EMPLOYMENT APPLICATION

Haulin Pay LLC
PO Box 449, Brookston, Indiana47923 765-532-2560

Haulin Pay 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.

Name
Address
What position are you applying for?
How did you find out about this position?
On what date can you start if hired?

Personal Information

Are you 18 years or older?
Are you a U.S. citizen or approved to work in the United States?
Will you consent to a mandatory controlled substance test?
Do you have any condition which would require job accommodations?
Have ever been convicted of a criminal offense (felony or misdemeanor)?

(Note: Haulin Pay LLC complies with the ADA and considers reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions. It is possible that a hire maybe tested on skill/agility and maybe subject to a medical examination conducted by a medical professional.)

Education and Training

Military

Are you a member of the Armed Services?

Previous Employment

Address
Address
Address

AT-WILLEMPLOYMENT

The relationship between you and the Haulin Pay LC is referred to as “employment at will.” This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Haulin Pay LLC. No representative of Haulin Pay LC has authority to enter into any agreement contrary to the foregoing “employment at will’ relationship. You understand that your employment is “at will,” and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company’s President.

Date / Time