5/21/2013 7:55:08 PM Del Papa Distributing Company Distributor of Anheuser-Busch Family of Beers in Southeast Texas

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APPLICATION FOR EMPLOYMENT
(PRE-EMPLOYMENT QUESTIONNAIRE) (AN EQUAL OPPORTUNITY EMPLOYER)

APPLICANTS WITH A DISABILITY ARE RESPONSIBLE FOR INFORMING A COMPANY REPRESENTATIVE OF THE NEED FOR AN ACCOMMODATION DURING THE APPLICATION PROCESS.
PERSONAL INFORMATION
First Name: SOCIAL SECURITY NUMBER: 
Last Name: 
PRESENT ADDRESS CITY    STATE    ZIP 
PHONE NUMBER # --   DATE OF BIRTH: 
(only required for truck drivers)
CELL PHONE # --  
Email Address:  
ARE YOU AUTHORIZED TO WORK IN THE UNITED STATES? Yes   OR   No
ARE YOU 18 YEARS OR OLDER? Yes   OR   No
ARE YOU 21 YEARS or OLDER> Yes   OR   No
ARE YOU RELATED TO ANYONE WHO IS NOW EMPLOYED BY THIS COMPANY? Yes   OR   No
HAVE YOU BEEN CONVICTED OF, PLED GUILTY TO, OR RECEIVED DEFERRED ADJUDICATION FOR A CRIME? Yes   OR   No
IF YES, EXPLAIN IF YOU WISH. 
EMPLOYMENT DESIRED
POSITIONS
(Hold CTRL and left mouse click to select multiple jobs you are interested in applying for)

 DATE YOU CAN START:    
RATE OF PAY EXPECTED: $.00 (Hourly   Bi-Weekly Annually)
     
LOCATION DESIRED
 
TYPE OF EMPLOYMENT DESIRED
ARE YOU EMPLOYED NOW? Yes   OR   No

IF SO, MAY WE INQUIRE OF YOUR PRESENT EMPLOYER? Yes  OR  No
  
EVER APPLIED TO DEL PAPA/T&S FLEET SERVICES BEFORE? Yes   OR   No

          WHEN?
WHO REFERRED YOU
TO THIS COMPANY?		 EMPLOYMENT
      AGENCY		 NEWSPAPER
      ADVERTISEMENT		 WALKED IN COLLEGE PLACEMENT
STATE EMPLOYMENT
      OFFICE		 OTHER: DEL PAPA / T&S FLEET SERVICES EMPLOYEE
      (THEIR NAME: )
EDUCATION   (IF ASKED TO PARTICIPATE IN AN INTERVIEW, EVIDENCE OF EDUCATION COMPLETED WILL BE REQUIRED; DIPLOMA, TRANSCRIPT, ETC.)  IF YOUR SCHOOL RECORDS ARE UNDER A DIFFERENT NAME THAN LISTED ABOVE, PLEASE ENTER THAT NAME: 
SCHOOL LEVEL NAME & LOCATION # OF YEARS ATTENDED DID YOU GRADUATE? SUBJECTS STUDIED
HIGH SCHOOL  
COLLEGE
TRADE, BUSINESS, OR CORRESPONDENCE SCHOOL
OTHER
SERVICE RECORD
HAVE YOU EVER BEEN IN THE MILITARY SERVICES? Yes   OR   No
IF YES, BRANCH:
AND DATES OF SERVICE:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)

EMPLOYMENT FOR THE PAST 10 YEARS
List complete information in this section. We will make every effort to contact previous employers, therefore correct telephone numbers and contact names are very important. Use a phone book or call information if necessary.
CURRENT / LAST EMPLOYER NAME: 
ADDRESS: Street/Box  City   State   Zip 
SUPERVISOR/CONTACT PERSON:    PHONE --    FAX --
POSITION:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)
EARNINGS: $ (Hourly   Bi-Weekly Annually)
REASON FOR LEAVING 
2nd LAST EMPLOYER NAME: 
ADDRESS: Street/Box  City   State   Zip 
SUPERVISOR/CONTACT PERSON:    PHONE --    FAX --
POSITION:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)
EARNINGS: $ (Hourly   Bi-Weekly Annually)
REASON FOR LEAVING 
3rd LAST EMPLOYER NAME: 
ADDRESS: Street/Box  City   State   Zip 
SUPERVISOR/CONTACT PERSON:    PHONE --    FAX --
POSITION:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)
EARNINGS: $ (Hourly   Bi-Weekly Annually)
REASON FOR LEAVING 
4th LAST EMPLOYER NAME: 
ADDRESS: Street/Box  City   State   Zip 
SUPERVISOR/CONTACT PERSON:    PHONE --    FAX --
POSITION:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)
EARNINGS: $ (Hourly   Bi-Weekly Annually)
REASON FOR LEAVING 
5th LAST EMPLOYER NAME: 
ADDRESS: Street/Box  City   State   Zip 
SUPERVISOR/CONTACT PERSON:    PHONE --    FAX --
POSITION:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)
EARNINGS: $ (Hourly   Bi-Weekly Annually)
REASON FOR LEAVING 
6th LAST EMPLOYER NAME: 
ADDRESS: Street/Box  City   State   Zip 
SUPERVISOR/CONTACT PERSON:    PHONE --    FAX --
POSITION:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)
EARNINGS: $ (Hourly   Bi-Weekly Annually)
REASON FOR LEAVING 
7th LAST EMPLOYER NAME: 
ADDRESS: Street/Box  City   State   Zip 
SUPERVISOR/CONTACT PERSON:    PHONE --    FAX --
POSITION:  From: (mm/dd/yyyy) To: (mm/dd/yyyy)
EARNINGS: $ (Hourly   Bi-Weekly Annually)
REASON FOR LEAVING 
IS THERE ANY REASON YOU MIGHT BE UNABLE TO PERFORM THE FUNCTIONS OF THE JOB FOR WHICH YOU HAVE
APPLIED?  Yes   OR   No
IF YES, EXPLAIN IF YOU WISH. 
WHICH PREVIOUS JOB DID YOU LIKE THE BEST? 
WHY? 
WHICH PREVIOUS JOB DID YOU LIKE THE LEAST? 
WHY? 
 
WORK AVAILABILITY  
(Please indicate times available to work on each day. Please label times with AM and PM.
If available all day, type "ALL", if unavailable, please type "NONE.")

Sunday Monday Tuesday Wednesday Thursday Friday Saturday
To To To To To To To
REFERENCES 
(Preferably individuals who are knowledgeable about your work ability. Do not include relatives.)
NAME CONTACT PHONE NUMBER RELATIONSHIP YEARS ACQUAINTED
1.
2.
3.
   FOR APPLICANTS APPLYING FOR A POSITION REQUIRING THE OPERATION OF A VEHICLE.
STATE ISSUED LICENSE NO. TYPE EXPIRATION DATE
    A. HAVE YOU EVER BEEN DENIED A LICENSE, PERMIT OR PRIVILEGE TO OPERATE A MOTOR VEHICLE? Yes   OR   No
    B. HAS ANY LICENSE, PERMIT OR PRIVILEGE EVER BEEN SUSPENDED OR REVOKED? Yes   OR   No
     ACCIDENT RECORD
     LIST ALL ACCIDENTS IN WHICH YOU WERE INVOLVED AS A DRIVER DURING THE PRECEDING FIVE YEARS.
DATE NATURE NUMBER OF FATALITIES PERSONS INJURED
     TRAFFIC VIOLATION RECORD
     LIST ALL VIOLATIONS OF MOTOR VEHICLE LAW OR ORDINANCES (OTHER THAN VIOLATIONS INVOLVING ONLY PARKING) OF WHICH YOU  WERE CONVICTED OR FORFEITED BOND OR COLLATERAL DURING THE THREE YEARS PRECEDING DATE OF THIS APPLICATION.
DATE NATURE NUMBER OF FATALITIES
     PREVIOUS DRIVING EXPERIENCE
(A) HAVE YOU BEEN EMPLOYED AS A DRIVER BY OTHER MOTOR CARRIERS PRIOR TO DATE OF THIS
APPLICATION?  Yes   OR   No
(B) IF SO, HOW LONG (in months) DID YOU OPERATE: 
STRAIGHT TRUCKS  TRACTORS AND SEMI-TRAILERS
OIL FIELD WINCH-TYPE TRUCKS TRACTOR-TANK SEMI-TRAILERS
TRUCKS AND POLE TRAILERS
(C) GIVE THE LENGTH OF TIME YOU WERE ENGAGED IN TRANSPORTING: 
GENERAL FREIGHT (REGULAR ROUTES)
MACHINERY AND HEAVY CARGO
PERISHABLES
LIQUIDS
OTHER (STATE KIND)

