Application | Upper Lakes Foods

Your Name*
First Last
Email*
Address
Street Address City State / Province / Region ZIP / Postal Code
Cellular Phone Number*
Emergency Contact Phone Number*
How did you find out about this position?
Have you previously worked for Upper Lakes Foods Inc.?*
- Yes
- No
Date of previous employment*
Supervisor's Name*
If hired, can you provide evidence of legal eligibility to work in the U.S.?*
- Yes
- No
Any offer of employment is conditioned upon completing form I-9 and providing the appropriate documents for identity and work authorization.

Position Desired*
Wage/Salary Desired
Are you available part time, full time, or both?
- Part time
- Full time
Date you can begin work
Ar you 18 years of age or older?*
- Yes
- No
If under 18 years of age, you will be required to submit a birth certificate or work certificate as required by state or federal law.
Your Availability for Work
Total hours per week you are available to work
Do you have any special requests or needs for a work schedule?

Name of High School Attended*
High School City & State*
Did you graduate from high school?
- Graduate
- GED
Name of College or Technical School Attended
College/Technical School City & State
Did you graduate from this college/technical school?
- Yes
- No
College/Technical Degree
College/Technical Major
Are you presently enrolled in school?
- Yes
- No
Name of Current School
Location of Current School
Expected Date of Graduation
List any job-related skills or accomplishments, membership in any professional organizations, including military service

Previous Employment
Please tell us about where you've worked, beginning with your most recent employer.
Name of Employer
Employer Address
Street Address City State / Province / Region ZIP / Postal Code
Name of Supervisor
First Last
Supervisor's Phone Number
Job Title
Duties
Employment Start Date
Employment End Date
Starting Pay or Salary
Ending Pay or Salary
Reason for Leaving
Second Most-Recent Employer
Name of Employer
Employer Address
Street Address City State / Province / Region ZIP / Postal Code
Name of Supervisor
First Last
Supervisor's Phone Number
Job Title
Duties
Employment Start Date
Employment End Date
Starting Pay or Salary
Ending Pay or Salary
Reason for Leaving
Third Most-Recent Employer
Name of Employer
Employer Address
Street Address City State / Province / Region ZIP / Postal Code
Name of Supervisor
First Last
Supervisor's Phone Number
Job Title
Duties
Employment Start Date
Employment End Date
Starting Pay or Salary
Ending Pay or Salary
Reason for Leaving

Provide three references (not relatives) who we may contact
Name of Reference #1*
First Last
How do you know them, and for how long?*
Reference #1 Phone Number*
Name of Reference #2*
First Last
How do you know them, and for how long?*
Reference #2 Phone Number*
Name of Reference #3*
First Last
How do you know them, and for how long?*
Reference #3 Phone Number*

List all addresses at which applicant has resided during the 3 years preceeding the date on which the application is submitted
Address City, State
Date of Birth*
Can you provide proof of age?*
- Yes
- No
Social Security Number*
Previous Employers
Employer Address Dates of Employment Reason for Leaving Subject to FMCSRs? Subject to alcohol and controlled substances testing?

List previous employers from the last 10 years from date of application.
Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you applied for, but did not obtain, safety-sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?
- Yes
- No
Have you sucessfully completed the return-to-duty process?*
- Yes
- No
Documentation must be provided before any safety-sensitive transportation function is performed.
Have you had an accident in the past 3 years or more?*
- Yes
- No
Accident Record
Date of Accident Nature of Accident (head-on, rear-end, upset, etc.) Injuries Fatalities
Have you had a traffic conviction or forfeiture in the past 3 years, other than parking violations?*
- Yes
- No
Traffic Convictions and Forfeitures
Location Date Charge Penalty
Driver Licences
State Licence No. Type Expiration Date
Have you ever been denied a license, permit or privilege to operate a motor vehicle?
- Yes
- No
Has any license, permit or privilege ever been suspended or revoked?
- Yes
- No
Please provide details about the licence(s) being denied, suspended, or revoked.
Do you have previous experience employed as a driver?*
- Yes
- No
Driving Experience*
Vehicle Class Type of Equipment (van, tank, flat, etc.) Start Date End Date Total No. of Miles (approx.)
List states operated in for last five years*
List any safe driving awards you hold
Award Issued By
List any special courses or training that will help you as a driver
List any trucking, transportation, or other experience that may help you in your work for this company
List courses and training other than shown elsewhere in this application
List special equipment or technical material you can work with (other than those already shown)
A motor carrier may require an applicant to provide information in addition to the information provided in this application. The information provided in accordance with this application may be used, and the previous employers will be contacted, for the purpose of investigating the applicant’s safety performance history. Applicants have a right to due process as a result of these investigations.
Applicant has the following rights regarding the investigative information that will be provided to the prospective employer:  (i) The right to review information provided by previous employers; (ii) The right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; (iii) The right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and the driver cannot agree on the accuracy of the information.
Drivers who have previous Department of Transportation regulated employment history in the preceding three years, and wish to review previous employer-provided investigative information must submit a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. The prospective employer must provide this information to the applicant within five (5) business days of receiving the written request. If the prospective employer has not yet received the requested information from the previous employer(s), then the five-business days deadline will begin when the prospective employer receives the requested safety performance history information. If the driver has not arranged to pick up or receive the requested records within thirty (30) days of the prospective employer making them available, the prospective motor carrier may consider the driver to have waived his/her request to review the records.
Authorization*
- I certify that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Agree to Terms Before Submitting Application
As an applicant, I understand that any misrepresentation by me on this application will be sufficient cause for cancellation of any consideration for employment and /or separation from employment. I give the employer the right to investigate all references and to secure additional information about me, if job related. I hereby release from liability, UPPER LAKES FOODS, INC. and its representative’s for seeking such information and all other persons, corporations, and organizations for furnishing such information. UPPER LAKES FOODS, INC. is an Equal Opportunity Employer and does not discriminate on the basis of race, color, creed, religion, ancestry, age, national origin, marital status or sexual orientation, gender, disability, social or economic status, or veteran status. This application will remain on file for six (6) months. At the conclusion of six (6) months, if I have not been contacted by UPPER LAKES FOODS, INC. it will be necessary for me to complete a new application. If employed, I understand that my employment is “at-will” and can be terminated at any time by UPPER LAKES FOODS, INC. or myself at any time with or without cause and without prior notice. I understand that no representative of UPPER LAKES FOODS, INC. has the authority to make any assurance to the contrary.
Authorization*
- I understand and agree to the above provisions.

Employment Application

Step 1 of 8

Your Availability for Work

Previous Employment

Second Most-Recent Employer

Third Most-Recent Employer

Provide three references (not relatives) who we may contact

Affirmative Action Applicant Survey - Please Read Carefully

Agree to Terms Before Submitting Application