Fresh Express & Logistics
235 Quail Court
Santa Paula, Ca. 93060
Office: 805-525-8503
Fax: 805-525-8500 /

Employment Application

APPLICANT INFORMATION

Full Name: /
DOB:

Last

/

First

/

M.I.

Address:

Street Address

/

Apartment/Unit #

City

/

State

/

ZIP Code

Phone: /
Email
Date Available: / ______ /
Social Security No.:
Position Applied for:
Are you a citizen of the United States? / YES / NO /
If no, are you authorized to work in the U.S.?
/ YES / NO
Have you ever worked for this company? / YES / NO /
If yes, when?
Have you ever been convicted of a felony? / YES / NO
If yes, explain: ______

LICENSE INFORMATION

State: ______License NO.: ______
Type: ______Expiration Date:______

REFERENCES

Please list three professional references.

Full Name: /
Relationship:
Company: /
Phone:
Address:
Full Name: /
Relationship:
Company: /
Phone:
Address:
Full Name: /
Relationship:
Company: /
Phone:
Address:

PREVIOUS EMPLOYMENT

Company: /
Phone:
Address: /
Supervisor:
Job Title:
Responsibilities:
From: /
To:
/
Reason for Leaving:
May we contact your previous supervisor for a reference? / YES / NO
Company: /

Phone:

Address: /

Supervisor:

Job Title:
Responsibilities:
From: /

To:

/

Reason for Leaving:

May we contact your previous supervisor for a reference? / YES / NO

DRIVING EXPERIENCE (Applies to Drivers ONLY)

List states operated in, for the last five (5) years: ______

List special courses/training completed (PTD/DDC, HAZMAT, ETC) ______

List any Safe Driving Awards you hold and from whom: ______

Class of equipment used: ______Other: ______

A.  Have you ever been denied a license, permit, or privilege to operate a motor vehicle? YES_____ NO _____

If yes, explain ______

B.  Has any license, permit, or privilege ever been suspended or revoked? YES______NO______

If yes, explain ______

MEDICAL HISTORY (Applies to Drivers ONLY)

Physical Exam expiration date: ______Provider’s Name: ______

Provider’s Address: ______Phone: ______

OTHER INFORMATION

Emergency contact name: ______Phone: ______

Relationship to you: ______

DISCLAIMER AND SIGNATURE

I authorize you to make sure investigations and inquiries to my personal, employment 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 personal from all liability in responding to inquiries and releasing information in connection with my application.

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.

Signature: /

Date:

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