Required entry fields are followed by * meaning you must provide the requested information to continue. If you encounter any errors during this process and cannot continue, please contact us at 1.800.892.3250.

Name*

First Middle Last

Nick Name / Maiden Name or other names you have used:

Today's Date:*

Social Security #:*

Date of Birth*

Street Address:*

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

Mailing Address:

(If different from Street Address)

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

Phone*

Cell Phone:

Cell Provider:

Email:*

Emergency Contact:*

Name / Relationship / Contact Number

Driver's License #:*

Driver's License State:*

Have you ever been employed by Elite HR Logistics before?

Yes
No

If Yes, please give date and positions

Can you present evidence of your U.S. Citizenship or proof of your legal right to live and work in this country?*

Yes
No

Are you telephone-accessible?

Yes
No

What areas are you willing to work?

WORK EXPERIENCE

List all current and previous employment for a minimum of FIVE (5) YEARS beginning with your most recent employer. Account for all periods of unemployment. Include Military service and any volunteer service that is relevant to the position for which you are applying. Do NOT mark "See Resume". You may attach a Resume at the end of this form, but please fill this form out first.

Are you currently employed?*

Yes
No

If "Yes", May we Contact your current employer?*

Yes
No

PREVIOUS EMPLOYER INFORMATION*

(Enter the last ten (10) years of your job history. Click on the + sign to add more rows of Previous Employer Info.)

Employer:	Contact Information:	From:	To:	Job Title:

ACKNOWLEDGEMENT OF AVAILABLE MODIFIED DUTY

ACKNOWLEDGEMENT OF AVAILABLE MODIFIED DUTY*

I have read and acknowledged.

Elite HR Logistics desires to provide our injured employees with the most expedient and quality medical care for their work related injuries. Elite HR Logistics has developed a modified duty program that will allow our injured workers to return to work on a modified duty status by making accomodations for any work restrictions as outlined by a company authorized physician.

AVAILABILITY

How were you referred to our company?

Date you are available for work:

Salary Rate: MINIMUM / HR

Salary Rate: DESIRED / HR

Type of Employment Accepted:

Choose any / all that apply.

Full Time
Part-Time
Temporary
Temp to Hire
Direct Hire
Direct Hire

Times

Please include Beginning to End Time (i.e., 7AM - 7PM) or ALL if you are available all day.

ADDITIONAL QUESTIONS

Bobtail Experience?

Yes
No

Years of Experience?

Box Truck Driving Experience?

Yes
No

Years of Experience?

Types of Equipment Operated:

ALL DRIVER LICENSES HELD IN PAST 3 YEARS

Use the + icon to add additional License's.

State:	License #:	Class:	Expiration Date:

Are you able to perform the essential functions of the job for which you are applying, either or without reasonable accommodation?

Yes
No

If "No", Describe the functions that cannot be performed.

Do you have any relatives employed with this company?

Yes
No

If "Yes", please list their names and positions:

Have you submitted an application with Elite HR Logistics before?

Yes
No

Have you ever been bonded?

Yes
No

If "Yes", Where?

Have you ever had Security clearance?

Yes
No

If "Yes", at what level?

Have you obtained any special skills as a result of service in the military?

Yes
No

If "Yes", please describe.

Do yo have any other special skills or qualifications which you feel would make you suited for work?

Yes
No

Example: Certified Forklift Operation, Machinist, Welder, Assembly, or Warehouse etc.

If "Yes", please describe.

Do you have a license or certificate for a particular skill?

Yes
No

If "Yes", issuing state?

Certified in:

License or Certification #:

Have you ever worked as a temporary employee?

Yes
No

Please list Company Assigned to and the Corresponding Temp Agency:

(For multiple entries use the + icon and list on separate lines)

Company Assigned To:	Temp Agency:

EDUCATIONAL BACKGROUND

Give record of all High Schools, Colleges, Universities, Trade or Vocational Schools you have attended.

High School

Name And Location

Number of Years:

Please enter a number from 1 to 8.

Major Subject or Course:

Degree Or Certificate?

College

Name And Location

Number of Years: (College)

Please enter a number from 1 to 8.

Major Subject or Course: (College)

Degree Or Certificate? (College)

Other School

Name And Location

Number of Years: (Other School)

Please enter a number from 1 to 8.

Major Subject or Course: (Other School)

Degree Or Certificate? (Other School)

Other School #2

Name And Location

Number of Years: (Other School #2)

Please enter a number from 1 to 8.

