Alaska Industrial, LLC

Our company is an equal opportunity employer and adheres to the principles and practices in the Civil Rights Act of 1964, which prohibits discrimination in employment on the basis of race, sex, religion or national origin and Public Law 90-202 which prohibits discrimination based on age.
This application will be given every consideration, but its receipt does not imply that the applicant will be employed. Each question should be answered in a complete and and accurate manner as no action can be taken on this application until all questions have been answered.

Today's Date:
Phone #:
Date of Birth:

An address must be supplied for the last three years of residence.

Present Address:
Previous Address:
Previous Address 2:
Social Security #:
Social Security # Confirmation:
If you are applying for a driver / equipment operator are you over 21?
Have you ever been convicted of any crime (excluding minor traffic violations) including DUI/DWI?:
If yes state the offense, location, date, and dispostion:
In case of emergency contact:
Emergency Contact Address:
Emergency Contact Phone:
Alternate Emergency Phone:


Have you ever served in the military:
Branch if yes:
Rank if yes:

Employment Desired

Are you seeking:
Position Applied For:
Location Applied For:
Date Available to start:
Desired Salary:
Have you ever applied to our company before:
Have you ever worked for our company before:
If your answer to either question above is yes, state when and where you applied and/ or worked:
How did you learn of our company and/ or position:
Are you or do you expect to be engaged in any other business or employment?
If yes specify those days or hours you will be unable or unwilling to work:


Are you legally authorized to work in the United States:

(Pursuant to the Immigration Reform and Control Act of 1986, if you are hired you must produce documents  which are specified by the Federal Government, establishing your identity and authorization for employment in the United States.)

Are you willing to take a drug screen?
Do you have a current D.O.T. Physical Card?
If yes, Date issued:


Give three references, not relatives or employers:

Reference 1

Reference 1 Name:
Reference 1 Address:
Reference 1 Phone:
Reference 1 Occupation:

Reference 2

Reference 2 Name:
Reference 2 Address:
Reference 2 Phone:
Reference 2 Occupation:

Reference 3

Reference 3 Name:
Reference 3 Address:
Reference 3 Phone:
Reference 3 Occupation:


Please enter the Name, Address, Location, whether or not you graduated, and if so courses studied:
High School:
Trade School:
If you did not graduate, why did you leave high school or college?
Are you planning to pursue further studies?
If so, when and what courses?
List any schoolastic honors, offices held and activities involved in during high school and college:
List and describe any other schools or specialized training:

Special Skills

Do you have a current D.O.T. Batch Card?
Date Issued:
D.O.T. Technicians Card?
Date Issued :
Do you Type?
Words Per Minute:
Do you have any computer or word processing experience training?
Please Describe:
What languages do you speak fluently?
List any other skills and/or abilities that you feel qualify you for a position:

Work History

List names of employers in consecutive order with present/ last listed first. Account for all periods of time including military service and periods of unemployment. If self-employed give firm name and supply business references. Note: If you are applying for a driving position, a three year driving employment history is required.

Name of employer:
Name/Title of last supervisor:
Address of employer:
Employed From:
Employed to:
Start Pay:
End Pay:
Phone of Employer:
Position Title:
Personal Duties:
Reason For Leaving:
Add another employer?
Name of employer 2:
Name/Title of last supervisor 2:
Address of employer 2:
Employed From 2:
Employed to 2:
Start Pay 2:
End Pay 2:
Phone of Employer 2:
Position Title 2:
Personal Duties 2:
Reason For Leaving 2:
Add another employer ?
Name of employer 3:
Name/Title of last supervisor 3:
Address of employer 3:
Employed From 3:
Employed to 3:
Start Pay 3:
End Pay 3:
Phone of Employer 3:
Position Title 3:
Personal Duties 3:
Reason For Leaving 3:
Add another employer ?
Name of employer 4:
Name/Title of last supervisor 4:
Address of employer 4:
Employed From 4:
Employed to 4:
Start Pay 4:
End Pay 4:
Phone of Employer 4:
Reason For Leaving 4:
Position Title 4:
Personal Duties 4:
Add another employer ?
Name of employer 5:
Name/Title of last supervisor 5:
Address of employer 5:
Employed From 5:
Employed to 5:
Start Pay 5:
End Pay 5:
Phone of Employer 5:
Reason For Leaving 5:
Position Title 5:
Personal Duties 5:
Are you presently employed?
If yes, may we contact your present employer?

Driving History

Have you ever tested positive, or refused to test, on any pre-employment drug or alcohol test administered by an employer to which you have applied for, but did not obtain, safety sensitive transportation work covered by DOT agency drug and alcohol testing rules during the past two years?:
If you answered yes, you have had a positive test or a refusal to test, do you have documentation of successful completion of the return-to-duty process?

Have you ever had circumstances of any denial, revocation or suspension of any license, permit, or privilege to operate a motor vehicle?

No, I have never had circumstances of any denial, revocation or suspension of any license, permit, or privilege to operate a motor vehicle?
Yes, I have had circumstances of any denial, revocation or suspension of any license, permit, or privilege to operate a motor vehicle?:
If yes, please give an explanation setting forth the facts and circumstances of any denial, revocation or suspension of any license, permit, or privilege to operate a motor vehicle:
I you are applying for a driving position you must provide a 3-year accident history. Provide an explanation of what happened and when (month/year):
List all violations, other than for parking, of which you convicted or forfeited bond or collateral for a 3-year period preceding the date of the application:

List all unexpired commercial motor vehicle operator's license or permit that have been issued:

Class 1:
State 1:
Exp. Date 1:
Class 2:
State 3:
Exp. Date 2:
Class 3:
State 2:
Exp. Date 3:

List the nature and extent of your driving experience in the operation of motor vehicles, including the type of equipment (such as buses, trucks, truck tractors, semi-trailers, full trailers and pole trailers) which you have operated.

Type of vehicle & amount of experience (years/months:


This certifies that this application was completed by me, that all entries on it and information in it are true and complete to the best of my knowledge. I certify that the answers given by me to the foregoing questions and statements are true and correct without any consequential omissions of any kind. I understand that any misleading or incorrect statement set forth in my application, resume or any other materials submitted as part of the employment application process or given by me during any interviews will render this application void and will be just cause for refusal of employment and if employed would be cause for my termination. I further agree to waive any and all claims i may have against Alaska Industrial LLC, whether owned in whole or part, and all of their present and former directors, officers, agents, employees, attorneys, partners, and representatives, now or in the future, in in any respect if my employment is terminated because of false statements, answers or omissions made by me in this questionnaire. I also authorize the companies, persons or schools named on this application to give any information regarding my employment record, including a statement of the reason for the termination of my employment, work performance abilities, and other qualities pertinent to my qualifications for employment to Alaska Industrial LLC; I hereby release said companies, schools or persons from all liability for any damage resulting from issuing this information. I certify that all statements and answers to questions are true and were made without reservations. I further understand that the taking of drug screens is a condition of my employment and refusal to take such screens when asked will result in my termination. In consideration of my employment, I agree to comply with the policies, rules, regulations and procedures of the company and understand that my employment is terminable at will, that I am not being employed for any specified time and that this application is not and is not intended to be a contract for current or continued employment. Further, I understand that my employment, with its compensation, can be terminated with or without cause or notice at any time, at the option of either the company or myself. I also understand that no manager or representative of the company, other than the CEO, general counsel or Human Resources has any authority to enter into any agreement with me for employment for any specified period of time or to make any agreement different from the contrary to the forgoing. I also understand that any such agreement, if made shall not be enforceable unless it is in writing and signed by me and one of the individuals designated above. The information provided by you herein may be used, and your prior employers may be contacted for the purposes of investigating your background.

Would you like a copy of this application E-mailed to you?