RideSource Inc. Employment Application Form

Applicants May Be Tested For Illegal Drugs

Date

MonthDayYear

Full Name*

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

E-mail

How did you hear about us?*

Position applied for

Number of hours you can work

Can you work nights?

YesNo

Can you work weekends?

YesNo

Days you are available to work.

Employment desired

Full Time OnlyPart Time OnlyFull or Part Time

Level of Education Completed

Are you willing to undergo a background check, in accordance with local law/regulations?

YesNo

Do you have a driver's license?

YesNo

Have you had any accidents during the past three years?

YesNo

If yes, how many?

Have you had any moving violations in the past three years

YesNo

If yes, how many?

Name of employer

Employer address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Employer Phone Number

Area CodePhone Number

Supervisor name

Dates of employment

Reason for leaving (be specific)

List the jobs you held, duties preformed, skills used or learned, advancements and promotions while you worked at this company

Name of employer 2

Employer address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Employer Phone Number

Area CodePhone Number

Supervisor name

Dates of employment

Reason for leaving (be specific)

List the jobs you held, duties preformed, skills used or learned, advancements and promotions while you worked at this company

Name of employer 3

Employer address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Employer Phone Number

Area CodePhone Number

Supervisor name

Dates of employment

Reason for leaving (be specific)

List the jobs you held, duties preformed, skills used or learned, advancements and promotions while you worked at this company

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying

In exchange for the consideration of my job application by RideSource Inc. (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, wither in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of RideSource Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that the relationship cannot be altered except by a written instrument signed by the President/General Manager of the Company. Both the undersigned and RideSource Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies, and procedures and such changes may include reduction of benefits.

I authorize investigation of all statements contained in this application. Im understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contact.

I also understand that (1) the Company has a drug an alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a reporting agency and investigative information as to my characters general reputation, personal characteristics, criminal background, and mode of living. Upon written request from me, the Company will provide me with additional information concerning the nature and scope of any such report requested by it, as required b the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of Ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either Party

By checking the box and signing below I agree that I have read and understand the above waiver, and that I am at least 25 years of age and have had a valid license for no fewer than 3 years.*

I agree

Signature*

First NameMiddle NameLast NameSuffix

Date of Signature*

MonthDayYear

The company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Thank you for completing this application form and for your interest in our business.

RideSource Inc. Employment Application Form

Work Experience

Application Form Waiver