Job Application

WE ARE AN EQUAL OPPORTUNITY EMPLOYER

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status.

Drug tests will be required of all applicants as a requirement for employment.

Date of Application:		Position(s) Applied for:
Last Name:		First Name:		Middle:
Address:		City:
State/Province:		Zip:
Home Phone:		Cell Phone:
E-Mail Address:		SS Number:
Are you currently employed?	Yes No	May we contact your current employer?	Yes No
Available to Work:	Full-Time Part-Time Full or part-time Temporary
Shift Preference:	1st 2nd	Date Available:
Salary Expectations:		hourlymonthlyyearly
How did you hear about us?:	Workforce Development Doll website Doll employee Advertisement College Other
Have you ever been employed with Doll Distributing?	Yes No	If so, when?
Have you been convicted of a felony within the last 7 years?	Yes No	Are you currently on "Lay-Off"?	Yes No
Conviction will not necessarily disqualify an applicant from employment.
Are you eligible to work in the U.S.?	Yes No
(proof of eligibility will be required)

Education:

Type of School	Name of School and Complete Mailing Address	Course of Study	No. Years Completed	Major or Degree
High School
College Bus. or Trade School
Professional School
Other

Skills

Specialized Skills - Check skills/equipment operated	Other skills:	Various Software Applications: (listall that apply):
Calculator Fax Machine Voice Mail Internet Windows-Based Computer Mac-Based Computer E-Mail (Outlook) Microsoft Word Microsoft Excel Microsoft Access Microsoft Power Point	You have characters left.	You have characters left.

Employment

List below last employers, starting with most recent first.

Dates (Month & Year)	Employer Information	Job Title and Duties	Earnings:	Reason for Leaving (be specific):
Employer: 1
End Date: Start Date:	Name:	You have characters left.	Ending: Starting:	You have characters left.
	City: State:
	Phone:
	Supervisor:
Employer: 2
End Date: Start Date:	Name:	You have characters left.	Ending: Starting:	You have characters left.
	City: State:
	Phone:
	Supervisor:
Employer 3
End Date: Start Date:	Name:	You have characters left.	Ending: Starting:	You have characters left.
	City: State:
	Phone:
	Supervisor:
Employer: 4
End Date: Start Date:	Name:	You have characters left.	Ending: Starting:	You have characters left.
	City: State:
	Phone:
	Supervisor:

DRIVER EXPERIENCE & QUALIFICATIONS

LICENSES - Driver's licenses held in the past 3 years must be shown

State	License No.	Type	Expiration Date

1) Have you ever been denied a license, permit or privilege to operate a motor vehicle?	Yes No
2) Has any license, permit, or privilege every been suspended or revoked?	Yes No
3) Have you ever been disqualified for violations of the Federal Motor Carrier Safety Regulations?	Yes No

DRIVING EXPERIENCE

Class of Equipment	Type of Equipment	Dates	Approx # of Miles

List states operated in for last five years
Which safe driving awards do you hold and from where?
Show special course or training that will help you as a driver

ACCIDENT REVIEW

Dates	Nature of Accident	Fatalities	Injuries

TRAFFIC CONVICTIONS OTHER THAN PARKING TICKETS FOR PAST 3 YEARS

Location	Date	Charge	Penalty

Comments:

List professional, trade, business, or civic activities and offices held.

[You may exclude organizations which indicate race, color,religion, gender, national origin, disabilities, or other protected status.]

Other Qualifications:

Summarize special job-related skills ac quired from employment or other experience.

 

Professional References

List names of 3 persons not related to you with whom you have worked - who are in a position to evaluate your suitability for employment (former work associates/supervisors, teachers)

Name	Title	Company	Telephone

Applicant's Statement

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision., including but not limited to a criminal background check, employment verification, reference checking, and a DOT motor vehicle report. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge at any time with or without case. It is further understood that this "at will" employment relationship may not be changed by any writing by authorized executive of this organization. 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 the employer. I understand that pre-employment testing will be required for employment. I hereby understand that I am required to provide the Company's designated medical provider, with complete and accurate medical information on the Medical Examination Report during the Pre-Placement physical. I understand that if I provide false, misleading, incomplete or inaccurate medical information, it will result in my application being rejected, or, if I am hired, in my employment being terminated. By clicking "Submit by Email" on the next page, I am agreeing to this Applicant's Statement.

APPLICANT DISCLOSURE AND AUTHORIZATION FORM
[IMPORTANT -- PLEASE READ CAREFULLY BEFORE SIGNING AUTHORIZATION]
DISCLOSURE REGARDING BACKGROUND INVESTIGATION

I hereby authorize Career Creations Inc., d/b/a Snelling Staffing Services, LLC and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment purposes and to provide a copy of the report to the company considering an offer of employment to me, Doll Distributing, LLC.

