Manatts General Employment Application

PO BOX 535
BROOKLYN, IA 52211
PHONE: 641-522-9206
FAXES: 641-522-9407 or 641-522-5594

Manatts Inc.
CDL Employment Application
All applicants who have a CDL must complete this applicaiton regardless of position applying for.

APPLICATION FOR EMPLOYMENT

NOTE TO THE APPLICANT: This application is used to evaluate your qualifications for employment. Please answer all of the questions on your application accurately. If you fail to do so, you may lose employment opportunities or delay consideration of your employment. This application is not an employment contract. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, disability, age, sex, or any other classification protected by federal, state, or local laws. Additional testing of job-related skills, as well as post-offer pre-employment physical (which will include a drug test) may be required.

Job Applied For:

Date: - -

A. PERSONAL INFORMATION
Name: First: Middle: Last:
Social Security Number:	- -
Address:
Street/Apt#:
City:
State:	Zip:

Home Phone Number:	Area Code: Phone Number: -
Cell Phone Number:	Area Code: Phone Number: -
Are you at least 18 years of age?	Yes No Child labor laws prohibit employment of individuals under the age of 18 in certain occupations considered to be hazardous.
Date of Birth:	- -
Have you worked for this company before?	Yes No
If yes, where?
Dates of previous employment:	From: - TO: -
Reason for leaving:
Are You eligible for employment in the United States?	Yes No
On what date would you be available for work?	- -
Are you available to work:	Full Time Part Time Temporary Summer Only
Are you on a lay-off and subject to recall?	Yes No
Can you travel if a job requires it?	Yes No
Would you accept employment:	Out-of-town Statewide Unaccompanied by family
Who referred you:
Rate of pay expected:

B. Education
Check Highest Grade Competed:	Elementary: 1 2 3 4 5 6 7 8
High School: 1 2 3 4	College: 1 2 3 4 5+
Last School Attended:	Name:
City:	State:
Degree:
Do you speak, read or write fluently in a language other than English?	Yes No
If YES, describe ability and list language(s):

C. DRIVER LICENSE INFORMATION

License Number: State:
Expiration Date: - -

CDL Type:

A B

Endorsements:

Have you ever been denied a license, permit or priviliege to operate a motor vehicle? Yes No

If Yes, explain:

Has any license, permit or privilege ever been suspended or revoked? Yes No

If Yes, explain:

Have you had an OWI in the past 5 years? Yes No

ACCIDENT RECORD FOR THE PAST 5 YEARS

CHECK IF NONE

	Date	Nature of Accident (Head-On, Rear-End, Upset, Etc.)	Fatalities (Number)	Injuries (Number)
Last accident	- -
Next Previous	- -
Next Previous	- -
Next Previous	- -
Next Previous	- -

TRAFFIC CONVICTIONS/FOREITURES FOR PAST 5 YEARS (OTHER THAN PARKING VIOLATIONS)

CHECK IF NONE

Location	Date	Charge	Penalty
	- -
	- -
	- -
	- -
	- -

D. EXPERIENCE:
What type of trucks or types and makes/models of construction equipment can you operate? Include number of years of experience.
What type of trucks or types and makes/models of construction equipment can you repair?
List any craft training programs or special courses you have taken.

E. EMPLOYMENT HISTORY
All CDL applicants who have held a CDL for 10 years, must provide the following information on all employers during the preceding 10 years. Entire 10 years must be accounted for. During periods of unemployment, list dates and write “ unemployed” in employer information. If you have not had a CDL for 10 years, provide information back to the date you first obtained CDL license. List employers starting with most recent first. 1. Employer Information
From: -	Employer Name:
To: -	Address: Include Street, City, State and Zip Code
	Employer Phone:	Area Code: Phone Number: -
	Positions Held/Duties:
	Supervisor name:
	Starting Pay:	Ending Pay:
Reason For Leaving:
May We Contact:	YES NO
First CDL Empoyer:	YES NO
2. Employer Information
From: -	Employer Name:
To: -	Address: Include Street, City, State and Zip Code
	Employer Phone:	Area Code: Phone Number: -
	Positions Held/Duties:
	Supervisor name:
	Starting Pay:	Ending Pay:
Reason For Leaving:
May We Contact:	YES NO
First CDL Empoyer:	YES NO
3. Employer Information
From: -	Employer Name:
To: -	Address: Include Street, City, State and Zip Code
	Employer Phone:	Area Code: Phone Number: -
	Positions Held/Duties:
	Supervisor name:
	Starting Pay:	Ending Pay:
Reason For Leaving:
May We Contact:	YES NO
First CDL Empoyer:	YES NO
4. Employer Information
From: -	Employer Name:
To: -	Address: Include Street, City, State and Zip Code
	Employer Phone:	Area Code: Phone Number: -
	Positions Held/Duties:
	Supervisor name:
	Starting Pay:	Ending Pay:
Reason For Leaving:
May We Contact:	YES NO
First CDL Empoyer:	YES NO
5. Employer Information
From: -	Employer Name:
To: -	Address: Include Street, City, State and Zip Code
	Employer Phone:	Area Code: Phone Number: -
	Positions Held/Duties:
	Supervisor name:
	Starting Pay:	Ending Pay:
Reason For Leaving:
May We Contact:	YES NO
First CDL Empoyer:	YES NO

F. REFERENCES Include only individuals familiar with your work ability. Do not include relatives.
Name:	Address/Phone	Years Known/Relationship
1.
2.
3.

TO BE READ AND SIGNED BY APPLICANT

I certify that the information contained in this application are true, complete, and accurate to the best of my knowledge. I understand that, if employed, false statements or omissions on this application may result in rejection of my application or discharge at any time during my employment.

I authorize you to make such investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended). I hereby release employers, schools, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Manatt’s Inc.

I understand and agree that, if hired, my employment is for no definite period and either I or the company can terminate the employment relationship at any time, with or without cause, and with or without notice. This employment relationship exists regardless of any other statements or policies to the contrary.

I realize that under certain provisions of Iowa law, I may be required to submit to a post offer pre-employment physical (which will include a drug test) as a condition of my employment. I hereby agree to submit to such an examination if required so by company policy and permit disclosure of the results to the company.

Signature: Date: - -
Typing your name in the above box constitutes an electronic signature and is treated in the same manner as an actual hand written signature.
(Note: This application will be active for 6 months)

This company does not unlawfully discriminate in hiring or any aspect of the employment relationship on the basis of age, race, color, sex, religion, national origin, disability, or any other basis protected by law in the jurisdiction in which the employment is performed.

AN EQUAL EMPLOYMENT OPPORTUNITY EMPLOYER