

Additional Information

Disclosure and Terms & Conditions