Applicants are considered without regard to race, creed, color, sex, religion, age, national origin or disability.

Date . . . . . . . . . . . 
Name (first, middle, last) 
Email Address  . . . . . . 

Present Address  . . . . . 
City . . . . . . . . . . .  State  Zip 
Phone  . . . . . . . . . . 
Best time to call  . . . . 

Permanent Address  . . . . 
City . . . . . . . . . . .  State  Zip 
Phone  . . . . . . . . . . 

Are you 18 years or older?  Yes 
                            No  

Are you prevented from lawfully becoming employed in this country because of
visa or immigration status? Yes 
                            No  

Employment Desired

Position . . . . . . . . . 
Date you can start . . . . 
Salary desired . . . . . . 
Are you employed now?       Yes 
                            No  
If so may we inquire of your present employer? Yes 
                                               No  
Ever applied to this company before? Yes 
No  Where?  
When?  Referred by:  

Educational Background

High School

 Name: 
City: State: Years Completed: 
Did you graduate? Yes  
No  

College

 Name: City: 
State: Years Completed: 
Did you graduate? Yes  No 
 Major: 
Minor: Degree/Diploma: 

College/Trade

 Name: 
City: State: Years Completed: 
Degree/Diploma: Subjects studied: 

Employment History

Begin with your present or most recent job and work backward 
in order, listing your employers for at least the past 10 years including all 
full-time and part-time employment. All time must be accounted for including military 
service, self-employment and periods of unemployment.

WE MUST HAVE TELEPHONE 
NUMBERS AND PERIODS OF EMPLOYMENT.

Current or Most Recent Employer

Employer: 
Address:  
City: State: Zip: Phone: 
Supervisor: May we call? Yes 
 No  
Dates Employed: to  Position held: 
Rate of Pay: Duties: 
Reason for Leaving? 

Second Last Employer

Employer: 
Supervisor: Address: 
 City: 
State: Zip: Phone: 
Dates Employed: to  Position held: 
Rate of Pay: Duties: 
Reason for Leaving? 

Third Last Employer

Employer: 
Supervisor: Address: 
 City: 
State: Zip: Phone: 
Dates Employed: to  Position held: 
Rate of Pay: Duties: 
Reason for Leaving? 

Fourth Last Employer

Employer: 
Supervisor: Address: 
 City: 
State: Zip: Phone: 
Dates Employed: to  Position held: 
Rate of Pay: Duties: 
Reason for Leaving? 

Which of these jobs did you like best?  
What did you like best about this job? 

Subjects of Special Study or Research Work

Special 
Study  Research work  
Special skills  Activities 
(Civic, Athletic, Etc.)  
EXCLUDE 
ORGANIZATIONS, THE NAME OF WHICH INDICATES THE RACE, CREED, SEX, AGE, MARITAL 
STATUS, COLOR OR NATION OF ORIGIN OF ITS MEMBERS.

Military Status

 Have you served in 
the U.S. Armed Forces? Yes  No 

Rank: 

References

Name:  
Address:  Business:  
Years Acquainted: 

Name: 
 Address:  
Business:  Years Acquainted: 

Name:  
Address:  Business:  
Years Acquainted: 

The 
following statement applies in: Maryland & Massachusetts. (Fill in name of state) 
It is unlawful in the state of  to require 
or administer a lie detector test as a condition of employment or continued employment. 
An employer who violates this law shall be subject to criminal penalties and civil 
liability.

In Case Of Emergency Notify: Name:  
Address:  Phone: 
 

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and , if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its president, and then only when in writing and signed by the president, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."

Equal Opportunity Employer

I hereby agree to submit to binding arbitration all disputes and claims arising out of the submission of this or other formal application. I further agree, in the event that I am offered employment by the company, as a condition of that employment all disputes that cannot be resolved by informal internal resolution which might arise out of submission of this application or out of my employment with the company, whether before, during or after such employment will be submitted to binding arbitration in lieu of any Federal or State investigative, administrative, civil or other legal Proceeding. I agree to such arbitration shall be conducted in accordance with the Stevens Transport Alternative Dispute Resolution Program. A copy of The Program is available at Stevens Transport for review, upon request.

I have read carefully the above information, understand and accept the contents thereof. 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.

This form has been revised to comply with the provisions of the Americans with Disabilities Act and the final regulations and interpretive guidance promulgated by the EEOC on July 26, 1991.

To submit your application do any of the following:
Print out and fax to (214) 647-3832 Attn: Human Resources
Print out and mail to:

         Stevens Transport, Inc.
         Attn: Human Resources
         P.O. Box 279010
         Dallas, TX 75227-9610
Hit the submit button below to send by e-mail
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