JOB APPLICATION

Delivery Matic LLC is an equal opportunity employer. This application will not be used for limiting or excluding any applicant from consideration for employment on a basis prohibited by local, state, or federal law. Should an applicant need reasonable accommodation in the application process, he or she should contact a company representative.

Please fill out all sections below:

Step 2: Personal Information

Have you ever applied to work for Deliverymatic before?

No Yes

Are you 18 years of age or older?

No Yes

Are you a U.S. Citizen or approved to work in the United States?

No Yes

Can you provide documentation as proof of citizenship or legal status?

No Yes

Will you consent to a mandatory random controlled substance test?

No Yes

Are you able to lift heavy objects up 50lb?

No Yes

Are you able to push heavy items up 300 lb. or heavier with assistance above 300 lb?

No Yes

Do you have any condition which would require job accommodations?

No Yes

Will you consent to a mandatory random background check?

No Yes

Have you ever been convicted of criminal offense (felony or misdemeanor)?

No Yes

Do you smoke or use any tobacco products?

No Yes

Do you have any forklift experience or certification?

Job Skills/Qualifications

Step 3: Eduction and Traning

High School

Name:

Location(City/State):

Year graduated:

Degree earned:

Collage/University

Name:

Location(City/State):

Year graduated:

Degree earned:

Vocational School/Specialized Training

Name:

Location(City/State):

Year graduated:

Degree earned:

Military

Are you a member of armed service?

No Yes

Addtional Information

Emergency Contact

Name:

Phone number:

Relationship to you:

Step 4: Previous Employment

Employer name:

Job title:

Job description:

Supervisor name:

Supervisor contact:

Employer address:

Employer phone:

Start date:

Leaving date:

Reason for leaving:

References

Please provide personal and professional reference(s) below:

Reference	Contact information

Applicant signature:

Date of application:

JOB APPLICATION

Please fill out all sections below:

Step 1: Applicant Information

Step 2: Personal Information

Step 3: Eduction and Traning

High School

Collage/University

Vocational School/Specialized Training

Military

Emergency Contact

Step 4: Previous Employment

References

Please provide personal and professional reference(s) below: