• Ph: 931-896-1500

Application for Employment

Queen City Disposal is an Equal Opportunity Employer and EEO/Affirmative Action Employer committed to excellence through diversity. Employment offers are made on the basis of qualifications and without regard to race, sex, religion, national or ethnic origin, disability, age, veteran status, or sexual orientation.

Please complete the entire application below or your application may be deemed incomplete and may not be considered. Applications with missing or incomplete data will not be considered for any position.

Position Applying For

Your Name (required)

Other names under which you have attended school or been employed:

Street Address:

City, State and Zip Code:

Home Phone:

Alternate Phone:

Your Email (required)

Rate of Pay:

Date of Birth:

Are you eligible to work in the US:
 Yes No

Are you 18 years of age or older:
 Yes No

Are you related to any current Queen City Disposal employee:
 Yes No

If yes, their name and relationship to you:

If required for position, do you have a valid commercial driver's license:
 Yes No

Have you ever been convicted of a felony/misdemeanor crime:
 Yes No

If yes, please explain:

Have you ever been denied a license, permit or privilege to operate a motor vehicle:
 Yes No

If yes, please explain:

Has any license, permit or privilege ever been suspended or revoked:
 Yes No

If yes, please explain:

Have you worked for a DOT regulated employer and were you covered under DOT regulated drug/alcohol testing during the last three years prior to this application:
 Yes No

If yes, who:

How did you learn about this employment opportunity (check all that apply):
 Newspaper Walk-in Referral by Employee Dept of Labor Online Listing Other

Driving Experience:

Front Load Truck (please include type and dates operated):

Roll Off Truck (please include type and dates operated):

Residential Truck (please include type and dates operated):

Other (please include type and dates operated):

Accident Record for Past 3 Years or More (please include date, nature of accident, number of fatalities, types of injuries and any chemical spills):

Traffic Convictions and Forfeitures, other than parking violations, for the Past 3 Years (include date, violation, location and penalty):

Skills: Please list technical skills, clerical skills, trade skills, etc. relevant to this position. Include relevant computer systems and software packages of which you have a working knowledge and note your level of proficiency (basic, intermediate, expert)

WORK EXPERIENCE - Please detail your entire work history. Begin with your current or most recent employer. If you held multiple positions with the same organization, detail each position separately. Omission of prior employment may be considered falsification of information. Please explain any gaps in employment. Include full-time military or volunteer commitments. PLEASE DO NOT complete this information with the notation “See Resume.” Applicants that desire to drive in intrastate/interstate commerce must provide the following information on all employers during the previous three years. You must have the same information for all employers that you have driven a commercial motor vehicle for the seven years prior to the initial three years (total of ten years employment record). Any gaps in employment must be explained; include dates (month/year) and reason.
PLEASE NOTE: Queen City Disposal reserves the right to contact all current and former employers for reference information.

Current or Most Recent Employer:

Address:

Phone:

Position held:

Dates of Employment:

Salary:

Reason for Leaving:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer:
 Yes No

Was this job position designated as a safety sensitive function in any DOT regulate mode, subject to random screening:
 Yes No

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Current or Most Recent Employer:

Address:

Phone:

Position held:

Dates of Employment:

Salary:

Reason for Leaving:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer:
 Yes No

Was this job position designated as a safety sensitive function in any DOT regulate mode, subject to random screening:
 Yes No

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Current or Most Recent Employer:

Address:

Phone:

Position held:

Dates of Employment:

Salary:

Reason for Leaving:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer:
 Yes No

Was this job position designated as a safety sensitive function in any DOT regulate mode, subject to random screening:
 Yes No

-------------------------------------------------------------

Current or Most Recent Employer:

Address:

Phone:

Position held:

Dates of Employment:

Salary:

Reason for Leaving:

Were you subject to the Federal Motor Carrier Safety Regulations (FMCSRs) while employed by this employer:
 Yes No

Was this job position designated as a safety sensitive function in any DOT regulate mode, subject to random screening:
 Yes No

PLEASE READ CAREFULLY - CLICKING THE SUBMIT BUTTON INDICATES THAT YOU UNDERSTAND AND ACCEPT THIS INFORMATION.
I certify that the information on this application and its supporting documents is accurate and complete. I understand and agree that failure to fully complete the form, or misrepresentation or omission of facts, represents grounds for elimination from consideration for employment, or termination after employment if discovered at a later date. I authorize Queen City Disposal to investigate, without liability, all statements contained in this application and supporting materials. I authorize references and former employers, without liability, to make full response to any inquiries in connection with this application for employment. If requested, I agree to submit to a physical exam, criminal and credit background investigation, and/or screening for illegal substances upon conditional offer of employment. I understand that this document is NOT an offer of employment, and that an offer of employment, if tendered, does NOT constitute a contract for continued guaranteed employment. I understand that employees of Queen City Disposal serve at-will, and the employment relationship may be terminated at any time by either party, or any or no reason, other than a reason prohibited by law. If employed, I will be required to furnish proof of eligibility to work in the United States, to file a State security questionnaire and State loyalty oath, and to comply with company and departmental regulations. I understand that if employed on a temporary basis, I would be paid for hours worked only, and would be ineligible for benefits including paid time off. If employed on a regular, benefits-eligible basis, I understand that I would be required to make mandatory contributions to the Queen City Disposal Retirement System or to an optional retirement program, if applicable. I understand that any benefits I receive may be subject to change or discontinuation at any time without prior notice. I understand that the first SIX MONTHS of regular employment represent a provisional period, during which I would not be eligible to apply for transfer or promotion and during which I may be terminated without right of appeal.