408 North Interstate 27    Lubbock, Texas 79403-3220

Local: 806/747-2912    Fax: 806/741-1445  

                Online Employment Form                
First Name M.I. Last Name Social Security Number
  -    - 
Address City State Zip
Address (if above is less than 3 years) City State Zip
Home Telephone       E-mail Business Telephone
Position Desired: 1st Choice:  2nd Choice: 
Date of Application: Date Available for Hire: Date of Applicant Birth: Min. Salary Desired:
                                                                                      
Have you ever been employed by Rusty's Weigh Scales & Service Inc.?
Yes       No       If yes, when:
Do you have any relatives or friends employed by Rusty's Weigh Scales & Service Inc.?
Yes       No       If yes, who:
Are you 18 years of age or older?
Yes       No       If no, what is your age:
Are you a citizen of the United States or otherwise lawfully authorized to work in the U.S.?
Yes       No
If you have served in the military, list experience or training which might be related to the job for which you are applying.
Have you ever been convicted of, or plead no contest to a felony or misdemeanor, including charges resulting in a suspended imposition of sentence, suspended execution of sentence, or any period of parole or probation?
Yes       No       Misdemeanor       Felony
If yes, explain:
(Conviction will not necessarily preclude employment)
List all motor vehicle accidents for the past 3 years. Be sure to list all violations of motor vehicle laws or ordinances. Provide a statement of facts and details of circumstances of denial, revocation or license suspension.
(Violations will not necessarily preclude employment)
 

Drivers License

  

State

Number

Expiration

Classifications

 

Education
School
(Begin with HS)
 		 Degree /
Diploma		 Date Received Major Field
High School / City / State
College / City / State
Summarize special job related skills and qualifications acquired from employment or other experience. Please list all experiences in operations of motor vehicles.

 

Work Experience
Start with your present or last job - include military service & periods of unemployment)
Employer (most recent):
 From:        
To:        
Address:
 City / State / Zip:
Supervisor:
 Telephone:
Work Performed:
Hourly Rate / Salary Start:   End:
Was this job DOT Regulated?
Yes       No
Reason for leaving:

 

Employer 2:
 From:        
To:        
Address:
 City / State / Zip:
Supervisor:
 Telephone:
Work Performed:
Hourly Rate / Salary Start:   End:
Was this job DOT Regulated?
Yes       No
Reason for leaving:


 

Employer 3:
 From:        
To:        
Address:
 City / State / Zip:
Supervisor:
 Telephone:
Work Performed:
Hourly Rate / Salary Start:   End:
Was this job DOT Regulated?
Yes       No
Reason for leaving:


 

Please Read Carefully
I certify that the facts contained in this application are true and complete to the best of my knowledge. I understand that, if employed, false information contained in this application may result in immediate discharge at any time during my employment.

I authorize any person or entity listed in this application to provide information which Rusty's Weigh Scales & Service Inc. may request in its evaluation of my qualifications for employment. I further agree that Rusty's Weigh Scale may furnish like information to those with whom I may seek employment in the future. I release all parties from all liability for any damage that may result from such furnishing of information to or by Rusty's Weigh Scale.

I understand that the terms, conditions, compensation, benefits, hours, schedules and duration of employment may be determined, changed or modified from time to time by Rusty's Weigh Scale. I understand further that my employment is at will and can be terminated, with or without cause, and with or without notice, at any time at the option of either Rusty's Weigh Scale or myself.

Pursuant to the requirements of the Fair Credit Reporting Act, it is noted that as part of our employment process a routine inquiry may be made with respect to an applicant's credit status, character, general reputation, personal characteristics and mode of living. Additional information as to the nature and scope of such report, if made, will be provided upon request to the applicant.
This application will remain on file for three (3) months from date of submittal. Further consideration after the three (3) month period will require you to submit a new application. All applications will be destroyed after three (3) months.
I have read the above information and I understand and by checking this box I acknowledge with a digital signature.