APPLICATION FOR EMPLOYMENT Logo

  • APPLICATION FOR EMPLOYMENT

  •  / /

  • Please return to: 42922 Old Hwy 10 Richmond, MO 64085 

    APPLICANT NOTE: This Eplication is intended for use in evaluating your qualifications for employment. It is not an employment contract. Please answer all questions completely and to the best of your ability. False or misleading statements are grounds for refusal or termination of employment and benefits. It is the policy of this company as an Equal Opportunity Employer to ensure that there shall be no discrimination against any employee or applicant for employment on the basis of age, race, color, creed, marital status, religion, sex, national origin, disability or veteran status, or any other status protected by law.

  • PERSONAL DATA

    The below information will be used to determine if you are insurable under our vehicle insurance company.
  •  - -

  • Are you 18 years of age or older?            

  • Are you legally eligible for employment in the United States? (Proof of eligibility will be required upon employment.)         

  • Social Security Number:      
    If preferred, you can contact us at 816-776-3512 after application submission and give us your social security number.

  • Have you ever applied here previously?        
    If yes, approximate date applied:       

  • Years at current address:      
    If less than 7 years list all other cities and states in which you lived during the past 7 years.
          

  • Have you ever been employed by Derry Wright previously?            
    If yes please answer the below:
    Start and End date of Employment:      
    Position held?      
    Reason for Leaving?

  • Do you have any relatives presently employed here?            
    If yes, please answer the below:
    Name of employee:         Relation to employee:      
    Employee's Job Title:      

  • Position

  • Position Desired:      
    Salary Expected:      
    What Date are you available to start working:   Pick a Date   
    Are you willing to travel?         
    If yes, are there any restrictions?   
    Work Availability:            
    Are you willing to relocate?         
    May we contact your current employer for verification?            

  • EMPLOYMENT HISTORY

  • PRESENT OR LAST EMPLOYER

  • Company Name:      
    Address:            
    Phone Number:             
    Type of Business:      
    Start Date:   Pick a Date   End Date   Pick a Date  
    Leave end date blank if still employed at this location
    Ending Salary:      
    Position Title:      
    Reason for Leaving:      
    Are you eligible for rehire?         
    May we contact this employer for a reference?      
    Name of Supervisor:      
    Title of Supervisor:      
    Supervisor's Phone Number:               

  • 2ND PREVIOUS EMPLOYER

  • Company Name:      
    Address:            
    Phone Number:             
    Type of Business:      
    Start Date:   Pick a Date   End Date   Pick a Date  
    Leave end date blank if still employed at this location
    Ending Salary:      
    Position Title:      
    Reason for Leaving:      
    Are you eligible for rehire?         
    May we contact this employer for a reference?      
    Name of Supervisor:      
    Title of Supervisor:      
    Supervisor's Phone Number:     

  • 3RD PREVIOUS EMPLOYER

  • Company Name:      
    Address:            
    Phone Number:        
    Type of Business:      
    Start Date:   Pick a Date   End Date   Pick a Date  
    Ending Salary:      
    Position Title:      
    Reason for Leaving:      
    Are you eligible for rehire?         
    May we contact this employer for a reference?      
    Name of Supervisor:      
    Title of Supervisor:      
    Supervisor's Phone Number:             

  • 4TH PREVIOUS EMPLOYER

  • Company Name:      
    Address:            
    Phone Number:       
    Type of Business:      
    Start Date:   Pick a Date   End Date   Pick a Date  
    Ending Salary:      
    Position Title:      
    Reason for Leaving:      
    Are you eligible for rehire?         
    May we contact this employer for a reference?      
    Name of Supervisor:      
    Title of Supervisor:      
    Supervisor's Phone Number:       

  • 5TH PREVIOUS EMPLOYER

  • Company Name:      
    Address:            
    Phone Number:           
    Type of Business:      
    Start Date:   Pick a Date   End Date   Pick a Date  
    Ending Salary:      
    Position Title:      
    Reason for Leaving:      
    Are you eligible for rehire?         
    May we contact this employer for a reference?      
    Name of Supervisor:      
    Title of Supervisor:      
    Supervisor's Phone Number:               

  •  

    MILITARY SERVICE (Complete if you have served in the US Military. A copy of your DD214 may be needed for verification

     

  • Branch      
    Final Base, City & State where assigned      
    Date Entered      
    Date Discharged      
    Rank and Position at Discharge      
    Name and Title of Supervisor      
    Phone Number      
    Did you receive a Dishonorable Discharge?         
    List service schools or special relevant experiences:      

  • EDUCATION

  • HIGH SCHOOL
    Name of High School:      
    City and State of School:      
    Degree Received?            
    Year Received:      
    Years of Attendance:      

    COLLEGE
    Name of High School:      
    City and State of School:      
    Degree Received?      
    Year Degree was Received:      
    Years of Attendance:      
    Major & Minor Field of Study:      

    OTHER - INCLUDING GED OR SPECIALTY SCHOOLS
    Name of School:      
    City and State of School:      
    Degree Received:      
    Year Degree was Received:      
    Years of Attendance:      
    Major & Minor Field of Study:      

  • ADDITIONAL QUALIFICATIONS


  • Languages in which you are fluent other than English:      

  • PERSONAL REFERENCES

    (List individuals familiar with your work but do not include relatives.)

  • Name:      
    City & State      
    Phone Number with Area Code:      
    Occupation:      

    Name:         
    City & State            
    Phone Number with Area Code:         
    Occupation:         

    Name:         
    City & State         
    Phone Number with Area Code:         
    Occupation:         

  •  

    I certify that I have read and understand the “Applicant Note” on Page One of this application and that the answers given by me to the foregoing questions and the statements made by me are complete and true to the best of my knowledge and belief. I understand that any false information, omission or misrepresentations of the facts called for in this application may result in rejection of my application or discharge at any time during my employment.

    I authorize the company and/or its agents including consumer-reporting companies to verify any of this information. I authorize all persons, schools, companies, law enforcement agencies, insurance companies, and consumer reporting bureaus to release any and all information regarding my background and driving records. I release all parties from any liability for damage that may result from furnishing this information to you.

    By my signature on this application, I acknowledge that the company did not inquire about and I did not provide any information regarding conviction/arrest records that have been sealed or expunged.

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