Employment Application

Position Applied For *

Salary Desired *

Position

Referral Source (Name)

Personal Information

First Name *

Middle Name *

Last Name *

Phone *

Email

Address *

City *

State *

ZIP *

Are you currently at least 18 years of age? * Yes
No

Education

What is the highest level of education have you completed? * High School
College/University
GED

If college, what is your degree?

Specialized training, skills, or abilities

Languages other than English you can speak, read, and/or write

Employment History

Are you currently employed? * Yes
No

Current Employer (or most recent employer)

Employer Name

Type of Business

Employer Phone

Address

City

State

ZIP

Date of Employment (Start date/end date)

(mm/yyyy)
(mm/yyyy)

Title of Your Position

Name & Title of Your Immediate Supervisor

May we contact this employer? Yes
No

Description of duties, responsibilities and equipment operated

Liked Most About Job

Liked Least About Job

Reason for Leaving

Did you drive a vehicle requiring CDL? Yes
No

Were you subject to the FMCSR's while employed here? Yes
No

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes
No

Previous Employer 1

Employer Name

Type of Business

Employer Phone

Address

City

State

ZIP

Date of Employment (Start date/end date)

(mm/yyyy)
(mm/yyyy)

Title of Your Position

Name & Title of Your Immediate Supervisor

May we contact this employer? Yes
No

Description of duties, responsibilities and equipment operated

Liked Most About Job

Liked Least About Job

Reason for Leaving

Did you drive a vehicle requiring CDL? Yes
No

Were you subject to the FMCSR's while employed here? Yes
No

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes
No

Previous Employer 2

Employer Name

Type of Business

Employer Phone

Address

City

State

ZIP

Date of Employment (Start date/end date)

(mm/yyyy)
(mm/yyyy)

Title of Your Position

Name & Title of Your Immediate Supervisor

May we contact this employer? Yes
No

Description of duties, responsibilities and equipment operated

Liked Most About Job

Liked Least About Job

Reason for Leaving

Did you drive a vehicle requiring CDL? Yes
No

Were you subject to the FMCSR's while employed here? Yes
No

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes
No

Previous Employer 3

Employer Name

Type of Business

Employer Phone

Address

City

State

ZIP

Date of Employment (Start date/end date)

(mm/yyyy)
(mm/yyyy)

Title of Your Position

Name & Title of Your Immediate Supervisor

May we contact this employer? Yes
No

Description of duties, responsibilities and equipment operated

Liked Most About Job

Liked Least About Job

Reason for Leaving

Did you drive a vehicle requiring CDL? Yes
No

Were you subject to the FMCSR's while employed here? Yes
No

Was your job designated as a safety-sensitive function in any DOT-Regulated mode subject to the drug and alcohol testing requirements of 49 CFR part 40? Yes
No

Employment Information

Are you legally eligible to work in the U.S.A? * Yes
No

On what date would you be available to work? * (mm/dd/yyyy)

Are you able to travel if the job requires it? YesNo

Do you know anyone who works for this company?

YesNo
If yes, who?
Relationship

Have you previously worked for A Plus?

YesNo
If yes, in what capacity?

Have you been convicted of a felony, misdemeanor and/or served time in the past? (This information will be reviewed for job relatedness)

YesNo
If yes, please explain where, when, and disposition of case:
(Conviction will not necessarily disqualify an applicant from employment.)

Have you had any such charges brought against you that were later reduced, dismissed or not adjudicated due to re-trial intervention?

YesNo
If yes, please describe in full:

Have you ever been accused or disciplined for theft or other conduct of a dishonest or fraudulent nature?

YesNo
If yes, please describe in full:

Have you served in the U.S. Armed Forces or National Guard?

YesNo
Describe your experience

Do you have a valid driver's license? YesNo

If yes, state issued

License Number

Any dates of driver's license suspensions

Do you have reliable transportation? YesNo

Professional References

Reference 1

Name

Title

Phone Number

Describe Your Relationship to this Reference

Reference 2

Name

Title

Phone Number

Describe Your Relationship to this Reference

Reference 3

Name

Title

Phone Number

Describe Your Relationship to this Reference

Optional Resumé Upload

Upload Resumé and optional Cover Letter

(Please submit a single PDF or Microsoft Word file)

Affirmative Action Survey (Optional)

Affirmative Action Survey

Gender Identification MaleFemale

Minority Status Identification Hispanic or Latino
White
Black
Native Hawaiian or other Pacific Islander
Asian
American Indian or Alaska Native
Two or More Races

How did you learn of this job opening? *

Walk-In
Advertisement - Newspaper
Advertisement - Internet
Job Service of Iowa
Other Government Agency
School/College
Employment Agency
Search Firm
Employee Referral (provide name of employee)
Other (specify)

Applicant's Statement

By signing below, I hereby certify to Hy-Vee Construction and A+ Communications & Security ("the company") that the facts set forth in my application for employment are current, correct, and complete. I understand that falsification of these facts, or providing misleading or incomplete information constitutes grounds for rejection of my application or, if I am employed by the company, grounds for my immediate dismissal from employment without recourse against the company for any liability except for wages earned through the date of dismissal.

I authorize the company and/or its designee or agent to investigate my background and/or information provided in this application for employment, including making inquires of my employer, former employer(s), educational institution(s), personal and profession reference(s) and other sources, by telephone or otherwise to obtain information concerning my personal character, habits, disposition, reputation, previous employment, criminal history, motor vehicle records, credit history, mode of living, work experience and educational background. I hereby consent to such investigation and forever release the company, as well as any such persons who inquire about me on the company's behalf and/or those who provide information in connection with such investigation, from any and all liability related to the inquiry, release, disclosure and/or use of such information.

I understand that if offered employment, my employment with the company would be "at will", meaning that either I or the company may terminate my employment, at any time and for any or no reason, with or without notice or warning. I understand and agree that nothing in this application, any interview, any policy or procedure or other statement by the company, whether written or oral, shall create or be deemed to create a contract, express or implied, between me and the company.

I understand and agree that, as a condition of employment with the company, should it be offered, I must submit to and pass successfully any and all pre-employment examinations require by the company, including drug/alcohol screening and background checks. I understand that as required under the Immigration Reform and Control Act of 1986, if hired I will be required to furnish appropriate documentation proving my employment authorization and identity within (3) days of my first date of employment.

Finally, I understand that I have been provided with the opportunity to speak with the company's Human Resources staff should I have any questions or concerns about the foregoing information. I have signed this Authorization and Acknowledgement with full understanding of and agreement to these terms.

I have reviewed the job description for this position and (check one):

I am able to meet all of the job requirements for this position.
I am able to meet all of the job requirements for this position, except as follows:

By checking this box and submitting this electronic application, I affirm that I have read and I agree to the conditions of the application above, and that all information I have provided in this application is correct and complete to the best of my knowledge.

Do you agree?* Yes, I agree.

Personal Information

Education

Employment History

Employment Information

Professional References

Optional Resumé Upload

Affirmative Action Survey (Optional)

Applicant's Statement

How To Apply