THANK YOU FOR APPLYING AT MONROE TRUCK ... Application.pdfWORK HISTORY Have you ever been discharged from a prior employer? Yes No If you answered yes to the above, please explain.

1051 West 7

th

Street

Monroe, WI 53566

608-328-8127 ~ Fax: 608-328-4278

THANK YOU FOR APPLYING AT MONROE TRUCK EQUIPMENT

We only accept applications or resumes for current job openings. When your application is completed, it is forwarded to Human Resources. Applications for the position applied for will be reviewed and a decision will be made as to which applicants will be interviewed. If your application is selected, we will contact you to set up an interview. Because of the large number of applications received, we are not able to contact all applicants regarding the status of their application. However, we do appreciate your interest in Monroe Truck Equipment.

Human Resources

APPLICATION FOR EMPLOYMENT

MONROE TRUCK EQUIPMENT, INC. 1051 W. 7th ST.

MONROE, WI 53566

EOE/M/F/Vet/Disabled

APPLICANT INFORMATIONLast Name: First Name: MI: Date of Application:

Current Address: City: State: Zip Code:

Previous Address: City: State: Zip Code:

Phone: Email:

Are you age 18 or older?

Yes No

Do you have the legal right to live and work in the U.S.? Yes No

EMPLOYMENT DESIREDPosition: Date Available:

Status: Full-Time Part-Time

Shift:

First Third Second Any

Became aware of job by: Walk-in Ad Employment Services Employee: _________________________________

Other: ____________________________________

Have you ever applied for a position with us before?

Yes No

If yes, when? _________________________________

Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?

Yes No

EDUCATION HISTORY – HIGH SCHOOL, TRADE/TECH SCHOOL, COLLEGE, ETC.

NAME OF SCHOOL CITY, STATE

YEARS ATTENDED

DID YOU GRADUATE COURSE OF STUDY/MAJOR

Yes No

No Yes

Yes No

Yes No

Other education, training, special skills or certificates/licenses you possess related to this job:

WORK HISTORYHave you ever been discharged from a prior employer?

Yes No If you answered yes to the above, please explain. An affirmative response will not necessarily disqualify an applicant.

WORK HISTORY (continued)

List the last 10 years’ work experience starting with the most recent. Use additional sheets if necessaryCurrent/Most recent Employer: City, State:

Phone: Employment Begin Date: Employment End Date:

Starting Position: Current/Last Position: Ending Wage:

Your Duties:

Immediate Supervisor: Reason for leaving:

Previous Employer: City, State:

Phone: Employment Begin Date: Employment End Date:

Starting Position: Last Position: Ending Wage:

Your Duties:

Immediate Supervisor: Reason for leaving:

Previous Employer: City, State:

Phone: Employment Begin Date: Employment End Date:

Starting Position: Last Position: Ending Wage:

Your Duties:

Immediate Supervisor: Reason for leaving:

REFERENCESName Business Phone Yrs. Known

If accepted for employment, I hereby agree to comply with all rules and regulations, to perform all assigned duties to the best of my ability, and to assume all responsibility for all

company property entrusted to my care.

I certify that the entries I have made on this form are true and correct to the best of my knowledge and I do understand any omissions or material mis-statements of fact are cause for

dismissal. I authorize investigation of information I have provided without any liability whatsoever arising therefrom. I further agree to undergo such medical examinations as may be

required from time to time during the period of my employment.

I understand and agree that I may terminate my employment at any time without notice or cause and the company possesses a right to terminate my employment or modify our

employment relationship at any time without cause or notice. I understand and agree further, that practices and statements set forth in policies, handbooks or other company literature

do not create an employment contract or term and that the company, at its discretion, may modify, amend or terminate present or future policies and practices relating to wages, hours

benefits and other terms and conditions of employment.

Finally, in consideration of my employment and any wages, salary or other remuneration paid to me by the company, I agree not to communicate or disclose to any person, not

employed by the company, any proprietary knowledge, confidential information or trade secrets acquired be my during my association with the company and that the company shall

have full title to every invention, discovery, or improvement conceived or delivered by me during my employment, and I agree, if requested, to execute such instrument and assignments

as may be necessary to enable the company to obtain letters or patent thereon in the U.S. and elsewhere.

___________________________________________________________________________ _____________________________________

Applicant Signature Date

Rev. 06/2014

DRIVER APPLICANTS ONLY

DRIVER INFORMATION Are you 21 years of age or older? (DOT Required)

Yes No Do you have a valid driver’s license? Yes No

State Licensed In:

Driver License #: License Class:

A B C D

Expiration Date:

Has your license, permit, or privilege to operate a motor vehicle ever been denied, revoked or suspended?

Yes No

If yes, please explain:

DRIVING EXPERIENCE

CLASS OF EQUIPMENT TYPE OF EQUIPMENT

(van, tank, flat, etc.) DATES

From To

APPROX. # OF MILES

(TOTAL)

Straight Truck

Tractor & Semi-Trailer

Tractor-Two Trailers

Other

ACCIDENT RECORD Past 3 years or more (attach sheet if more space is needed)

DATES NATURE OF ACCIDENT

(head-on, rear-end, upset, etc.) INJURIES FATALITIES

Last Accident

Next Previous

Next Previous

TRAFFIC CONVICTIONS/FORFEITURES Past 3 years other than parking violations

DATE LOCATION CHARGE PENALTY

Note: A motor carrier may require an applicant to provide information in addition to the information required by the Federal Motor Carrier

Safety Regulations.

Voluntary Self-Identification

Monroe Truck Equipment is an Equal Opportunity Employer. As required by law, we must record certain

information to be made a part of our Affirmative Action Program. Government agencies at times require

statistical information concerning the sex, ethnicity, veteran, disability and other protected status of our

applicants and employees. So that we can report such information accurately, it would help us if you would

volunteer to supply the information requested in this form.

In extending this invitation you are also advised that: workers (applicants) are under no obligation to respond,

but may do so in the future if they choose; responses will remain confidential within the Human Resources

Department; and responses will be used only for the necessary information to include in our Affirmative Action

Program. We are a company that values diversity. We actively encourage women, minorities, and veterans to

apply. Refusal to provide this information will have no bearing on your application and will not subject you to

any adverse treatment.

Race or Ethnic Identity Protected Veteran Status

☐ Hispanic or Latino

☐ White (not Hispanic or Latino)

☐ Black or African American (not Hispanic or Latino)

☐ Native Hawaiian or Pacific Islander (not Hispanic or Latino)

☐ Asian (not Hispanic or Latino)

☐ American Indian or Alaskan Native (not Hispanic or Latino)

☐ Two or More Races (not Hispanic or Latino)

Disabled Veteran

Recently Separated Veteran

Active Duty Wartime or Campaign Badge

Veteran

Armed Forces Service Medal Veteran

If you believe you belong to any of the categories of

protected veterans listed above, please indicate by

checking the appropriate box below.

☐ I identify as one or more of the classifications of

protected veteran listed above

☐ I am not a protected veteran

Gender

☐ Male

☐ Female

☐ I do not wish to Self-Identify

Applicant Signature: Date:

Applicant Name (printed):

Race/Ethnic Identification Categories

Applicants are considered for employment, and employees are treated during employment, without regard to race, color, national origin, religion, sex, age, marital or veteran status, medical condition or handicap, or any other legally protected status.

Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or

origin regardless of race.

White (Not Hispanic or Latino): A person having origins in any of the original peoples of Europe, the Middle East, or

North Africa.

Black or African American (Not Hispanic or Latino): A person having origins in any of the black racial groups of

Africa.

Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino): A person having origins in any of the peoples

of Hawaii, Guam, Samoa, or other Pacific Islands.

Asian (Not Hispanic or Latino): A person having origins in any of the original peoples of the Far East, Southeast Asia,

or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the

Philippine Islands, Thailand, and Vietnam.

American Indian or Alaska Native (Not Hispanic or Latino): A person having origins in any of the original peoples of

North and South America (including Central America), and who maintain tribal affiliation or community attachment.

Two or More Races (Not Hispanic or Latino): All persons who identify with more than one of the above five races.

Protected Veteran Identification Categories

This employer is a Government contractor subject to the Vietnam Era Veterans' Readjustment Assistance Act of 1974, as amended by the Jobs for Veterans Act of 2002, 38 U.S.C. 4212 (VEVRAA), which requires Government contractors to take affirmative action to employ and advance in employment: (1) disabled veterans; (2) recently separated veterans; (3) active duty wartime or campaign badge veterans; and (4) Armed Forces service medal veterans. These classifications are defined as follows:

A “disabled veteran” is one of the following:

a veteran of the U.S. military, ground, naval or air service who is entitled to compensation (or who butfor the receipt of military retired pay would be entitled to compensation) under laws administered by theSecretary of Veterans Affairs; or

a person who was discharged or released from active duty because of a service-connected disability.

A “recently separated veteran” means any veteran during the three-year period beginning on the date of such veteran's discharge or release from active duty in the U.S. military, ground, naval, or air service.

An “active duty wartime or campaign badge veteran” means a veteran who served on active duty in the U.S. military, ground, naval or air service during a war, or in a campaign or expedition for which a campaign badge has been authorized under the laws administered by the Department of Defense.

An “Armed forces service medal veteran” means a veteran who, while serving on active duty in the U.S. military, ground, naval or air service, participated in a United States military operation for which an Armed Forces service medal was awarded pursuant to Executive Order 12985.

Voluntary Self-Identification of Disability

Form CC-305 OMB Control Number 1250-0005

Expires 1/31/2017 Page 3 of 4

Why are you being asked to complete this form?

Because we do business with the government, we must reach out to, hire, and provide equal opportunity to

qualified people with disabilities.i To help us measure how well we are doing, we are asking you to tell us if you

have a disability or if you ever had a disability. Completing this form is voluntary, but we hope that you will

choose to fill it out. If you are applying for a job, any answer you give will be kept private and will not be used

against you in any way.

If you already work for us, your answer will not be used against you in any way. Because a person may

become disabled at any time, we are required to ask all of our employees to update their information every five

years. You may voluntarily self-identify as having a disability on this form without fear of any punishment

because you did not identify as having a disability earlier.

How do I know if I have a disability?

You are considered to have a disability if you have a physical or mental impairment or medical condition that

substantially limits a major life activity, or if you have a history or record of such an impairment or medical

condition.

Disabilities include, but are not limited to:

Please check one of the boxes below:

☐ YES, I HAVE A DISABILITY (or previously had a disability)

☐ NO, I DON’T HAVE A DISABILITY

☐ I DON’T WISH TO ANSWER

__________________________ __________________

Your Name Today’s Date

Blindness Autism Bipolar disorder Post-traumatic stress disorder (PTSD)

Deafness Cerebral palsy Major depression Obsessive compulsive disorder

Cancer HIV/AIDS Multiple sclerosis (MS) Impairments requiring the use of a wheelchair

Diabetes

Epilepsy

Schizophrenia

Musculardystrophy

Missing limbs orpartially missing limbs

Intellectual disability (previously called mentalretardation)

Voluntary Self-Identification of Disability

Form CC-305 OMB Control Number 1250-0005

Expires 1/31/2017 Page 2 of 4

Reasonable Accommodation Notice

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities.

Please tell us if you require a reasonable accommodation to apply for a job or to perform your job. Examples

of reasonable accommodation include making a change to the application process or work procedures,

providing documents in an alternate format, using a sign language interpreter, or using specialized equipment.

i Section 503 of the Rehabilitation Act of 1973, as amended. For more information about this form or the equal

employment obligations of Federal contractors, visit the U.S. Department of Labor’s Office of Federal Contract

Compliance Programs (OFCCP) website at www.dol.gov/ofccp.

PUBLIC BURDEN STATEMENT: According to the Paperwork Reduction Act of 1995 no persons are required

to respond to a collection of information unless such collection displays a valid OMB control number. This

survey should take about 5 minutes to complete.

To submit application:Save a copy to your computer & E-mail to [email protected]

ORPrint a copy and mail to:Monroe Truck Equipment

1051 W. 7th StreetMonroe, WI 53566

Attn: Human Resources Dept.