Employment Application

For an opportunity with Xpress, please fill out the application below and upload your resume.

APPLICANT INFORMATION

Name:

Current Address:

City:

State:

Zip:

Home Phone:

Alternate Phone (Cell or Pager):

E-mail Address:

Date Available:

Desired Salary:

Position Applied For:

Are you a citizen of the United States: YES NO

If no, are you authrized to work in the United States: YES NO

Have you ever worked for this company: YES NO

If yes when?:

Have you ever been convicted of a felony: YES NO

If yes, explain:

If applying for a driving position, Do you have a valid MICHIGAN Chauffeur's License?

YES NO

If applying for a driving position, Have you any experience chauffeuring individuals with disabilities?

YES NO

EDUCATION

Highschool:

Highschool Address:

From: To:

Did you graduate?: YES NO

Degree:

College:

College Address:

From: To:

Did you graduate?: YES NO

Degree:

Other:

Other Address:

From: To:

Did you graduate?: YES NO

Degree:

REFERENCES

Please list three professional references

Full Name:

Relationship: Company:

Phone:

Address:

Full Name:

Relationship: Company:

Phone:

Address:

Full Name:

Relationship: Company:

Phone:

Address:

PREVIOUS EMPLOYMENT

Company:

Phone: Supervisor:

Address:

Job Title:

Starting Salary: $ Ending Salary: $

Reason For Leaving:

From: To:

May we contact your previous supervisor for a reference?: YES NO

Company:

Phone: Supervisor:

Address:

Job Title:

Starting Salary: $ Ending Salary: $

Reason For Leaving:

From: To:

May we contact your previous supervisor for a reference?: YES NO

Company:

Phone: Supervisor:

Address:

Job Title:

Starting Salary: $ Ending Salary: $

Reason For Leaving:

From: To:

May we contact your previous supervisor for a reference?: YES NO

DISCLAIMER & SIGNATURES

I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Initials with "@" symbol: Date (MM/DD/YYYY):