DOT Employment Application - Page 1 of 5

PO Box 1034
3020 Energy Drive
Dickinson, ND 58602

(701) 456-9184
(800) 932-8740
www.fisherind.com
Federal law obligates us to provide reasonable accommodation to the known disabilities of applicants and employees, unless to do so would pose an undue hardship. Please feel free to let us know if you need an accommodation to complete the application process or to perform any essential elements of the position sought.
To Applicant: We deeply appreciate your interest in our organization and assure you that we are sincerely interested in your qualifications. A clear understanding of your background and work history will aid us in placing you in the position that best meets your qualifications and may assist us in possible future upgrading.
Position Desired
 Current Job Openings
Last Name
 First Name
 Middle
 Date
Monday, September 06, 2010
Street Address
SSN
Telephone
 Date of Birth
City
State
 Zip
 Email (optional)

Have you ever applied for employment or worked for us before?

 Yes  No

If yes, month and year:

Apart from absence for religious observation, are you available for full time work?

Yes  No

If not, what hours can you work?

Are you legally eligible for employment in the United States?
Proof of citizenship or immigration status will be required upon employment (I.E.:Passport, Alien Registration Card, driver's license, Social Security card and birth certificate.)

 Yes  No

Date available for employment:

If you are less than 18 years of age, can you provide required proof of your eligibility to work?You will be required to provide a school work permit

 Yes  No

Rate of pay expected
$ per

Will you work overtime if asked?

 Yes  No

If requested, would you be willing to take a pre-employment drug/alcohol-screening test as a condition of employment?

 Yes  No  

The position for which you are applying may require overnight or out of town employment, do you have any objections to this arrangement?

 Yes  No  

Have you ever been fired or forced to resign from previous employment?

 Yes  No  

Does present employer know you plan employment change?

 Yes  No  
       Why do you desire to make a change? 
Source of Referral to Fisher Industries:

 Contact on my own
 Current/Past Employee
 Employment Agency

 Newspaper
 Radio
 TV

 Our Website
 Other Website

 School Placement
 Career Day/Job Fair
 Other 
We are an equal opportunity employer: Prospective employees will receive consideration without discrimination because of race, color, sex, age, disability, national origin, religion, or any other prohibited basis of discrimination, as provided under applicable state and federal law.
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