Name *

First Name

Last Name

Date *

MM

DD

YYYY

Current Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Permanent Address (If different from above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Date of Birth *

MM

DD

YYYY

Date Available to Begin Work *

MM

DD

YYYY

Have you previously worked for Thrift Development? *

Yes

No

Were you referred to us by someone? *

Yes

No

Do you currently have a valid driver's license? *

Yes

No

Issue Date

MM

DD

YYYY

Expiration Date

MM

DD

YYYY

Have you ever been denied a permit, license, or privilege to operate a vehicle? *

Yes

No

Has your license, permit, or privilege ever been suspended or revoked? *

Yes

No

Have you ever received a citation, been arrested for, or convicted of Reckless Driving or any Alcohol/Drug related driving charge (i.e. DUI, DWI, OVI, etc.)? *

Yes

No

Have you ever been arrested, convicted, or charged with a crime for which jail time was a possible punishment? *

Yes

No

Discharge Date:

MM

DD

YYYY

Before obtaining employment or during your employment with Thrift Development you may be required to submit for testing for use of illegal drugs and Thrift Development may conduct a background check on your motor vehicle and criminal history. Would you object to this? *

Yes

No

Date of Birth

MM

DD

YYYY

Gender *

Male

Female

“I hereby certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules and regulations, and I agree that my employment may be changed, with or without cause, and with or without notice, at any time by the company.” *

Agree

Disagree

Date of Signature *

MM

DD

YYYY