Ripley's Inc. Employment Application

Experience & Qualifications

Driver Licenses

Rows	State	License Number	Type	Expiration Date
Driver's License
Driver's License
Driver's License

Driving Experience

Rows	Type of Equipment (van, tank, flat, etc.)	Start Date	End Date	Appr. # of Miles (Total)
Straight Truck
Tractor and Semi-Trailer
Tractor-Two Trailers
Other 1
Other 2
Other 3

References

Rows	Name	Address	Phone	Years Acquainted
Reference 1
Reference 2
Reference 3

Education
School/College Name
School/College Name
School/College Name
Number of Years attended

Previous Employment

Include all employers for the past three years and any employment that required driving for the past 10 years.
Employer 1 Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name

First NameLast Name
Phone

Area CodePhone Number
Dates Employed (start)

MonthDayYear
Date
Dates Employed (end)

MonthDayYear
Date
Duties
Reason for leaving
Employer 2 Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name

First NameLast Name
Phone

Area CodePhone Number
Dates Employed (start)

MonthDayYear
Date
Dates Employed (end)

MonthDayYear
Date
Duties
Reason for leaving
Employer 3 Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Supervisor Name

First NameLast Name
Phone

Area CodePhone Number
Dates Employed (start)

MonthDayYear
Date
Dates Employed (end)

MonthDayYear
Date
Duties
Reason for leaving
Traffic Convictions and Forfeitures

List all in the past three years.

Rows	Location	Date	Charge	Penalty
1
2
3
4

No Traffic Convictions or Forfeitures in the past three years (sign on the line)
Have you ever been denied a license, permit, or privilege to operate a motor vehicle?

YesNo
If "Yes," provide details:
Has any license, permit, or privilege ever been suspended or revoked?

YesNo
If "Yes," provide details:
Have you ever tested positive or refused to be tested on a Pre-Employment Drug Screen for an employer that you did not go to work for?

YesNo
If "Yes," give date and name of employer:
Note:

Employment is contingent on passing a pre-employment drug test.
Employment is contingent on passing a pre-employment drug test.

Accident Record (for past three years)

Rows	Date	Nature of Accident (head on, rear end, etc.)	Fatalities/Injuries/Property Damage
1
2
3
4

No Accidents in the past three years (sign on the line)

General
Are you able to perform the essential functions of this job with or without reasonable accommodation?
Have you ever served in the US Military?

YesNo
Disclaimer

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I authorize the references listed above to give you any all information concerning my previous employment as well as any pertinent information they may have, and release all parties from all liability for any damage that may result from furnishing same to you.

I understand, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause. By checking yes below I agree with the above disclaimer and that I approve Ripley’s Inc. to conduct a criminal background check prior to employment.
Choose One

YesNo
Signature
Date

MonthDayYear
Date
Upload Resume

Upload a File

Cancelof
Prior to any employment offer from Ripley’s Inc., a Department of Motor Vehicle background authorization form will need to completed, as well as pre-employment drug testing. These forms are available at our main office and are completed during the interview process.

Our policy is to provide equal employment opportunity to all qualified persons without regard to race, creed, color, religious belief, sex, age, national origin, ancestry, physical or mental disability, or veteran status.
Should be Empty:

Ripley's Inc. Employment Application

Experience & Qualifications

Education

Previous Employment

Traffic Convictions and Forfeitures

Note:

General