(740) 587-2452

NUWAY Employment Application

*required
* Date:
* Driver's License #:

CDL


If CDL yes:


* Full Name:
* Email Address:
* Phone:
Street Address:
City:
Zip:

Are you authorized to work in US?


Position applying for:





Other:

Are you currently employed?


* Date you can start:
If currently employed, name and telephone of current employer:
Current Employer Phone:

Physical Record: Do you have physical limitations that prelude you from performing any work for which you are being considered?

If yes, describe limitations and what measures can be done to accommodate your limitations:

Previous employers: (list past 3 employer work history starting with current or most recent employer)

1. Name of employer:

Phone # of employer:

Start Date:

End Date:

Position held:

Reasong for leaving:

2. Name of employer:

Phone # of employer:

Start Date:

End Date:

Position held:

Reasong for leaving:

3. Name of employer:

Phone # of employer:

Start Date:

End Date:

Position held:

Reasong for leaving:

Equipment Operators Only: Please list equipment type, make, size, and years of experience you have operating.

Truck Drivers Only: Please list type, make, size of trucks and years of experience driving.

All Applicants: List any experience you have had with regard to the position you are applying for that is not previously listed.

References: Give the names, addresses, and phone numbers of (3) individuals not related to or living with you.

1. Reference Name:

1. Reference Address:

1. Reference Number:

2. Reference Name:

2. Reference Address:

2. Reference Number:

3. Reference Name:

3. Reference Address:

3. Reference Number:


Name, phone #, and relationship of a relative not living with you:

Relative Name:

Relative Number:

Relative Relationship:


Contact in case of emergency:

Emergency Contact Name:

Emergency Contact Address:

Emergency Contact Number:

“I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements in this application shall be grounds for dismissal. I authorize investigation of all information and statements contained herein and the references listed above to give you any and all information concerning my financial history and previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice.”

* Signature:

Date: