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Date of Application:

First Name*

Last Name*

Address*

City*

State*

Zip Code*

Telephone Number*

Driver’s License Number *

CDL Class *

Years of CDL experience?*

Email*

If necessary, the best time to call you: *

Are you legally eligible for employment in the United States?

NoYes

NOTE:Proof of citizenship or immigration status will be required before employment.

Are you 18 years of age or older?

NoYes

Please Choose One:

MaleFemale

What position are you applying for?

Do you have any Special Skills?

Do you have any Household Goods or Furniture Moving Experience?

NoYes

Part-Time or Full-Time Desired?

Part TimeFull TimeSeasonal

Will you work overtime if required?

NoYes

When can you start?

Do you have a reliable way to get to work?

NoYes

Have you ever been employed here before?

NoYes

If Yes, please give the dates:

From To

Have you ever been convicted of a felony including theft or assault in the last seven (7) years?
(Such conviction may be relevant if job related, but does not bar you from employment.)

NoYes

If Yes, please explain:

Education (Please indicate highest level attained and year of graduation, if appropriate.)

High School

Date of Graduation

Level Attained

College

Date of Graduation

Level Attained

Other School

Date of Graduation

Level Attained

How did you hear about this opportunity?

On the Internet (Please tell us where you saw it.)From an Anchor employeeRelativeOther (Please tell us)

Employment History:

Employer

Job Title

Dates Employed

From

To

Hourly Rate / Salary

Employer

Job Title

Dates Employed

From

To

Hourly Rate / Salary

Are you a US Military Veteran?

What Branch did you serve in?

When did you serve?

from

To

Were you honorably discharged?
NoYes

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