Snelling Staffing ("The Company") may obtain information about you from a consumer reporting agency for employment purposes. Thus, you may be the subject of a "consumer report" and/or an "investigative consumer report" which may include information about your character, general reputation, personal characteristics, and/or mode of living, which can involve personal interviews with sources such as your neighbors, friends, or associates. These reports may contain information regarding your credit history, criminal history, social security verification, motor vehicle records ("driving records"), verification of your education or employment history, worker's compensation injuries, or other background checks. You have the right, upon written request made within a reasonable time after receipt of this notice, to request disclosure of the nature and scope of any investigative consumer report. Please be advised that the nature and scope of the most common form of investigative consumer report obtained with regard to applicants for employment is an investigation into your education and/or employment history conducted by [One Source, The Background Check Company, PO Box 24148 Omaha, NE 68124, 1.800.608.3645] or another outside organization. The scope of this notice and authorization is all-encompassing, however, allowing [Employer] to obtain from any outside organization all manners of consumer reports and investigative consumer reports now and throughout the course of your employment to the extent permitted by law. As a result, you should carefully consider whether to exercise your right to request disclosure of the nature and scope of any investigative consumer report.

ACKNOWLEDGMENT AND AUTHORIZATION

I acknowledge receipt of the DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of "consumer reports" and/or "investigative consumer reports" by the Company at any time after receipt of this authorization and throughout my employment, if applicable. To this end, I hereby authorize, without reservation, any law enforcement agency. administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by [One Source, The Background Check Company, PO Box 24148 Omaha, NE 68124, 1.800.608.3645], another outside organization acting on behalf of [Employer], and/or [Employer] itself. I agree that a facsimile ("fax"), electronic or photographic copy of this Authorization shall be as valid as the original.

New York applicants or employees only: You have the right to inspect and receive a copy of any investigative consumer report requested by [Employer] by contacting the consumer reporting agency identified above directly.

Minnesota and Oklahoma applicants or employees only: Please check this box if you would like to receive a copy of a consumer report if one is obtained by the Company.

California applicants or employees only: By signing below, you also acknowledge receipt of the NOTICE REGARDING BACKGROUND INVESTIGATION PURSUANT TO CALIFORNIA LAW. Please check this box if you would like to receive a copy of an investigative consumer report or consumer credit report at no charge if one is obtained by the Company whenever you have a right to receive such a copy under California law.

Name:	Last:	First:	Middle:
Other Names/Alias
Social Security* #		Date of Birth*
Driver's License #		State of Driver's License
Phone Number
Present Address
City/State/Zip
All Previous Addresses in the Last Seven Years
Signature**: By clicking the "Submit by Email" button below, this acts as your signature for release.			Date:
*This information will be used for background screening purposes only and will not be used as hiring criteria.

Snelling Release for Consumer Report And Investigative Consumer Report Information

In connection with any consumer report and/or investigative consumer report ("Report") that I authorized Snelling Employment, LLC, dba Snelling, Snelling Services, LLC, dba Snelling or their designated agents and representatives (collectively "Snelling") to obtain through the use of an outside vendor as part of the hiring process, except as otherwise prohibited by law, I hereby release, waive, discharge, exonerate and agree not to sue Snelling, the vendor who generated the Report or it’s agents, representatives, employees, independent contractors, officers, directors, and shareholders (collectively "the Report Vendor") from and for any all claims, damages, losses, liabilities, rights expenses, demands, causes of actions of any nature whatsoever arising out of or related to such Report or any information, documents or records provided in connection therewith, whether such information, documents or records are provided directly to Snelling or the Report Vendor by me, or obtained independently by Snelling or the Report Vendor, my prospective or current employer , or its agents on my behalf.

Signature**: By clicking the "Submit by Email" button below, this acts as your signature for release.

Date:

By submitting this via email, I hereby grant permission to Career Creations Inc., d/b/a Snelling Staffing Services, LLC to conduct a background search.

Notification to Testing

I understand that, Doll Distributing LLC, requires pre-placement drug testing for all prospective employees in any position. The prospective employee must submit to a controlled substance test involving collection of urine to include marijuana, cocaine, amphetamines (including methamphetamine), opiates and phencyclidine (PCP). I understand that, if I test positive for the use of controlled substance, I will not be qualified for employment at Doll Distributing LLC. I also understand I will be given a reasonable opportunity to confer with the company's medical review officer (MRO) before any positive drug test result is report to the company. The MRO will maintain the results of the drug test with the company, who will report to eh company whether the test result was negative or positive. The results of any test will not be released to any additional parties, except as provided by state or federal law, without my written authorization.

I further understand that the Federal Motor Carrier Safety DOT 49CFR, section 382.307 requires prospective employees to submit to a controlled substance test involving collection of urine to include marijuana, cocaine, amphetamines (including methamphetamine), opiates and phencyclidine (PCP). I understand that, if I test positive for the use of a controlled substance, I will not be medically qualified to operate a commercial motor vehicle for interstate commerce. I also understand I will be given a reasonable opportunity to confer with the company's medical review officer (MRO) before any positive drug test result is report to the company. The MRO will maintain the results of the drug test with the company, who will report to eh company whether the test result was negative or positive. The results of any test will not be released to any additional parties, except as provided by state or federal law, without my written authorization.

NOTE: Please retain this information for your records only. NO signature is needed for this form.

NOTE: Applicants 17 years old and younger will require signature of parent or guardian. Please ask for this form if under age 18.

Resume

(Optional)Filename:

Motor Vehicle Record

(Optional)Filename:

Where to send this application: