Online Employment Application

APPLICANT NAME*

STREET ADDRESS*

CITY*

EMAIL

POSITIONS APPLIED FOR*

IF HIRED, CAN YOU FURNISH PROOF YOU ARE LEGALLY ELIGIBLE TO WORK IN THE U.S?*
YESNO

HAVE YOU WORKED FOR THIS COMPANY BEFORE?*
YESNO

REFERRED BY

IF YES, PLEASE EXPLAIN IN DETAIL (CONVICTION OF A FELONY IS NOT AN AUTOMATIC DISQUALIFICATION TO EMPLOYMENT - ALL CIRCUMSTANCES WILL BE CONSIDERED.):

EMPLOYER

ADDRESS

CITY

WERE YOU SUBJECT TO THE FMCSRs≠ WHILE EMPLOYED?
YESNO

WAS YOUR JOB DESIGNATED AS A SAFETY-SENSITIVE FUNCTION IN ANY DOT-REGULATED MODE SUBJECT TO THE DRUG AND ALCOHOL TESTING REQUIREMENTS OF 49 CFR PART 40?
YESNO

REASON FOR LEAVING

I authorize Rohrer's Incorporated, its agents, employees, or representatives to make such investigations of my employment, education, financial, driving, and/or other related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools, health care providers, licensing authorities, and other persons, corporations, or organizations from all liability to inquiries and releasing truthful information, in a lawful manner, in connection with my application.

I certify that all information I have provided in order to apply for and secure work with Rohrer’s Incorporated is true, complete, and correct. I understand that any false, misleading, or omitted information in my application or interview(s) may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date. I understand, also, that I am required to abide by all rules and regulations of the Company.

I understand that if I am extended an offer of employment, it may be conditioned upon my successfully passing a pre-employment physical and/or drug and/or alcohol screen examination. I hereby consent to both pre- and/or post-employment physical and drug and/or alcohol screen exams as a condition of employment, if required. Federal Motor Carrier Regulations Part 282 Controlled Substances and Alcohol Use Testing applies to CDL drivers of this company; tests will be administered in compliance with the Federal Motor Carrier Safety Regulations.

I understand this application or subsequent employment does not create a contract of employment nore guaranteed employment for any definite period of time. if employed, I understand that employment is on an at-will basis, and this means that Rohere’s Incorporated or I can terminate the relationship, at any time, with or without cause and/or notice.

For commercial drivers/mechanics: I understand that information I provide regarding current and/or previous employers will be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand I have the right to:

Review information provided by previous employers; Have errors in the information corrected by previous employers to re-send the corrected information to the prospective employer; and Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.