Mcfarlane S Bark, Inc
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McFarlane’s Bark, Inc.
13345 S.E. Johnson Road 8806 N.E. 117th Avenue
Milwaukie, OR 97222 Vancouver, WA 98662
503-659-4240360-892-6125
THIS APPLICATION MUST BE FILLED OUT COMPLETELY and SIGNED
- Applications are kept for 6 months –
DRIVER APPLICANTS COMPLETE ALL PAGES OF THIS APPLICATION
Application for Employment
Where did you hear about this position? ______
Position Applying for ______Date ______
Name ______Phone Number ( )______
Address______
City, State, Zip Code______How Long at this Address?: ______
Previous Address: ______How Long at this Address?: ______
Social Security Number ______Referred by______
Date available to work ______Hours and days of the week you are available ______
______
Are you now employed, on a lay-off and/or subject to recall? (Circle One) YES or NO
Dates From ______To ______
Reason for Leaving Previous Employer ______
Positions(s) Held ______
______
Are you physically capable of heavy manual work? (Circle One) YES or NO
Rate of pay expected ______
Education and/or training related to the job for which you are applying. Equipment able to operate (be very specific).
* EQUAL OPPORTUNITY EMPLOYER ~ Pre Employment Drug and Alcohol Screenis an initial $cost$
to the applicant and returned upon passing screen from the lab*
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Employment Experience
Most recent first – list last three Employers
Employer ______Telephone Number ( )______
Address ______
City, State, Zip ______
Supervisors Name ______Length of Employment From: ______To: ______
Job duties ______
______
Employer ______Telephone Number ( )______
Address ______
City, State, Zip ______
Supervisors Name ______Length of Employment From: ______To: ______
Job duties ______
______
Employer ______Telephone Number ( )______
Address ______
City, State, Zip ______
Supervisors Name ______Length of Employment From: ______To: ______
Job duties ______
By signing below, I certify this application was completed by me and that the information is true and correct. By my signature below I also acknowledge that McFarlane’s Bark, Inc. is a drug and alcohol free work place and with a satisfactory return of the pre employment drug and alcohol screen is a condition of obtaining employment with McFarlane’s. I understand that it is my responsibility to pre pay for the pre-employment drug and alcohol testing. Upon receipt of satisfactory results I will be reimbursed the fee. If I am a Driver Applicant I agree to undertake a pre-employment physical. I also understand that these companies have a Random Testing Program.
Signed ______Date ______
Inquiry To Past Employer Page 3 of 5
To: ______From: McFarlane’s Bark, Inc
Previous Employer Company Name 13345 S.E. Johnson Road
______Milwaukie, OR 97222
Street Address, City, State, Zip CodePhone: 503-659-4240 Fax: 503-659-0237
______
Person to Contact Fax Phone
The person named below has made application for employment as ______
and states that he/she was employed by you as ______from ______(begin date) to ______(end date).
Kindly reply to the inquiry below respecting this applicant. As stated below, the applicant has waived any claim of liability against your company for information submitted in response to this inquiry.
Sincerely,
______
Name of applicant ______Social Security #: ______
Is employment record correct as stated above? ______
If not, please provide correct begin and end dates: ______
What kinds of work did applicant do? ______
If employed as a driver, what equipment was driven?______
Number of accidents ______Number preventable ______
Was applicant’s driver’s license ever suspended or revoked? ______
Reason for leaving your employment ?______
Is applicant competent for the position seeking with our company? ______
Would you re-employ? Yes _____ No _____ Explain: ______
Other remarks: ______
By: ______Date: ______
______Detach here for your files ______
FORMER EMPLOYER LIABILITY RELEASE
Former Employer Name ______Phone ______
I the undersigned applicant authorize my former employer to furnish and release any information regarding my service of employment to my prospective employer, McFarlane’s Bark, Inc.
Applicants Signature ______Date: ______
DRIVER APPLICANTS ONLY Page 4of 5
Commercial License Number ______Class _____Endorsments______Expires ______
Date of Last Physical ______Do you have a D.O.T. Card? (Circle one) Yes or No
ACCIDENTS
DatesNature of AccidentsFatalitiesInjuries
(Head-on, Rear end, etc.)
Other than Parking violations, list the Traffic Convictions and Forfeitures for the last 3 years:
DATELOCATIONCHARGEPENALTY
Has your license or permit ever been denied or suspended? (circle one) Yes or No
If Yes, explain:
DRIVING EXPERIENCE
Class of EquipmentType of EquipmentDatesApproximate Miles
(Van, Tank, Flat, etc.) (Total)
Straight Truck
Tractor & Semi Trailer
Tractor-Two Trailers
Other ______
List States operated in for last 5 years ______
List special courses or training that have helped you as a driver:
List any Safe Driving Awards you hold and from whom ______
Revised: 4/21/16 Remove DJ KMcF, 3/16/11 Corporate Meeting KMcF, 11/9/10 Corporate Resolution, 11/1/01 km 03/11/05 spm
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Request For Check Of Driving Record
Driver and Motor Vehicle Services
Attn: Record Services
1905 Lana Avenue, NE
Salem, Oregon 97314
Oregon.gov records and fees
Dear Sir/Madame,
Please furnish me with my driving record for the past three (3) years of my Employment and Non-Employment Driving Record History; payment is included herein.
Request By:
Name ______
Address ______
Former Address ______
Date of Birth ______State ______License #______
Signature______Date______
DMV Record is required when applying for Driver position at: McFarlane’s Bark, Inc.