H R Ewell, Inc Application For Employment
PO Box 8, East Earl PA 17519-0008 (answer all questions - please print)

In compliance with Federal and State equal employment opportunity laws, qualified applicants are considered for all positions without regard to race, color, religion, sex, national origin, age, marital status, veteran status, non-job related disability, or any other protected group status.

Date of Application:
Position(s) Applied for: Name Social Security No.
Last First Middle

List your addresses of residency for the past 3 years.

Current Address
Street City
Phone()-How Long?
State ZipCode
Previous
Addresses
How Long?
Street City State&ZipCode
How Long?
Street City State&ZipCode
How Long?
Street City State&ZipCode

Do you have the legal right to work in the United States?
Date of Birth//Can you provide proof of age?
(Required for Commercial Drivers)
Have you worked for this company before?Where?
Dates: FromToRate of PayPosition
Reason for leaving
Are you employed?If not, how long since leaving last employment?
Who referred you?Rate of pay expected
Have you ever been bonded?Name of bonding company
(Answer only if a job requirement)
Have you ever been convicted of a felony?
If yes, please explain fully on a seperate sheet of paper. conviction of a crime is not an automatic bar to employment - all circumstances will be considered.

Is there any reason you might be unable to perform the functions of the job for which you have applied (as described in the attached job description)?

If yes, explain if you wish.

Employment History

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state, and zip code.

Applicants to drive a commercial motor vehicle* in intrastate or interstate commerce shall also provide an additional 7 yearsí information on those employers for whom the applicant operated such vehicle. (NOTE: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

EMPLOYER DATE
NAME
 FROM
MO.YR		 TO
MO.YR
ADDRESS
 POSITION HELD
CITYSTATEZIP SALARY/WAGE
CONTACT PERSONPHONE NO. REASON FOR LEAVING

EMPLOYER DATE
NAME
 FROM
MO.YR		 TO
MO.YR
ADDRESS
 POSITION HELD
CITYSTATEZIP SALARY/WAGE
CONTACT PERSONPHONE NO. REASON FOR LEAVING

EMPLOYER DATE
NAME
 FROM
MO.YR		 TO
MO.YR
ADDRESS
 POSITION HELD
CITYSTATEZIP SALARY/WAGE
CONTACT PERSONPHONE NO. REASON FOR LEAVING

EMPLOYER DATE
NAME
 FROM
MO.YR		 TO
MO.YR
ADDRESS
 POSITION HELD
CITYSTATEZIP SALARY/WAGE
CONTACT PERSONPHONE NO. REASON FOR LEAVING

EMPLOYER DATE
NAME
 FROM
MO.YR		 TO
MO.YR
ADDRESS
 POSITION HELD
CITYSTATEZIP SALARY/WAGE
CONTACT PERSONPHONE NO. REASON FOR LEAVING

*Includes vehicles having a GVWR of 26,001 lbs. Or more, vehicles designed to transport 15 or more passengers, or any size vehicles used to transport hazardous materials in a quantity requiring placarding.

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED) IF NONE, WRITE NONE
DATES NATURE OF ACCIDENT
(HEAD-ON, REAR-END, UPSET, ETC.)		 FATALITIES INJURIES
LAST ACCIDENT
NEXT PREVIOUS
NEXT PREVIOUS

TRAFFIC CONVICTIONS AND FORFEITURES FOR THE PAST 3 YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

LOCATION DATE CHARGE PENALTY
(ATTACH SHEET IF MORE SPACE IS NEEDED)

EDUCATION
HIGHEST GRADE COMPLETED HIGH SCHOOL COLLEGE
LAST SCHOOL ATTENDED

(NAME) (CITY)

EXPERIENCE AND QUALIFICATIONS - DRIVER
DRIVER
LICENCES		 STATE LICENCE NO. TYPE EXPIRATION DATE


A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?
B. Has any license, permit or privilege ever been suspended or revoked?
IF THE ANSWER TO EITHER A OR B IS YES, ATTACH STATEMENT GIVING DETAILS

DRIVING EXPERIENCE IF NONE, WRITE NONE
CLASS OF EQUIPMENT TYPE OF EQUIPMENT
(VAN, TANK, FLAT, ETC.)		 DATES
FROM               TO		 APPROX. NO OF MILES
(TOTAL)
STRAIGHT TRUCK |
TRACTOR AND SEMI-TRAILOR |
TRACTOR-TWO TRAILORS |
MOTORCOACH-SCHOOL BUS |
OTHER |

LIST STATES OPERATED IN FOR LAST FIVE YEARS

SHOW SPECIAL COURSES OR TRAINING THAT WILL HELP YOU AS A DRIVER:

WHICH SAFE DRIVING AWARDS DO YOU HOLD AND FROM WHOM?

SHOW ANY TRUCKING, TRANSPORTATION OR OTHER EXPERIENCE THAT MAY HELP IN YOUR WORK FOR THIS COMPANY

LIST COURSES AND TRAINING OTHER THAN SHOWN ELSEWHERE IN THIS APPLICATION


LIST SPECIAL EQUIPMENT OR TECHNICAL MATERIALS YOU CAN WORK WITH (OTHER THAN THOSE ALREADY SHOWN)

TO BE READ AND SIGNED APPLICANT

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.
I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquires regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the Company.


Date
Applicant's Signature


PROCESS RECORD


APPLICANT HIRED REJECTED
DATE EMPLOYED POINT EMPLOYED
DEPARTMENT CLASSIFICATION

(IF REJECTED, SUMMARY REPORT OF REASONS SHOULD BE PLACED IN FILE)

THIS SECTION TO BE FILLED IN BY RESPONSIBLE
OFFICER OR COMPANY RESPRESENTATIVE

1. APPLICATION
2. INTERVIEW
3. PAST EMPLOYMENT
4. WRITTEN EXAM
5. ROAD TEST
6. CRIMINAL AND
TRAFFIC CONVICTIONS
SUPERIOR GOOD FAIR BELOW AVERAGE POOR WRITTEN RECORD ON FILE

SIGNATURE OF INTERVIEWING OFFICER

TRANSFERS

FROM: TO:
DATE:
REASON FOR TRANSFER 		FROM: TO:
DATE:
REASON FOR TRANSFER
FROM: TO:
DATE:
REASON FOR TRANSFER 		FROM: TO:
DATE:
REASON FOR TRANSFER


TERMINATION OF EMPLOYMENT

DATE TERMINATEDDEPARTMENT RELEASED FROM
DISMISSEDVOLUNTARILY QUITOTHER
TERMINATION REPORT PLACED IN FILESUPERVISOR