Employment Application | Consolidated Scrap Resources

Personal Information

Name*

First Last

Address

Street Address City State ZIP

Home Phone

Cell Phone

Email*

Which CSR locations applying for?

Harrisburg
York
Lebanon
Gettsburg

Position Desired

Pay Expected

Will you work overtime if asked?

Yes
No

When will you be avilable to begin work?

Apart from absence for religious observance, are you available for full-time work?

Yes
No

If no, what hours can you work?

Have you ever been convicted of a felony or misdemeanor?

Yes
No

If yes, please explain

Are you legally eligible for employment in the United States?

Yes
No

In the past three years, have you tested positive for illegal drugs or alcohol?

Yes
No

If yes, do you have documented evidence of completing the DOT Return-to-Duty process?

Yes
No

In the past three years, have you refused to take a drug or alcohol test?

Yes
No

If yes, have you completed the DOT Return-to-Duty requirements?

Yes
No

“What, if any, endorsements or restrictions do you have on your license?”.

Do you have any special training or skills?

(languages, machine operation, computer software, etc.)

Education

High School, College, and Business/Trade/Technical

School Name & Location	Course of Study	Did you Graduate?	Degree or Diploma

Employment History

Please give accurate, complete full-time and part-time employment record for the last 5 years. Start with your present or most recent employer.

Current/Previous Employers

Employer Name & Location	Dates Employed	Position	Weekly Pay	Name/Phone of Supervisor

Military

Have you served in the U.S. Armed Forces?

Yes
No

If yes, in what Branch?

Describe any training received relevant to the position for which you are applying.

Driver Experience and Qualifications

Only those applying for Class “A” or “B” CDL should complete the following section.

Driver Licenses

State	Type	Expiration Date

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

Yes
No

Please explain:

Has any license, permit or privilege ever been suspended or revoked?

Yes
No

Please explain:

Driving Experience

Type of Equipment	Dates (From – To)	Approx. Number of Total Miles

Straight Truck / Tractor and Semi-Trailer / Tractor – Two Trailers / Other

List States operated in for last five years

Special courses or training that will help you as a driver

Which safe driving awards do you hold and from whom?

Accident Record for Past 3 Years

Dates	Nature of Accident	Fatalities	Injuries

Traffic Convictions and Forfeitures for the Past 3 Years

Location	Date	Charge	Penalty

E-Sign

Please read before signing:*

This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application and release any and all persons, companies or agencies responding to such investigations from any liability for releasing information. I understand that the Company may request information on my driving record from state and DOT agencies and I hereby authorize such investigations. I understand that I may be required to register with the Federal Motor Carrier Safety Administration (FMCSA) Drug & Alcohol Clearinghouse to authorize Consolidated Scrap to conduct a full query. I also understand that the misrepresentation or omission of facts called for in this application is cause for rejection of this application and/or subsequent dismissal from employment.

I further understand and agree that I may be required to take a post-offer/pre-employment physical or mental examination. I understand that I may be required to submit a substance abuse test as a condition of hiring or continued employment. I hereby agree to take such tests at such time and place designated by the Company and release the Company, its officer, directors, agents or employees from any and all claims arising in connection with the conduct of said tests or the use of the information obtained therefrom. I understand that I may be asked as part of the post-offer/pre-employment physical process about whether I use tobacco or nicotine products and/or be subject to testing for nicotine in my system. I further understand that if I am hired by CSR and qualify for health benefits under the CSR plan, my health insurance premium cost may by affected because I use tobacco and/or nicotine products.

I understand and agree that this waiver form remains valid during my tenure as an employee and may be used at any time by Consolidated Scrap for the purpose of obtaining updated information. A copy of this form will be as valid as the original.

I further understand that this application does not constitute a contract for or an offer of employment but is merely one step in the employment process.

I hereby acknowledge that I have read the above statements and understand them completely.

E-Signature

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