Employment Application

    Instructions

    Please fill out all fields to the best of your ability. All information submitted is kept private and not shared with 3rd parties.

    If you are interested in a job as a driver for Pacifica Trucks, please fill out the Company Drivers application, not this one.

      Please enter your full name.

        e.g. mm/dd/yyyy

          Please enter your home address:

          Street
          Apt# / PO Box
          City
          StatePostal Code

            ext.

              ext.

                Please list the position(s) at Pacifica Trucks for which you would like to be considered.

                    Are you legally eligible for employment within the USA? Proof of identity, citizenship, and/or immigration status will be required upon employment.

                      Have you ever been employed with this company before?

                        If you answered yes regarding previous employment, please provide employment dates, position held, and your reasons for leaving.

                          Have you ever been convicted of a felony? Do not include information regarding any marijuana conviction that is more than two years old.

                            If you answered yes regarding felony conviction(s), please list the date(s) and provide an explanation. (A conviction may be relevant if job-related, but does not necessarily bar you from employment.)

                              If you are offered a job, and are under 18 years of age, can you furnish a work permit?

                                Enter your drivers license information here if the position for which you are applying requires driving. Include the state and driver's license number.

                                  Please select the first date you would be available to start. e.g. mm/dd/yyyy

                                      Educational Background

                                        Did you graduate from high school?

                                          If you attended more than one high school, list the most recent.

                                            Please enter the name of the college or university, the location, and indicate your major and any degree obtained. If you attended more than one, enter the most recent here.

                                              Please enter the name of the college or university, the location, and indicate your major and any degree obtained. If you attended more than one, enter the most recent in the field above, and next most recent here.

                                                Skills and Qualifications

                                                  Summarize special skills and qualifications acquired from employment, membership in professional organizations, or other experiences that may qualify you for work with our Company. Exclude those that indicate race, color, national origin, ancestry, religion, sex, gender, gender identity, sexual orientation, political affiliations or activities, military service, marital status, pregnancy, age (40 and above), physical or mental disability, medical condition, or genetic information or characteristics.

                                                    Employment History

                                                    Please provide information for your employment history, up to 3 employers ago. Start & End Dates may be approximate.

                                                      Most Recent Employment

                                                        e.g. mm/dd/yyyy

                                                          e.g. mm/dd/yyyy

                                                                      2nd Most Recent Employment

                                                                        e.g. mm/dd/yyyy

                                                                          e.g. mm/dd/yyyy

                                                                                      3rd Most Recent Employment

                                                                                        e.g. mm/dd/yyyy

                                                                                          e.g. mm/dd/yyyy

                                                                                                      Signature

                                                                                                      I hereby certify that all of the foregoing information I have supplied in the Application is correct and complete. I further understand that any falsification of information will constitute grounds for immediate dismissal. I authorize the Company to verify the information provided, including authorization to contact any or all of my previous employers and references for full information, and I hereby release the Company from any and all liability for doing so. I also understand that all offers of employment are conditioned upon the satusfactory completion of reference and/or background checks. If employed and in consideration of my employment, I agree to conform to the rules, policies and procedures of the Company.

                                                                                                      I understand that, if hired, I will be an at-will employee, which means that (a) I may terminate my employment at any time, (b) the Company may transfer, reassign, suspend or demote me at any time, and (c) my employment may be terminated at any time, with or without notice and with or without cause. I further understand that no one has any authority to enter into any agreement of employment for any specified period of time, or to make any agreement contrary to the foregoing other than in an express written agreement that is signed by me and by the Company President.

                                                                                                        By entering your name here, you agree that you are electronically signing this application.

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