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Rally Stores, Inc. Online Application

Thank you for your interest in Rally. This application is for reference purposes only. Candidates for employment will be asked to complete a formal application prior to being hired. Federal, State and Local laws prohibit discrimination based on race, color, sex, religion, national origin, ancestry, age, disability, marital status or other legally protected status.

Prior to hiring, all employee candidates are required to submit a drug test and background check.
Rally Stores, Inc. is an equal opportunity employer.

Last Name:	First Name:

Middle Initial:

Social Security Number:

Email Address (Optional):

Address:

City:

State:

Zip Code:

Phone Number:

How Long?:

Previous Addresses:

Address 1:

City:

Zip Code:

How Long?:

Address 2:

City:

Zip Code:

How Long?:

Address 3:

City:

Zip Code:

How Long?:

Do you have the legal right to work in the United States?

Yes

Can you provide legal proof of age?

Yes

Were you ever employed by this company before?		If Yes, where?
YesNo

Dates of Employment:		Rate of Pay:
from	to

Position:	Reason for leaving:

Are you now employed?	If not, how long since last employment?:
YesNo

Who referred you?:	Rate of Pay expected:

Is there any reason that you might be unable to perform the functions of the job for which you have applied (as described in the attached job description)?
YesNo

If Yes, explain if you wish

Employment History:

Employer 1		Date:
Company Name:		From:	To:

Address:	City:	Position Held:

State:	Zip Code:	Salary/Wage:

Contact Person:	Phone Number:	Reason for Leaving:


Employer 2		Date:
Company Name:		From:	To:

Address:	City:	Position Held:

State:	Zip Code:	Salary/Wage:

Contact Person:	Phone Number:	Reason for Leaving:


Employer 3		Date:
Company Name:		From:	To:

Address:	City:	Position Held:

State:	Zip Code:	Salary/Wage:

Contact Person:	Phone Number:	Reason for Leaving:


Employer 4		Date:
Company Name:		From:	To:

Address:	City:	Position Held:

State:	Zip Code:	Salary/Wage:

Contact Person:	Phone Number:	Reason for Leaving:


Employer 5		Date:
Company Name:		From:	To:

Address:	City:	Position Held:

State:	Zip Code:	Salary/Wage:

Contact Person:	Phone Number:	Reason for Leaving:


Employer 6		Date:
Company Name:		From:	To:

Address:	City:	Position Held:

State:	Zip Code:	Salary/Wage:

Contact Person:	Phone Number:	Reason for Leaving:

Accident Record for the past 3 years or more:
Dates:	Nature of Accident: (Head on, Rear End, etc.)	Fatalities:	Injuries:
Last Accident:

Next Previous:

Next Previous:

Traffic Convictions and forfeitures for the past 3 years:
Location:	Date:	Charge:	Penalty:
Location 1:

Location 2:

Location 3:

Please check all which apply:

Graduated High School

Attended College

2-Year Degree

4-Year Degree

Last School Attended:

City:

Experience and Qualifications–Driver:
Driver Licenses	State:	License No.:	Type:	Expiration Date:

Have you ever been denied a license, permit or privilege to operate a motor vehicle?
YesNo

Has any license, permit or privilefe ever been suspended or revoked?
YesNo

If you answered Yes to either above, please explain:

Driving Experience: (if none, enter "none")
Class of Equipment:	Type of Equipment: (Van,Tank,Flat,etc.)	Dates:		Approx. # of Miles:
Straight Truck:		From:	To:

Tractor/Semi-Trailer:

Tractor-Two Trailers:

Motorcoach-School Bus:

Other:

List States operated in for last five years:

List special courses or training that will help you as a driver:

List Safe Driving Awards and who awarded them:

List any trucking, transportation or other experience that may help in your work for this company:

List courses and training other than shown elsewhere in this application:

List special equipment or technical materials you can work with (other than those already shown):

PLEASE READ CAREFULLY
THIS IS NOT AN EMPLOYMENT AGREEMENT OR CONTRACT.
However, by submitting this form you are agreeing to the following:

I certify that the information I have provided on this employment application is true and correct, and that no attempt has been made to conceal pertinent information. I understand that if any information given by me in this application is proven to be false or misleading, I will not be eligible for employment. If accepted for employment, I understand that the use of illegal drugs is prohibited and that any offer of employment is contingent upon satisfactory results of any required drug test and background investigation.

Thank you for applying with Rally! Your application will remain active for 90 days and remain on file for 1 year. We will notify you if a position that matches your qualifications becomes available. Again, we appreciate your interest in Rally.