SUSPENDED FORM

Name

Date of Birth

Phone

Address

Email

Last 4 digits of SSN

What position are you applying for?

Full or part time?

Full time Part time

Available start date

What is your current employment status?

Employed Self-Employed Unemployed Student

Education - Highest diploma completed

From:

Have you ever been convicted of a crime (excluding misdemeanors or traffic violations) which has not been annulled, expunged or sealed by the Court? (a yes response does not automatically disqualify your application)

Yes No

Are you being referred by a business partner, current or past employee of Canyon Transportation (Name):

________________________________________________________________________

Employment History

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List two professional references that we can contact

1 - Name

1 - Company

1 - Email

1 - Phone

2 - Name

2 - Company

2 - Email

2 - Phone

________________________________________________________________________

Certification & Authorization

The above information is true and correct. I understand that, in the event of my employment by the Company, I shall be subject to dismissal if any information that I have given in this application is found to be false or misleading or if I have failed to give any information herein requested, regardless of the time elapsed after discovery. I authorize the Company to inquire into my educational, professional and past employment history references as needed to verify my qualifications for this position. I hereby give my consent to any former employer to provide employment-related information about me to the company and will hold the company and my former employer harmless from any claim made on the basis that such information about me was provided or that any employment decision was made on the basis of such information. I further authorize the Company to obtain any credit, consumer, and/or criminal background information, under the requirements of the Fair Credit Reporting Act (FCRA). If employed, I will be required to provide original documents, which verify my identity and right to work in the United States under the Immigration Reform and Control Act (IRCA) of 1986. The document(s) provided will be used for completion of Form 1-9.