Lifts Transportation Full Application

EMPLOYMENT APPLICATION

(PLEASE PRINT AND COMPLETELY ANSWER ALL QUESTIONS)

Our company, Abacus Transportation, LLC, DBA Lifts Transportation DBA Medtrex, (“Company”) fully subscribes to the principles of Equal Employment Opportunity. It is our policy to provide employment, compensation, and other benefits related to employment based on qualifications, without regard to race, color, religion, national origin, age, sex, veteran status, genetic information, disability, or any other basis prohibited by federal, state or local law. In accordance with requirements of the Americans with Disabilities Act and applicable federal, state and/or local laws, it is our policy to provide reasonable accommodation upon request during the application process to applicants in order that they may be given a full and fair opportunity to be considered for employment. As an Equal Opportunity Employer, we intend to comply fully with applicable federal, state, and/or local employment laws, and the information requested on this application will only be used for purposes consistent with those laws. To the extent required by applicable law, The Company maintains a smoke-free workplace.

COMPANY NAME: Abacus Transportation, LLC

Position Applied For:

Date:

PERSONAL DATA

Full Name:

First

Middle

Last

Email:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Phone:

Salary Expectations:

If you are under 18 years of age, please specify your age:

(This information will be used only for child labor law purposes).)

Are there any days, shifts or hours you will not work?*

(*Note: It is not necessary for you to identify unavailability for work because of religious observance or practice or any other protected classification. Subsequent to any job offer, we will consider whether a reasonable accommodation can be made.)

If yes, please explain:

Are you available for out of town work?*

Will you work overtime, if required?*

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EMPLOYMENT HISTORY

Please complete for all full-time or part-time employment beginning with most recent employer. You may

include as part of your employment history any verified work performed on a volunteer basis. All applicants should start with their most recent job, include military assignments and voluntary employment, and provide ten (10) years of history. (A separate sheet may be attached.) You must explain any gaps in your employment history.

EMPLOYMENT #1

Company Name:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Date Employeed: From

Rate of Pay: Start

State job titles and describe job duties:

Telephone:

Name of Supervisor:

May we contact:

Date Employeed: To

Rate of Pay: Last

Reason for leaving:

EMPLOYMENT #2

Company Name:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Date Employeed: From

Rate of Pay: Start

State job titles and describe job duties:

Telephone:

Name of Supervisor:

May we contact:

Date Employeed: To

Rate of Pay: Last

Reason for leaving:

EMPLOYMENT #3

Company Name:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Date Employeed: From

Rate of Pay: Start

State job titles and describe job duties:

Telephone:

Name of Supervisor:

May we contact:

Date Employeed: To

Rate of Pay: Last

Reason for leaving:

EMPLOYMENT #4

Company Name:

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Date Employeed: From

Rate of Pay: Start

State job titles and describe job duties:

Telephone:

Name of Supervisor:

May we contact:

Date Employeed: To

Rate of Pay: Last

Reason for leaving:

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Applicant Acknowledgment

I certify that the answers given herein and during the entire application process (including but not limited to any criminal record inquiries made following this application, resumes, attachments to this application, interviews, or otherwise, if applicable) are true and complete to the best of my knowledge.

I understand that any misrepresentations, omissions of facts, or incomplete answers during the application process may disqualify me from further consideration for employment. I further understand that, if employed, any misrepresentations or omissions of facts during the application process may be cause for my dismissal at any time without prior notice.

I consent to and authorize the Company to contact my former employers, references, and any and all other persons and organizations for information bearing upon my qualifications for employment. I further authorize the listed employers, schools, and personal references to give the Company (without further notice to me) any and all information about my previous employment and education, along with any other pertinent information they may have. I hereby waive any actions which I may have against either party(ies) for providing a good faith reference.

I EXPRESSLY AGREE AND UNDERSTAND THAT, IF EMPLOYED, MY EMPLOYMENT IS NOT FOR A SPECIFIC TERM, IS BASED ON MUTUAL CONSENT AND MAY BE TERMINATED BY ME OR THE COMPANY WITH OR WITHOUT NOTICE OR CAUSE AT ANY TIME. I FURTHER UNDERSTAND THAT NO ORAL PROMISE, EMPLOYER POLICY, CUSTOM, BUSINESS PRACTICE OR OTHER PROCEDURE (INCLUDING PERSONNEL HANDBOOK OR ANY PERSONNEL MANUALS) CONSTITUTE AN EMPLOYMENT CONTRACT OR MODIFICATION OF THE AT-WILL EMPLOYMENT RELATIONSHIP BETWEEN ME AND THE COMPANY. I ALSO UNDERSTAND THAT MY AT-WILL EMPLOYMENT STATUS WITH THE COMPANY MAY ONLY BE ALTERED IN AN INDIVIDUAL CASE OR GENERALLY IN A WRITING SIGNED BY THE OWNER, PRESIDENT OR CEO OF THE COMPANY.

I understand I may be required to qualify for employment based on additional employment criteria. For example, I may be required to take job-related tests; take a driver’s examination; submit to a background investigation or take a pre-employment drug test. If I am offered employment or start work before any required test is completed, I understand that my employment is contingent on a satisfactory result on all required tests. I authorize the release of any background check results and of any drug/alcohol test to any state or federal authority requesting such information and in response to a valid subpoena or other legal document. I agree to sign any additional forms necessary for pre-employment checks and/or tests to be conducted.

Full Name

Signature:

Clear Signature

Date:

Please email completed application to info@liftstransportation.com or mail it to:

Abacus / Lifts Transportation - Application 730 Main Street S Pine City, MN 55063

If you have any questions, please feel free to contact Russ Peterson at (320) 390-2379.

Full Application

EMPLOYMENT APPLICATION

PERSONAL DATA

DRIVING RECORD

EDUCATION

HIGH SCHOOL

COLLEGE / UNIVERSITY

Technical / GED

Licenses / Certification / Other

EMPLOYMENT HISTORY

EMPLOYMENT #1

EMPLOYMENT #2

EMPLOYMENT #3

EMPLOYMENT #4

PROFESSIONAL REFERENCES

REFERENCE #1

REFERENCE #2

REFERENCE #3

MILITARY

CHOOSE WHEN YOU WORK

YOUR INCOME YOUR WAY

WORK WITH THE VERY BEST

SAFETY, SPEED,
AND COMFORT.

WE SETTLE FOR NOTHING LESS

SCHEDULE YOUR DRIVE

CONTACT US

Full Application

EMPLOYMENT APPLICATION

PERSONAL DATA

DRIVING RECORD

EDUCATION

HIGH SCHOOL

COLLEGE / UNIVERSITY

Technical / GED

Licenses / Certification / Other

EMPLOYMENT HISTORY

EMPLOYMENT #1

EMPLOYMENT #2

EMPLOYMENT #3

EMPLOYMENT #4

PROFESSIONAL REFERENCES

REFERENCE #1

REFERENCE #2

REFERENCE #3

MILITARY

CHOOSE WHEN YOU WORK

YOUR INCOME YOUR WAY

WORK WITH THE VERY BEST

SAFETY, SPEED, AND COMFORT. WE SETTLE FOR NOTHING LESS

SCHEDULE YOUR DRIVE

CONTACT US

SAFETY, SPEED,
AND COMFORT.

WE SETTLE FOR NOTHING LESS