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Xpress One NY inc.

Xpress One NY Employment Application Form

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Xpress One NY Employment Application Form Personal Information

First Name:*

Middle Initial

Last Name:*

Social Security Number or EIN*

Address Line 1:*

Address Line 2:

City:*

State:* AlabamaArizonaCaliforniaConnecticutDistrict of ColumbiaGeorgiaIdahoIndianaKansasLouisianaMarylandMichiganMississippiMontanaNevadaNew JerseyNew YorkNorth DakotaOklahomaPennsylvaniaSouth CarolinaTennesseeUtahVirginiaWest VirginiaWyoming

Zip Code:*

E-Mail:*

Home Phone:

Business Phone:

Cell Phone:*

Carrier:*

Work Preference

Date Available*

Postion Applied For:**

Independent Contractor Driver
Foot Messenger
Biker

Minimum Acceptable Weekly Salary:*

Employment Requested:*

Full Time Part Time

Education

High School Name/Location:

Diploma Received:*

Diploma
Equivalency
None

College Name/Location:

Degree Earned:

Attended from:

Attended To:

Major/Minor:

Employment History

Name Of Employer:*

Address Line 1:*

Address Line 2:

City:*

Zip Code:*

Employed From:*

Employed To:*

Employer Phone:*

Weekly Salary:*

Job Title:*

Supervisor Name:*

Reason For Leaving:*

Name Of Employer:*

Address Line 1:*

Address Line 2:

City:*

Zip Code:*

Employed From:*

Employed To:*

Employer Phone:*

Weekly Salary:*

Job Title:*

Supervisor Name:*

Reason For Leaving:*

Skills Section

Related Knowledge/Skills:*
References

Please list two references that have knowledge of your professional experience.

Reference Name:*

Address:*

Phone:*

Reference Name:*

Address:*

Phone:*

Background

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR A FIRST DEGREE MISDEMEANOR?

Yes
No

ARE YOU A U.S. CITIZEN OR ARE YOU LEGALLY AUTHORIZED TO WORK IN THE U.S.?

Yes
No