Virginia Truck Center
Application for Employment

Virginia Truck Center is an equal opportunity employer, and does not discriminate on the basis of race, creed, color, national origin, age, sex, mental or physical handicap, arrest record, or veteran status. Hiring decisions will be based on the qualifications of the applicant to perform the position applied for.

Personal Information
Last Name
 First Name
 Middle Name
Address 1
Address 2
City
 State
 Zip
Contact Phone
 Email Address

Position(s) Applied For
 Date Of Application

Have you ever filed an application with us before?
 No       Yes
If Yes, give date:
Have you ever been employed with us before?
 No       Yes
If Yes, give date:

Are you currently employed?
 No       Yes
If Yes, may we contact your present employer?
 No       Yes

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Proof of citizenship or immigration status will be required upon employment 		No       Yes

Have you been convicted of a felony within the last 7 years?
Conviction will not necessarily disqualify an applicant from employment. 		No       Yes
If Yes, please explain:

Are you available to work: (please check all that apply)
Full Time            Part Time            Shift Work             Temporary Work

Employment Experience
Start with your present or last job.  Include any job-related military service assignments and volunteer activities.  You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status.

Employer #1
Name
Dates Employed
Work Performed
Address
From
To
 
Telephone Number
Hourly Rate/Salary
Job Title
Starting
Final
Supervisor
  
Reason for Leaving

Employer #2
Name
Dates Employed
Work Performed
Address
From
To
 
Telephone Number
Hourly Rate/Salary
Job Title
Starting
Final
Supervisor
  
Reason for Leaving

Employer #3
Name
Dates Employed
Work Performed
Address
From
To
 
Telephone Number
Hourly Rate/Salary
Job Title
Starting
Final
Supervisor
  
Reason for Leaving


Employer #4
Name
Dates Employed
Work Performed
Address
From
To
 
Telephone Number
Hourly Rate/Salary
Job Title
Starting
Final
Supervisor
  
Reason for Leaving

Education
Please provide us only with the highest grade completed/school.

Name And Address Of School
 Course Of Study
 Years Completed
 Diploma/Degree

Indicate Any Foreign Languages You Can Speak, Read, And/Or Write By Entering Them In the Boxes Below
 
Fluent
Good
Fair
Speak
Read
Write

Describe Any Job Related Training Recieved:

Additional Information
Other Qualifications
Summarize special job-related skills and qualifications acquired from employment or other experience.
State any additional information you feel may be helpful to us in considering your application.

Note to Applicants: Do NOT Answer This Question Unless You Have Been Informed About The Requirements Of The Job For Which You Are Applying.
Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? Yes
No

Click here to access Applicant's Statement and Agreement. (This form must be signed and brought with you if interview is granted.)

All information provided by me in this application for employment is true, correct and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause of dismissal. I release from all liability or damage those individuals or corporations who provide information relating to my prior employment.