You are applying at which MPI Location? *Choose an OptionKansas CityTulsa
Today’s Date: *
Full Name: (Last, First, Middle) *
Street Address: *
Home Phone: *
City, State, Zip: *
Cell Phone: *
Date of Birth*: *
Pay Expected: *
*Employment is subject to verification of minimum legal age.
Position Desired: *
Have you ever applied for employment with us before? *Choose an OptionYesNo
If Yes, give month and year:
Apart from religious observance, are you available for full-time work? *Choose an OptionYesNo
If not, what hours can you work?
Are you legally eligible for work in the United States? *Choose an OptionYesNo
Will you work overtime if asked? *Choose an OptionYesNo
When will you be available to begin work? *
Other special training or skills (language, machine operation, etc.)
How did you learn of our organization?
Driver Information
License Class: *
License #: *
How long have you held this license? *
State where license was obtained: *
Expiration Date: *
What types of vehicles have you had experience driving? *
Have you had a drug test in the past 6 months to 1 year? *Choose an OptionYesNo
Do you have a D.O.T. card? *Choose an OptionYesNo
Have you participated in a random D.O.T. drug test? *Choose an OptionYesNo
Have you received any driving violations in the last 3 years? *Choose an OptionYesNo
Has your license ever been suspended? *Choose an OptionYesNo
If Yes, why?
Please give a history of your driving record including any accidents: *
Additional Information
Have you been convicted of a crime, excluding misdemeanors and summary offenses, which has not been annulled, expunged or sealed by a court? *Choose an OptionYesNo
If Yes, describe in full:
Education Information
Highest Level of Schooling *Choose an OptionCollegeHigh SchoolOther
Name/Location of School *
Course of Study:
Years Completed: *
Did You Graduate? *Choose an OptionYesNo
Degree or Diploma: *
Additional Information about my education (optional)
Employment Information
Please give an accurate and complete full-time and part-time employment record. Start with the most recent employer.
Company Name:
Phone:
Address:
Supervisor:
State job title and describe your work:
Employed from:
Employed to:
Weekly pay started at:
Weekly pay last:
Reason for leaving:
* * *
Weekly pay, started at:
Weekly pay, last:
COMPLETE THIS SECTION IF YOU SERVED IN THE U.S. ARMED FORCES
Branch of Service:Select an OptionArmyNavyAir ForceMarinesNational Guard
Active Duty from:
Active Duty to:
Rank at discharge:
Date of discharge:
Describe your duties and any special training:
I hereby certify and declare under penalty of perjury that the information provided by me in the Application for Employment is true, correct, and complete to the best of my knowledge. I understand that if employed, any misstatement or omission of fact on this application shall be considered cause for dismissal. I authorize you to obtain a report containing information obtained through personal interviews with my neighbors, friends, and acquaintances. The report, if obtained, may include information as to my character, general reputation, personal characteristics, and mode of living. I understand I have the right to make a written request within a reasonable period to receive additional detailed information about any such investigation.
Signature (Type your full name) *
Date: *
2 + 2 = ?Please prove that you are human by solving the equation *
