Job Application If you need help completing this application, please notify the person who sent you this form. Every effort will be made to have someone help you in a reasonable amount of time. This application will be held on active status for 90 days, beyond which you may reapply. Pre Employment Information A worker's appearance determines how the customers perceive the Home City Ice Company. To convey the image Home City Ice wants, the following is required of Home City Ice Personnel when ON or USING Home City Ice Property: Uniform Clothing (shirts, pants, shorts, jackets and hats) must be Home City Ice issued. When wearing shorts, socks are to be plain white or white with a blue stripe. Workers out of uniform will not be permitted to work until they are in compliance. This may include renting uniforms for the day from the manager. No Tobacco Products (Smoking or Dipping) while working. Necklaces, bracelets and such are to be kept hidden below uniforms. Earrings, piercings of any kind and ear gauges are not permitted. Summer Holidays All employees of The Home City Ice Company are expected to work on weekends and holidays. Especially, the busy main summer holidays Memorial Day, 4th of July and Labor Day. The days preceeding and following those holidays are busy as well. Please keep this in mind, if it is a problem, it could affect your employment opportunity with this company. I have read and accept the Pre Employment Information Personal Information First Name * Middle Name Last Name * Street Address * City * State * Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code * Email * Phone * Location * AL - BIRMINGHAM AL - GUNTERSVILLE AL - HUNTSVILLE AR - MOUNTAIN HOME AR - ROGERS FL - ORLANDO GA - COLLEGE PARK GA - DORAVILLE GA - ELBERTON GA - MACON GA - MARIETTA IL - CHICAGO IL - DECATUR IL - EFFINGHAM IL - ELGIN IL - KANKAKEE IL - MARION IL - MORTON IL - ROCKFORD IL - SPRINGFIELD IL - WOODRIDGE IN - ATTICA IN - CROWN POINT IN - EVANSVILLE IN - EVANSVILLE (MECHANIC) IN - FORT WAYNE IN - INDY (WASH ST) IN - LAWRENCE IN - LOGANSPORT IN - MUNCIE IN - NORTH WEBSTER IN - RICHMOND IN - SOUTH BEND IN - TERRE HAUTE KY - BOWLING GREEN KY - COLUMBIA KY - GREENVILLE KY - LEXINGTON KY - LOUISVILLE KY - MOREHEAD KY - OWENSBORO KY - PADUCAH KY - PIKEVILLE / PRESTONSBURG KY - WILDER (SOUTHERN CINCINNATI / NKY) MD - CUMBERLAND MI - BENTON HARBOR MI - COLDWATER MI - DETROIT MI - GALESBURG MI - GRAND RAPIDS MI - LANSING MI - MOUNT PLEASANT MI - ROCHESTER MI - TRAVERSE CITY MO - BRANSON MO - CAPE GIRARDEAU MO - FARMINGTON MO - KANSAS CITY MO - PACIFIC MO - POPLAR BLUFF MO - ST. LOUIS OH - ABERDEEN OH - ASHLAND OH - AUSTINTOWN OH - BRIDGEPORT OH - CLEVELAND OH - CLEVES (MAINTENANCE) OH - CLEVES (MECHANIC) OH - COLUMBUS OH - DAYTON OH - DELAWARE OH - FOREST PARK (NORTHERN CINCINNATI) OH - GALLIPOLIS OH - LIMA OH - MASSILLON OH - PORTSMOUTH OH - SANDUSKY OH - TOLEDO OH - ZANESVILLE PA - EAST GREENVILLE PA - ERIE PA - HANOVER PA - JOHNSTOWN PA - LANCASTER PA - PHILADELPHIA / HULMEVILLE PA - PITTSBURGH / BETHEL PARK PA - PITTSBURGH / CHESWICK PA - WILKES-BARRE SC - TRAVELERS REST TN - CLARKSVILLE TN - LEWISBURG TN - NASHVILLE TN - PARIS WI - BRISTOL WI - OCONOMOWOC WV - BECKLEY WV - CLARKSBURG WV - GASSAWAY WV - MILTON WV - MORGANTOWN WV - PARKERSBURG Relatives or Friends Employed By Home City Ice Position Any Position Loading Maintenance Mechanic Office Packaging Route Delivery Semi Driver Date of Birth Are you 18 years of age or older? YesNo If under 18, do you have a work permit? YesNo If you are not a U.S. citizen, do you have the right to work in the U.S.A.? YesNo Date to Begin Training Date to Start if Hired Salary Desired ($) Availability Sunday Monday Tuesday Wednesday Thursday Friday Saturday How did you find out about the job opening at the Home City Ice Company? Barefoot Student Careerbuilder College Central Craigslist Email Facebook Flyer Friend Glassdoor Indeed.com Instagram Job Fair LinkedIn Newspaper Post-It School Ad / Newspaper SnagAJob Truck Sign Twitter Walk In WayUp Yard Sign Education Information Grade School Grade Completed Did not attend 1 2 3 4 5 6 7 8 High School Grade Completed Did not attend 9 10 11 12 Did you graduate? YesNo College Years Completed Did not attend 0 1 2 3 4 5 Did you graduate? YesNo Graduate / Technical School Years Completed Did not attend 0 1 2 3 4 Did you graduate? YesNo U.S. Military Service YesNo Rank / Years of Service Active Reserves / Guard YesNo Employment History Add (CDL Drivers Provide Last 10 Years) I have no employment history Driving Experience Type of Vehicles Driven Car Bus Van Straight Truck Tractor Trailer Can you drive a stick shift? YesNo Commercial Vehicle Employer's Name Endorsements Class Driver's License # State Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Year Expires Type CDLOperator Has your license ever been suspended? YesNo How long? Please explain why Do you have auto insurance? YesNo Has your auto insurance ever been canceled or refused? YesNo Traffic Tickets (Convictions - Past 3 Years) Traffic Tickets Add Accident Record (Past 3 Years) Accidents Add References Add Terms and Conditions It is our policy to seek and employ the best qualified personnel and to consider all applicants without regard to race, color, religion, age, sex, national origin or disability that can be reasonably accommodated without undue hardship. I understand that neither this completed application nor a commitment of employment, if made, constitutes a contract of employment. Further, that if I am hired my employment will be at-will, meaning that either myself or my employer may terminate the employment relationship at any time, with or without cause and with or without notice. Offers of employment, if made, become effective only when and if all hiring requirements are satisfactorily completed. Physical exams, drug/alcohol screening, background checks including employment, criminal and driving records may be required. Licensing or other certifications may be required for certain positions. I authorize the investigation of all statements I make on this application or any interviews I may have in the future. If offered employment, I authorize the background records and reference checks required for employment and release those contacts to give any and all pertinent information, personal, medical, or otherwise. I further release and agree to hold harmless this organization and all parties providing information from all liability for any claims or damage that may result from furnishing such information to you. If hired, I agree to comply with all standards set by the employer for workplace conduct, performance and reliability. The information I will give on this application will be true and complete to the best of my knowledge and belief, with my understanding that any false information given now or at any interview will be sufficient reason for immediate dismissal. License Information If you are applying for a driving position, please verify that your license information is correct. License Number License State Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming By clicking Submit, I acknowledge reading and accept the Terms and Conditions. × Previous Position Start Date End Date Company Name Address City State Alabama Alaska Alberta Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Supervisor Name Position Contact Phone Contact Email Reason For Leaving × Traffic Ticket Date Type × Accident Date Who Cited Nature × Reference Name Address Phone Relationship Business Years Known
