Careers at UNEX

Apply For a Position At Unex

Please Answer All Questions Completely

Our Company fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans with Disabilities Act and applicable state laws, it is our policy to provide reasonable accommodation upon request during the application process to eligible applicants in order that they may be given a full and fair opportunity to be considered for employment. As an Equal Opportunity Employer, we intend to comply fully with applicable federal and State employment laws and the information requested on this application will only be used for purposes consistent with those laws. To the extent required by applicable law, the Company maintains a smoke-free workplace.

Position Applied For*

Date*

Personal Data

Salary Expectations

Your Full Name*

First Last

E-mail*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

If you are under 18, please specify your age

Are there any days, shifts or hours you will not work?*

YES
NO

If yes, please explain

Are you available for out of town work?*

YES
NO

Will you work overtime, if required?*

YES
NO

When would you be able to start work?

For the following question, please note that answering “yes” does not automatically exclude you from further consideration for the position.

Have you ever been found at fault in a civil action for an intentional tort (intentional commission of a wrongful act)?*

YES
NO

How did you learn of our Company?

If referral, who were you referred by?

Have you ever applied or worked at our Company before?*

YES
NO

If yes, provide dates:

Are you legally authorized to work in the United States?

YES
NO

Will you now or in the future require sponsorship for employment visa status (e.g.,H-1B visa status)?

YES
NO

Note: The Federal Immigration and Reform and Control Act of 1986 requires that a DHS Employment Eligibility Verification “Form I-9” be completed for every new hire and that within 3 business days of beginning work every new hire must present to the employer documentation establishing his/her identity and authorization to work. This federal requirement must be satisfied as a condition of employment.

Driving Record

(Answer only if driving is a requirement of the job for which you are applying).

Do you have a valid driver’s license?*

YES
NO

If yes, in what state?

If yes, what is the license number?

Have you had any tickets?

YES
NO

If yes, please explain:

Education

Describe any educational degrees, skills, training or experience you believe are relevant to the job applied for:

High School

YES
NO

Name, City and State of Educational Institution

Graduated?

YES
NO

If no, Degree Credits Earned

Type of Degree Received or Expected

Grade Point/ Overall GPA

College or University

YES
NO

Name, City and State of Educational Institution

Graduated?

YES
NO

If no, Degree Credits Earned

Type of Degree Received or Expected

Major

Minor

Grade Point/ Overall GPA

Technical/GED

YES
NO

Name, City and State of Educational Institution

Graduated?

YES
NO

If no, Degree Credits Earned

Type of Degree Received or Expected

Major

Minor

Grade Point/ Overall GPA

Licenses/ Certification/Other

YES
NO

Name, City and State of Educational Institution

Graduated?

YES
NO

If no, Degree Credits Earned

Type of Degree Received or Expected

EMPLOYMENT HISTORY:

Please complete for all full-time or part-time employment beginning with most recent employer. You may include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include active military assignments and voluntary employment and provide ten (10) years of history. (A separate sheet may be attached.) You must explain any gaps in your employment history.

Company Name

Phone Number

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Supervisor:

Dates employed:

Initial Rate of Pay:

Final Rate of Pay:

State job titles and describe job duties:

Reason for leaving:

May we contact this employer?

YES
NO

Add 2nd Company?

YES
NO

Company Name

Phone Number

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Supervisor:

Dates employed:

Initial Rate of Pay:

Final Rate of Pay:

State job titles and describe job duties:

Reason for leaving:

May we contact this employer?

YES
NO

Add 3rd Company?

YES
NO

Company Name

Phone Number

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Name of Supervisor:

Dates employed:

Initial Rate of Pay:

Final Rate of Pay:

State job titles and describe job duties:

Reason for leaving:

May we contact this employer?

YES
NO

Please explain any gaps in your employment history:

Have you ever been discharged or forced to resign?

YES
NO

If yes, explain:

Did you receive any discipline in your last 12 months of active employment with your previous employer?

YES
NO

If yes, explain:

Were you given a performance evaluation within the last 12 months of active employment?

YES
NO

If yes, what was the range of scores used and what was your score?

Have you signed any non-competition or non-solicitation agreement with any other employer that might restrict you from working for this company (you may be required to furnish a copy of the agreement)?

YES
NO

If yes, explain:

EMERGENCY CONTACT

(Please list someone to contact in case of an emergency.)

Name

Phone Number

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

REFERENCES

(Please list three persons not related to you who know your qualifications.)

List

Name	Address	Phone	Relathionship

Military

(Complete only if you served in the military.)

Branch of Service:

Number of Years /Months of Service:

Rank at Discharge:

Date of Discharge:

Reason for Leaving:

Describe any military skills, training or experience you believe are relevant to the job you applied for:

APPLICANT’S ACKNOWLEDGMENT

I certify that the answers given herein (including but not limited to the Commercial Motor Vehicle Driver Supplement if applicable) are true and complete to the best of my knowledge. I understand that any misrepresentations, omissions of facts or incomplete answers in any application document may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts in any application document may be cause for my dismissal atany time without prior notice.

I consent to and authorize this Company to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools and personal references to give the Company (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have and hereby waive any actions which I may have against either party(ies) for providing a good faith reference.

I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR MY EMPLOYER WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING THE BASIC EMPLOYMENT POLICIES, PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE EMPLOYER. I ALSO UNDERSTAND THAT THIS ASPECT OF MY EMPLOYMENT MAY NOT CHANGE ABSENT AN INDIVIDUAL WRITTEN AGREEMENT SIGNED BY BOTH ME AND THE PRESIDENT OF THE COMPANY.

I understand that applicants for certain positions may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation or take a pre-employment drug test. If I am offered employment or start work before any required test is completed, my employment is contingent on a satisfactory result on all required tests. I authorize the release of any background check results and of any drug/alcohol test to any state or federal authority requesting such information and in response to avalid subpoena or other legal document.

Confirmation*

I certify that this information is accurate

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CAREERS AT UNEX

Apply For a Position At Unex

Please Answer All Questions Completely

Personal Data

Driving Record

Education

EMPLOYMENT HISTORY:

EMERGENCY CONTACT

REFERENCES

Military

APPLICANT’S ACKNOWLEDGMENT

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