Join our team : Who We Are : Uribe Refuse

Application for Employment

Date (Required)

Name (First, Last)

First Name *

Last Name *

Phone Number (Required)

Email address (Required)

Social Security # (Required)

Current Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

How long have you been at this address (Years and months) (Required)

Date of Birth (Required)

When can you start? (Required)

Position applying for (Required)

Are you a US citizen or otherwise authorized to work in the US on an unrestricted basis? (You may be required to provide documentation) (Required)

Do you have a valid drivers license? (Required)

Drivers License #

State of Issue

Expiration Date

Commercial CDL Class (Required)

Have you had any accidents during the past 3 years? (Required)

If yes, please list. Include Date, Nature of Accident and number of Fatalities and/or Injuries

Have you had any moving violations during the past 3 years? (Required)

If yes, how many?

Please list each including Date, Location, Charge and Penalty.

Have you ever been denied a license, permit, or privilege to operate a motor vehicle (Required)

Do you have any experience driving commercial class equipment? (Required)

Type of equipment

If yes, please list, including: Class of equipment, Type of Equipment (Van, Tank, Flat, Etc.), Dates (From and To), and approx miles driven.

Have you ever been convicted of a felony? (This will not necessarily effect your application) (Required)

If yes, please describe the nature of charges and dates

Employment History

DOT requires that employment for at least 3 years and/or commercial driving experience for the past 10 years be shown

Employer 1

Company Name (Required)

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Date Started (Required)

End Date (Required)

Wage (Required)

Name of Supervisor (Required)

May we contact? (Required)

Responsibilities (Required)

Reason for leaving (Required)

Employer 2

Company Name

Address

Country

Address Line 1

City

State/Province

Postal Code

Start Date

End Date

Wage

Name of Supervisor

May we contact?

Responsibilities

Reason for leaving

Employer 3

Company Name

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Address

Country

Address Line 1

City

State/Province

Postal Code

Start Date

End Date

Wage

Name of Supervisor

May we contact?

Responsibilities

Reason for leaving

Education

High School (Required)

Diploma? (Required)

If No, GED?

College

Major

Degree

Other Training

In addition to your work history are there any other skills, qualifications, or experience that we should consider?

Acknowledgement & Understanding

I certify that the facts set forth in this application for employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements on this application shall be considered sufficient cause for dismissal. Uribe Refuse Services, Inc. is hereby authorized to make any investigations of my prior educational and employment history. I understand that employment at Uribe Refuse Services, Inc. is “at will,” which means that either I or Uribe Refuse Services, Inc. can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. All employment is continued on that basis.

I agree

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Application for Employment

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Acknowledgement & Understanding

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