Major Subject or Course: (Other School #2)

Degree Or Certificate? (Other School #2)

REFERENCES

List three persons not related to you who have knowledge of your work performance within the last three (3) years.

Name:

First Last

Occupation:

Number of Years Known:

Please enter a number from 1 to 50.

Phone:

Name: (Person 2)

First Last

Occupation: (Person 2)

Number of Years Known: (Person 2)

Please enter a number from 1 to 50.

Phone: (Person 2)

Name: (Person 3)

First Last

Occupation: (Person 3)

Number of Years Known: (Person 3)

Please enter a number from 1 to 50.

Phone: (Person 3)

ACCIDENT RECORD FOR PAST 3 YEARS

(Required if Driving)

Date:

Location of Accident:

Type of Vehicle Operated:

Injuries:

Yes
No

FMCSA / DOT-defined Accident:

Yes
No

DOT-preventable Accident:

Yes
No

Circumstances:

Explanation:

Date: (#2)

Location of Accident: (#2)

Type of Vehicle Operated: (#2)

Injuries:: (#2)

Yes
No

FMCSA / DOT-defined Accident: (#2)

Yes
No

DOT-preventable Accident: (#2)

Yes
No

Circumstances: (#2)

Explanation: (#2)

Date: (#3)

Location of Accident: (#3)

Type of Vehicle Operated: (#3)

Injuries: (#3)

Yes
No

FMCSA / DOT-defined Accident: (#3)

Yes
No

DOT-preventable Accident: (#3)

Yes
No

Circumstances: (#3)

Explanation: (#3)

Has your license ever been revoked or suspended by a State or Federal Agency?

Yes
No

State or Federal Agency that suspended license:

Date of Suspension

Please provide statement of circumstances:

IIPP

IIPP - Injury and Illness Prevention Program (IIPP)

The Injury and Illness Prevention Program (IIPP) is a basic written workplace safety program. Title 8 of the California Code of Regulations (T8CCR) section 3203, requires every employer to develop and implement an effective IIPP. An effective IIPP improves the safety and health in your workplace and reduces costs by good management and employee involvement. The documents related to the IIPP are linked on this page. Please take a moment to familiarize yourself with them on the IIPP PAGE - Click here.

I aknowledge and have read these documents.*

Elite HR Logistics Fleet Safety Manual
Elite HR Logistics IIPP Manual
IIPP - Injury and Illness Prevention Program

SUBSTANCE ABUSE TESTING

EMPLOYEE SUBSTANCE ABUSE POLICY

The Policy of the company is to maintain a drug and alcohol free work enviroment that is safe and productive for our employees and others having business with our Company. To meet these objectives, the following policy has been adapted.

"The unlawful use, possession, purchase, sale, distribution or being under the influence of any illegal drug and/or the misuse of legal drugs while on Company or Client premises or while performing services for our Company or Client is strictly prohibited. The Company also prohibits reporting to work or performing services while impaired by the use of alcohol or consuming alcohol while on duty.

In order to ensure compliance with this policy, substance abuse screening may be conducted in the following situations:

Pre-Employment: As may be required / requested by our Company or Clients.
For Cause: Upon reasonable cause to believe that a substance abuse problem exists, testing may be conducted.
Random: Unannounced random selection of employees may be performed.
Post Accident: Any employee involved in an accident/injury while performing services for our Company or Client that results in property damage or bodily injury requiring medical treatment will be required to submit to a substance abuse screening.

Compliance with this policy is a condition of employment. Employees who test positive or who refuse to submit to a substance abuse screening will be subject to termination. Notwithstanding any provision herein, this policy will be enforced at all times in accordance with applicable State Laws.

I have read the EMPLOYEE SUBSTANCE ABUSE POLICY.*

Yes

YOUR RESUME:

Attach your resume below:

Max. file size: 64 MB.

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Signature*

NOW HIRING FORKLIFT OPERATOR FOR OUR OTTUMWA, IA WAREHOUSE!

Job Description

Benefits

Location

Schedule & Pay

Benefits

Requirements

Social Networks

Application Online

ACKNOWLEDGEMENT OF AVAILABLE MODIFIED DUTY

AVAILABILITY

ADDITIONAL QUESTIONS

ALL DRIVER LICENSES HELD IN PAST 3 YEARS

EDUCATIONAL BACKGROUND

REFERENCES

ACCIDENT RECORD FOR PAST 3 YEARS

IIPP

IIPP - Injury and Illness Prevention Program (IIPP)

SUBSTANCE ABUSE TESTING

EMPLOYEE SUBSTANCE ABUSE POLICY

YOUR RESUME: