Application For Employment

Please complete all required fields which are indicated by an asterisk.

Indicate the Company for which you are applying*:

Holtzman OilHoltzman PropaneHoltzman TransportValley Ice











Holtzman OilHoltzman PropaneHoltzman TransportValley Ice



YesNo

Position Desired





NightsWeekendsFull TimePart Time

YesNo



Education and Training




YesNo




YesNo




Current or Most Recent Employer


YesNo






When Started*




When left or current*




 




Previous Employer






When Started




When left or current







Previous Employer






When Started




When left or current







Previous Employer






When Started




When left or current







References

List below the names of three persons (not friends or relatives) whom you have known for at least one year.


















YesNo


YesNo

To be completed by driver applicants only:









EQUAL EMPLOYMENT OPPORTUNITY SURVEY:

Participation is voluntary


MaleFemale

Hispanic or LatinoAmerican Indian or Alaska NativeAsainBlack or African AmericanNative Hawaiian or other Pacific IslanderWhiteTwo or More Races (all persons who identify with more than one of the above five races.)


YesNo

Gulf WarKorean EraVietnam EraWorld War IIDisabled VeteranOther Eligible

CONSENT TO DISCLOSURE OF INFORMATION:

READ CAREFULLY BEFORE SIGNING

I certify that all my answers in this Employment Application are true and complete to my best knowledge, and I understand that this Application will remain active for thirty (30) days only.

I authorize the Company to investigate and verify my answers and I give the Company permission to contact schools, previous employers, references, and others in its investigation. I release both the Company and the party providing the information from any liability for this purpose. I also release the Company from any liability for providing information about my employment record to any prospective employer, government agency, or other party having a legal and proper interest.

I also authorize the Company to secure financial and credit information through a consumer reporting agency, and I understand that, upon my written request made within a reasonable time, the consumer reporting agency will provide me with additional information concerning the nature and scope of any credit report investigation. I also agree to participate in computerized interviewing, assessment testing, and any other similar Company requirements which are conditions of employment.

I understand that any false or misleading answer in this Employment Application or other pre-employment inquiry is grounds for rejection of my Application or immediate termination if I have been employed.

If employed, I will comply with all Company policies and rules found in any Company policy manual, employment handbook, or other communication from the Company. I understand the Company may change its policies and rules in the future without giving notice to me.

I understand that the Company may require drug and alcohol testing as a condition of employment, or if I am involved in a work related injury, subject to applicable federal and state laws, and I consent to any such testing.

I agree not to use or disclose outside my employment with the Company any confidential information, wages, trade secret, or proprietary information, whatever its form, obtained in connection with my employment with the Company.

I understand that employment with the Company will be TERMINABLE AT WILL, that no employment contract will be valid unless made in writing and signed by the Company's President and that my employment may be ended at any time, for any reason, by me or the Company. If employed, I further understand that my first ninety (90) days are a probationary period (which may be extended in the Company's discretion) to determine whether my continued employment is appropriate.