welldoctor.biz - Job Application

WE DO NOT hire anyone who cannot provide 2 work related references.

TO BEGIN YOUR APPLICATION:
Can you provide 2 work references upon hiring?*

YesNo
Employment Application

All information obtained within this application will be held in strict confidence, subject to applicable law. We will not discriminate because of sex, age, race, physical disability, religion, ethnicity, marital status, ancestry, or place of origin.
Please read all questions carefully and complete all required fields prior to submitting your application.
Application Date*

MonthDayYear
Tax ID #
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail Address*
example@example.com
Date of Birth*

MonthDayYear
Date Available For Employment*

MonthDayYear
Are You Legally Entitled To Work In The United States?*

YesNo
Highest level of education completed:
Full-time or Part-time employment?

Full-timePart-time
Able to work in Cold and Heat?

YesNo
# hours /week expected?
Hourly $ pay expected?
Do you have an Arrest Record?*

YesNo
If YES, please explain.
Are you experienced driving a truck and trailer?*

YesNo
Do you have dependable transportation?*

YesNo
Type of vehicle you drive?
Clean driving record?*

YesNo
Do you have a valid driver's license?*

YesNo
Drivers License Number
State
WORK HISTORY / EXPERIENCE

Please list your 2 most current work history/experience
(1) Employer's Name (Most current)
(1) Supervisor's Name
(1) Telephone
(1) Position Held
(1) Reason for Departure
(1) Duties
(1) Start Date

MonthDayYear
(1) End Date

MonthDayYear
(1) May we contact this employer?

YesNo
(1) If NO, reason why not
(2) Employer's Name
(2) Supervisor's Name
(2) Telephone
(2) Position Held
(2) Reason for Departure
(2) Duties
(2) Start Date

MonthDayYear
(2) End Date

MonthDayYear
(2) May we contact this employer?

YesNo
(2) If NO, reason why not
List Other Positions / Experience
False information given or implied on an application for is grounds for immediate dismissal without further notice.

I hereby state that all information provided is accurate and may be verified by you. I agree that I may be discharged if Well Doctor at anytime learns of falsification or material omission in the information provided on this application form and related documents. Well Doctor may contact my former employers. All references are hereby authorized to release all information which they may have relevant to my employment with them. I hereby release Well Doctor , its affiliates, successors, and assigns, and all references from any liability that might be claimed because of information provided by such references. I agree that I will follow all Well Doctor policies, rules, and procedures. I understand that Well Doctor reserves the right to add, change, and/or delete any policies, procedures, work rules, and/or benefits at anytime. I agree to make myself available for random drug testing. I have never been convicted of a felony and I have no criminal charges pending against me.
Submit Resume

Cancelof
Signature*

Clear
Trace before submitting*
Thank you for applying with Us.
Should be Empty: