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Services
Careers
- Open Positions
- Job Application
Contact
Employees
Pay My Bill

Employment Form

The Allen Company Application for Employment

An Equal Opportunity / Affirmative Action Employer Drug-Free Workplace

3009 Atkinson Avenue, Suite 300 Lexington, KY 40509 | P: (859) 543-3361 | F: (859) 543-3362 | www.theallen.com

Position Applying For(Required)

Date Available to Work(Required)

Month

Day

Year

Are you legally able to work in the United States?(Required)

Yes

No

Have you ever worked for our company before?(Required)

Yes

No

If so, when and where?(Required)

Legal Name (Include Middle Name)(Required)

First Middle Last

Home Phone #

Mobile Phone #(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

EDUCATION

Highest Grade Completed(Required)

Grade School 1

Grade School 2

Grade School 3

Grade School 4

Grade School 5

Grade School 6

Grade School 7

Grade School 8

High School 9

High School 10

High School 11

High School 12

College Year 1

College Year 2

College Year 3

College Year 4

Grad School Year 1

Grad School Year 2

Grad School Year 3

Grad School Year 4

Have You Taken the G.E.D. Test?(Required)

Yes

No

Name and Location of High School(Required)

Name and Location of College/University(Required)

Number of College Credits Completed (Indicate If Hours Are Semester Or Quarter)(Required)

Number of College Credits Carrying, If Applicable (Indicate If Hours Are Semester Or Quarter)

List College Minor/Major and Degrees(Required)

Name and Location of Grad School(Required)

Number of Grad School Credits Completed (Indicate If Hours Are Semester Or Quarter)(Required)

Number of Grad School Credits Carrying, If Applicable (Indicate If Hours Are Semester Or Quarter)

List Grad School Minor/Major and Degrees(Required)

Have you attended vocational, business, or military school?(Required)

Yes

No

If yes, list name and location of school, major/minor, and degrees(Required)

List special equipment or machines you can operate or any additional skills(Required)

Do you have a valid Driver's License?(Required)

Yes

No

Driver's License State

Driver's License Number(Required)

Driver's License Expiration Date

Month

Day

Year

Do you have a valid commercial driver’s license (CDL)?(Required)

Yes

No

CDL Class(Required)

CDL Endorsements(Required)

Has your driver's license or CDL ever been revoked or suspended?(Required)

Yes

No

Do you have Automatic Only CDL restriction?(Required)

Yes

No

If yes, explain reason

Have you ever been convicted of a felony? (A felony conviction may not automatically exclude you from consideration)(Required)

Yes

No

If yes, list charge(s), date(s) and location(s)(Required)

EMPLOYMENT HISTORY

Begin with your most recent and relevant job and provide as much detail as possible.

Are you currently employed?(Required)

Yes

No

May we contact your present employer?(Required)

Yes

No

Current Employer's Starting Date(Required)

Month

Day

Year

Current Position(Required)

Current Position's Starting Salary(Required)

Current Salary(Required)

Name of Current Employer(Required)

Current Employer's Phone #(Required)

Current Employer's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Current Supervisor(Required)

Current Job Duties(Required)

Reason for Seeking New Employment(Required)

********** PREVIOUS EMPLOYMENT (1) **********

Start Date

Month

Day

Year

End Date

Month

Day

Year

Position

Starting Salary

Ending Salary

Name of Employer

Employer's Phone #

Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Duties

Reason for Leaving

********** PREVIOUS EMPLOYMENT (2) **********

Start Date

Month

Day

Year

End Date

Month

Day

Year

Position

Starting Salary

Ending Salary

Name of Employer

Employer's Phone #

Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Duties

Reason for Leaving

********** PREVIOUS EMPLOYMENT (3) **********

Start Date

Month

Day

Year

End Date

Month

Day

Year

Position

Starting Salary

Ending Salary

Name of Employer

Employer's Phone #

Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Duties

Reason for Leaving

********** PREVIOUS EMPLOYMENT (4) **********

Start Date

Month

Day

Year

End Date

Month

Day

Year

Position

Starting Salary

Ending Salary

Name of Employer

Employer's Phone #

Employer's Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supervisor

Job Duties

Reason for Leaving

Have you ever been disciplined or fired from a job?(Required)

Yes

No

If so, explain reason(Required)

CHARACTER REFERENCES (Other than relatives)

Reference Name (1)(Required)

First Last

Reference Address (1)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference Phone (1)(Required)

Reference Name (2)(Required)

First Last

Reference Address (2)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference Phone (2)(Required)

Reference Name (3)(Required)

First Last

Reference Address 3(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference Phone (3)(Required)

Reference Name (4)(Required)

First Last

Reference Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference Phone (4)(Required)

PLEASE READ EACH STATEMENT CAREFULLY, CHECK THE BOX SIGN AND DATE AT THE BOTTOM

Consent(Required)

I understand that filling out this application does not imply any promise of my employment with The Allen Company, Inc.

Consent(Required)

I certify, under penalty of law, that the information given in this application is true and complete to the best of my knowledge.

Consent(Required)

I am aware that, should investigation at any time reveal any falsification, I may not be considered for employment or, if employed, I may be terminated.

Consent(Required)

I also understand that a background check will be required, and that, in accordance with the Drug-Free Workplace Program, drug testing will be required.

Consent(Required)

I authorize The Allen Company, Inc to investigate my previous employment and to make such other investigations as may be deemed necessary. I release The Allen Company, Inc. and my current and previous employers from all liability resulting from such information.

Consent(Required)

Should I be offered employment, I will be able to show proof of my legal right to work in the United States as required by the Immigration Reform and Control Act.

Consent(Required)

I understand that if this application is not filled out in its entirety and signed and dated it will automatically be disqualified.

The Allen Company, Inc. is an Equal Employment Opportunity (EEO)/ Affirmative Action employer. Qualified applicants are considered for employment without regard to race, religion, sex, national origin, age, marital status, sexual orientation, veteran status, disability, or other protected classification as defined by applicable law and regulation.

EEO DATA REPORTING FORM

The Federal Government requires the following information to be collected for statistical reporting as a part of the Affirmative Action Program. Refusal to answer will not result in adverse treatment for any applicant. This information is not to be used in the employment processes nor released in a manner which identifies the individual. This form will be removed prior to being forwarded to any hiring authority.

Gender

Male

Female

Untitled

Ethnicity (Race)

American Indian / Alaskan Native

Asian / Pacific Islanders

African American / Black / Non-Hispanic

Hispanic / Latino

White / Caucasian / Non-Hispanic

Veteran

Disabled Veteran

Vietnam Veteran

Newly Separated Veteran

Other Protected Veteran

Date of Separation

Month

Day

Year

Disabled: Are you an individual with a physical or mental impairment which substantially limits one or more of your major life activities?

Yes

No

How did you hear about this Job Opening?

FAIR CREDIT REPORTING ACT DISCLOSURE STATEMENT

Consent(Required)

In accordance with the provisions of Section 604(b)(2)(A) of the Fair Credit Reporting Act, Public Law 91-508, as amended by the Consumer Credit Reporting Act of 1996 (Title II, Subtitle D, Chapter I, of Public Law 104-208), you are being informed that reports verifying your previous employment, previous drug and alcohol test results, and your driving record may be obtained on you for employment purposes. These reports are required by Sections 382.413, 391.23, and 391.25 of the Federal Motor Carrier Safety Regulations.

BACKGROUND CHECK AUTHORIZATION

Consent

By completing this form and signing below, I authorize The Allen Company, Inc. to request a Criminal Background Check a Motor Vehicle Record Check.

Social Security Number(Required)

Date of Birth(Required)

Month

Day

Year

Maiden Name

List any other names used

Signature(Required)

Date Signed(Required)

MM slash DD slash YYYY

Δ

Contact

The Allen Co. Main Office:
3009 Atkinson Ave, Lexington, KY 40509
(859) 543-3361
Mon-Fri: 9am to 5pm
kim_mulder@theallen.com

The Allen Company, Inc is proud to be a Drug-Free Workplace. The Allen Company is an Equal Employment Opportunity (EEO)/ Affirmative Action employer.

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