Application for Employment

L.J. Rogers Trucking treats all employees and applicants for employment without unlawful discrimination as to race, creed, color, national origin, sex, age, disability, marital status, sexual orientation, past, present, future service in the uniformed services, genetic carrier status or citizenship status in all employment decisions, including but not limited to recruitment, hiring, compensation, training and apprenticeship, promotion, upgrading, demotion, downgrading, transfer, lay-off and termination, and all other terms and condition of employment.

 
Step
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Required Fields
   
 
Applying As
 
Contractor Name
Contract Phone
( ) -  Ext.   
 
   
General Information
   
 
First Name
Middle Name
Last Name
Maiden Name or Other
Social Security No.
Birth Date
 
Height
Weight
 
   
Address
   
 
Address 1
Address 2
City
State
Postal/Zip Code
 
   
Contact Information
   
 
Email Address
 
Alt. Email Address
 
Day Phone No.
( ) -  Ext.   
Evening Phone No.
( ) -  Ext.   
 
   
Family Information
   
 
Spouse's First Name
Spouse's Last Name
No. of Dependents
Age of Dependants
Spouse's Employer
Spouse's Phone No.
( ) -  Ext.   
 
   
Emergency Contact
   
 
First Name
Last Name
Phone No.
( ) -  Ext.   
Alternative Phone No.
( ) -  Ext.   
Relation
  Add
 
   
Education/Military
   
 
Highest Grade Completed
Highest College Completed
Other Education
Served in the Military
Branch
Date From
 
Date To
 
Date of Discharge
 
Rank at Discharge
Type of Discharge
 
   
List All Residences & Dates for the Last Three (3) Years
   
 
Address 1
Address 2
City
State
Postal/Zip Code
Date From
 
Date To
 
  Add