     AUTHORIZATION

I CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS CORRECT TO THE BEST OF MY KNOWLEDGE, AND I UNDERSTAND THAT ANY FALSE OR MISLEADING INFORMATION ON THIS APPLICATION IS GROUNDS FOR REJECTION OF THIS APPLICATION OR TERMINATION. I AUTHORIZE INVESTIGATIONS AND INQUIRIES OF MY PERSONAL, EMPLOYMENT, DRIVING, AND/OR FINANCIAL HISTORY, AND OTHER RELATED MATTERS BY THE COMPANY AND/OR ITS AGENTS AS MAY BE NECESSARY IN ARRIVING AT AN EMPLOYMENT DECISION. I AUTHORIZE, WITHOUT RESERVATION, ALL FORMER EMPLOYERS, REFERENCES, SCHOOLS, INFORMATION SERVICE BUREAUS, AND OTHER PERSONS TO PROVIDE ANY AND ALL INFORMATION THEY MAY HAVE CONCERNING MY BACKGROUND, AND RELEASE ALL PARTIES FROM ALL LIABILITY FOR ANY DAMAGE. IF, AFTER AN APPLICANT HAS BEEN HIRED, THE COMPANY LEARNS THAT THE APPLICANT HAS BEEN CONVICTED OF A CRIMINAL OFFENSE, THE COMPANY RESERVES THE RIGHT TO CONSIDER SUCH CONVICTION IN DETERMINING WHETHER THE EMPLOYEE WILL REMAIN EMPLOYED WITH THE COMPANY I AGREE TO CONFORM TO THE RULES AND REGULATIONS OF PAPA DISTRIBUTING COMPANY OR T&S FLEET SERVICES. I UNDERSTAND THAT MY EMPLOYMENT AND COMPENSATION CAN BE TERMINATED, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT NOTICE, AT ANY TIME. I UNDERSTAND THAT NO REPRESENTATIVE OR AGENT OF DEL PAPA DISTRIBUTING COMPANY, OR T&S FLEET SERVICES, OTHER THAN THE PRESIDENT OF THE COMPANY, HAS ANY AUTHORITY TO ENTER INTO ANY AGREEMENT FOR EMPLOYMENT FOR ANY SPECIFIC PERIOD OF TIME, OR TO MAKE ANY AGREEMENT CONTRARY TO THE FOREGOING. ANY MODIFICATION OF THIS POLICY, OR AGREEMENT CONTRARY TO THE FOREGOING, MUST BE SIGNED BY THE PRESIDENT, AND MUST SPECIFICALLY REFER TO THE EMPLOYEE WHO RELIES ON SUCH MODIFICATION OR AGREEMENT. I AM ALSO AWARE OF CONSENT TO A DRUG AND ALCOHOL SCREEN AS PART OF A PHYSICAL EXAMINATION PRIOR TO ASSUMING MY WORK DUTIES.I UNDERSTAND THAT IF THE DRUG AND ALCOHOL TEST IS POSITIVE, THE JOB OFFER WILL BE WITHDRAWN.