Employment Application

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Dominion Terminal Associates is an equal opportunity employer and does not discriminate in hiring or terms and conditions of employment in any manner as prescribed by law.

Name:
Address:
Position Applying for
Please Attach Resume.

Employment History

(List last three jobs, and if applicable, any additional jobs held during the last five years)
Date Employed



Date Employed



Date Employed

Technical Plant Skills: Applicants for Plant Work, Please indicate years of experience.

BulldozerForkliftAcetyleneSet up machineBackhoeHeli-arcMigMobile CraneComputer Operated EquipmentTigOther: please specify

Please check if you read: BlueprintsMicrometerRule or Scale

Describe level of your technical and/or computer skills:

Do you have a non-solicitation or non-compete agreement with any prior employer ?

Referral Source:

FriendRelativeAdvertisementEmployment AgentOther

Do you have a relative working with the organization? :

YesNo

Have you filed an application with this organization before? if yes,give date:

Are you legally eligible to work in the U.S. ?:

YesNo

Are you Over the age of 18 Years?

YesNo

Have you ever committed a Felony?

YesNo

If So, explain

Are you available to work overtime when necessary ? Date available for work:

May we contact your present employer ?

YesNo

List three references who have known you for at least two years

Name Address and telephone Occupation/Company

Education

School Print Name, Number and Street, City, State and Zip Code for Each School # Yrs. Completed Degree/Major
High School
College
GraduateSchool

List any professional certifications and licenses held

Certification/License Issued by Date

Dominion Terminal Associates (DTA) is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, national origin, sex, age, veteran status, disability, or other status protected by law.

The contents of any employee handbook, policies and procedures, or benefits offered to eligible, full time or part-time, regular employees are subject to amendment, alteration, or abolishment of any or all of these policies and benefits as circumstances warrant with or without advance notice to employees, other than as may be required by law.

Signature

I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between DTA and myself for either employment or for the providing of any benefits. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon DTA

If I am offered and accept employment with DTA, I understand that my employment is at-will and that as such DTA and I each remain free to terminate our employment relationship, with or without advance notice for any reason or for no reason at all. I further understand that an oral promise, policy, custom, business practice or other procedure (including any employee handbook or employment related material) does not constitute an employment contract or modification of the atwill employment relationship between the employer and myself. Only the President of DTA has authority to modify the atwill nature of employment or to modify any policy. Any such modification to the at-will status must be in writing as an express amendment to the at-will policy and approved by the Board of Directors and signed by the President in order to be enforceable.

I have read, understand, and agree to adhere by the policies as set forth in this application and other employment related materials in the event I am offered employment. Should I be offered employment

I understand that my employment will be contingent upon the satisfactory completion and maintenance of all contingencies required for the position.

I understand that misrepresentations, omissions of facts or incomplete information requested in this application may remove me from further consideration for employment. In addition, if employed, any misrepresentations or omissions of facts called for in this application may be cause for dismissal at any time without any previous notice.

I certify that the answers given herein are true and complete to the best of my knowledge. I authorize the investigation of all matters contained in this application and hereby give permission to contact schools, previous employers, licensing agencies, boards and associations, references, and others in order to verify the facts and information furnished with regard to my character and qualifications, and hereby release and indemnify DTA, its officers, directors and agents, and authorized representatives from any claims or liability as a result of such contact. I also hereby release employers, schools, agencies, boards, associations, reporting entities and other persons from all liability in responding to inquiries in connection with this application.


Signature