Delivery Route Helper - Full Time

Personal Information

Full Legal Name*

First Middle Last

Phone Number*

Alt. Phone Number*

Best time to call

Address*

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

Email Address*

Are you legally eligible for employment in this country?*

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Are you on a layoff and subject to recall?*

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No

Are you seeking a permanent position?*

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No

Are you active Military/National Guard, subject to deployment?*

Yes
No

Are you able to perform the essential functions of the position without reasonable accomodations?*

Yes
No

If Necessary for the job, I am able to:

Work overtime if required?*

Yes
No

Pass a pre-employment drug screening?*

Yes
No

Provide a valid Vermont drivers License?*

Yes
No

If yes, is this a Commercial Drivers License?*

Yes
No

Position

Position You Are Applying For*

Desired Department*

Available Start Date*

Desired Pay*

Employment Desired*

Full Time
Part Time
Seasonal / Temporary

Education

Schools Attended*

School Name	Location	Years Attended	Degree Received	Major

References

References*

Name	Title	Company	Phone

Employment History

Previous Employers*

Employer Name	Job Title	Dates Employed	Work Phone	Address

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Type of Job

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Signature

Signature Disclaimer*

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

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