Printable Piggly Wiggly Printable Application

It's important to have the correct information when applying for a job.

Looking for a job at Piggly Wiggly? You're in luck! The printable application form is now available on our website. Just download, print, and fill out the form to get started. The deadline to submit your application is June 30, so don't delay! Good luck!

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DRIVER’S APPLICATION FOR EMPLOYMENT

PIGGLY WIGGLY ALABAMA DISTRIBUTING COMPANY INC.

2400 J. Terrell Wooten Drive, Bessemer, AL 35020

APPLICATION FOR EMPLOYMENT

PERSONAL (PLEASE PRINT PLAINLY)

“ MISREPRESENTATIONS AS TO PRE EXISTING PHYSICAL OR MENTAL CONDITIONS MAY VOID

YOU WORKMEN’S COMPENSATION ”

The Civil Rights act of 1964 prohibits discrimination in employment because of race, color, religion or national origin. Public Law prohibits discrimination of age. The laws of some states prohibit some or all of the above mentioned types of discrimination.

Date of Application ______________________

Social Security No .

List your addresses of residency for the past 3 years.

Date of Birth ______/_________/________

_______________________________________________ Phone (______)

________________________________________________________________________ How Long? _____________________

State & Zip Code

____________________________________________________________ How Long? ____________________

State & Zip Code

____________________________________________________________ How Long? ____________________

State & Zip Code

Have you worked for this company before? ________________ Dates: From ____________ To ______________

Position ______________________ Reason for leaving ________________________________________________

Are you currently employed? __________ If not, how long since leaving last employment __________________

Have you ever been convicted of a crime, excluding misdemeanors and summary offenses? ________________

If yes, Describe in full ___________________________________________________________________________

Who referred You? _______________________________ Can you provide proof of age? ___________________

Do you want to work fulltime or part time? ________ Specify days and hours if part time__________________

If hired, on what date will you be available to start work? ____________________________________________

Date of last DOT Physical Examination ___________________

Person to be notified in case of accident or emergency

Phone Number __________________________________________________________________________________________________

Please fax completed copy to:

All driver applicants to drive in interstate commerce must provide the following information on all employers during the preceding 3 years. List complete mailing address, street number, city, state and zip code.

Applicants to drive a commercial motor vehicle in intrastate or interstate commerce shall also provide an additional 7 years information on those employers for whom the applicant operated such vehicle. (Note: List employers in reverse order starting with the most recent. Add another sheet as necessary.)

Reason For Leaving

Were you subject to the FMCSRs while employed?

Was your Job designated as a function in any mode subject to the Drug and Alcohol testing requirements of 49 CFR part 40?

Reason For Leaving

Were you subject to the FMCSRs while employed?

Was your Job designated as a function in any mode subject to the Drug and Alcohol testing requirements of 49 CFR part 40?

Reason For Leaving

Were you subject to the FMCSRs while employed?

Was your Job designated as a function in any mode subject to the Drug and Alcohol testing requirements of 49 CFR part 40?

Reason For Leaving

Were you subject to the FMCSRs while employed?

Was your Job designated as a function in any mode subject to the Drug and Alcohol testing requirements of 49 CFR part 40?

May we contact the employers listed above? If, not, indicate below which one(s) you do not wish us to contact.

Please fax completed copy to:

ACCIDENT RECORD FOR PAST 3 YEARS OR MORE (ATTACH SHEET IF MORE SPACE IS NEEDED). IF NONE, WRITE NONE.

Nature Of Accident

TRAFFIC CONVICTIONS AND FORTEITURES FOR THE PAST 3YEARS (OTHER THAN PARKING VIOLATIONS) IF NONE, WRITE NONE

(ATTACH SHEET IF MORE SPACE IS NEEDED)

EXPERIENCE AND QUALIFICATIONS – DRIVER

List all driver licenses or permits held in the past 3 years.

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle?

B. Has any license, permit or privilege ever been suspended or revoked?

If the answer to either A or B is Yes, GIVE DETAILS ______________________________________________________________________________________________

Driving Experience Check Yes or No

Class of Equipment

Circle Type Of Equipment

Approx. No. of Miles

(Van, Tank, Flat, Dump, Refer)

(Van, Tank, Flat, Dump, Refer)

Tractor – Two Trailers

(Van, Tank, Flat, Dump, Refer)

Tractor – Three Trailers

(Van, Tank, Flat, Dump, Refer)

List States operated in for last five years __________________________________________________________________________________________________________

Circle Highest Grade Completed

1 2 3 4 5 6 7 8 High School

1 2 3 4 College

Last School Attended _____________________________________________________________________________________________

Show special courses or training that will help you as a Driver: ________________________________________________________________________________________

Which safe driving awards do you hold and from whom? _____________________________________________________________________________________________

Please fax completed copy to:

You must account for all periods of unemployment in the last five (5) years.

List all lost time in excess of 30 days.

To be read and signed by applicant

I understand that this is an application and not a contract or a unilateral offer to enter into a contract of any kind betwee n the undersigned and the employer. The use of this application form does not indicate that there are any positions open and does not in any way obligate this employer.

I understand that employment is conditional upon and I authorize you to make such investigations and inquire of my personal, employment, financial and other legally related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or persons from any and all liabilities and responding to inquires in connection with my application.

I hereby certified that all of the information I have given on this application is true and complete and that there are no false statements or omissions contained in my response to the questions in this application. I understand that any false information or omissions whether made or omitted intentionally or written and later discovered, may be cause for refusal to hire me or for immediate dismissal without further notice.

This application is current for only [60] days. At the conclusion of this time, if I have not heard from the Employer an d still wish to be considered for employment, it will be necessary for me to fill out a new application.

I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will b e contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to:

∙ Review information provided by previous employers.

∙ Have errors in the information corrected by previous employers and for those previous employers to the corrected information to the prospective employer; and

∙ Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.

Signature ______________________________________________________ Date _______________________________________

Please fax completed copy to: