DOT EMPLOYMENT APPLICATION

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

Applicants may be tested for illegal drugs after an offer of position is made by Triangle Distributing Co.

Proof of Citizenship or immigration status will be required upon offer of employment.

Name *
Name
Phone Number *
Phone Number
A number you can be reliable reached.
Present Address *
Present Address
If less than 3 years continue on additional sheet.
(Be specific)
Employment Desired *
Check all that apply
Available Start Date *
Available Start Date
Are you currently on "lay-off" status and subject to recall? *
High School Name, Address, Number of Years Completed, Major/Degree
College Name, Address, Number of Years Completed, Major/Degree
Business or Trade School Name, Address, Number of Years Completed, Major/Degree
Professional School Name, Address, Number of Years Completed, Major/Degree
Do you have a valid drivers license? *
Check all that apply/Type of license
Have you had any moving violations in the past 5 years? *
Reference
Reference
Please list references other than relatives
Telephone
Telephone
How do you know this person professionally?
Reference
Reference
Telephone
Telephone
How do you know this person professionally?
Have you ever been in the armed forces? *
Are you now a member of the National Guard?
Walk-in, advertisement, referral, web, other?
Have you ever worked for this company before? *
Do you know anyone who works currently or in the past works for this company? *
If Yes, Who?
If Yes, Who?
Work Experience
Please list your work experience for the past 10 years - beginning with your most recent job held.
Address
Address
Phone
Phone
Supervisor's Name
Supervisor's Name
Employment Start Date
Employment Start Date
Employment End Date
Employment End Date
Leave blank if still employed
Start
End
Be specific
May we contact your current employer?
Address
Address
Phone
Phone
Supervisor's Name
Supervisor's Name
Employment Start Date
Employment Start Date
Employment End Date
Employment End Date
Start
End
Be specific
Address
Address
Phone
Phone
Supervisor's Name
Supervisor's Name
Employment Start Date
Employment Start Date
Employment End Date
Employment End Date
Starting
Ending
Be specific
Address
Address
Phone
Phone
Supervisor's Name
Supervisor's Name
Employment Start Date
Employment Start Date
Employment End Date
Employment End Date
Starting
Ending
Address
Address
Phone
Phone
Supervisor's Name
Supervisor's Name
Employment Start Date
Employment Start Date
Employment End Date
Employment End Date
Start
End
Be specific
If applying for a clerical position a separate questionnaire regarding technical skills will be administered during the interview process.
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. This application for employment shall be considered active for a period of time and not to exceed 30 days. Any applicant wishing to be considered for employment beyond this period of time should inquire as to whether or not applications are 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 the Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. I hereby understand and acknowledge that upon offer of a position involving physical labor I will be asked and will be expected to complete a physical strength evaluation to determine my suitability for the position for which I have applied. 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 and “Code of Conduct” of this employer.
I agree to the terms and conditions above *
Information for applicants of DOT-covered Positions
(Employee DOT acknowledgment form)
Federal law required applicants to indicate whether they have previously refused to be tested or received a positive test on nay pre-employment test for any other DOT employer. Please provide this information below. It is a federal offense to falsify this information. *
Agreeing to the terms below means that you have read this information, that you have had an opportunity to review a copy of the Triangle Distributing Company’s Drug and Alcohol testing policy, and, that if you are offered a position, you consent to begin tested for drugs as a condition of employment.
Each applicant for a DOT-covered position at Triangle Distributing Company, Inc., after being notified that s/he/will be offered a job, must be drug tested, in accordance with federal regulations 49CFR Part 382. If the test result is positive, and if the applicant refuses to submit to a pre-employment test, the job offer will be withdrawn. We must have a negative test result in our file before we can request or allow an employee to perform a safety-sensitive function for us. The cost of the initial screening test and the confirmatory test will be paid by Triangle Distributing company and administered by Bellin Health Solutions. Every applicant who provides a positive test result will have an opportunity to speak with a Medical Review Officer of Bellin Health Solutions about any recounted use of prescription and non-prescription drugs that might explain the positive test result. The applicant whose test result is positive may, within 72 hours, request a re-test, at his/her own expense. The re-test will be conducted on the same sample as was provided for the initial test, and must be conducted by a different testing laboratory that meets the requirements of certification DOT’s testing requirements.
I agree to the terms and conditions above *