Rally Stores, Inc. Online Application

Last Name:   First Name:   Middle Initial:

Social Security Number:   E-Mail Address:

Address:

City: State: Zip Code:

Phone:   How Long?

Previous Addresses
Address1:
City1: Zip Code1: How Long?

Address2:
City2: Zip Code2: How Long?

Address2:
City2: Zip Code2: How Long?

Do you have the legal right to work in the United States? YesNo  
Can you provide proof of age? YesNo  

Were you ever employed by this company before? YesNo  
If yes, where? Position: Pay Rate:
Dates of Employment: From: To:
Reason for Leaving:

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

Who Referred you? Expected Pay Rate:

Is there any reason 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:

Employment History (start with your most recent job)
If currently employed may we contact your current employer? YesNo  

	Company Name	Your Job	Last Pay Rate
	Address	City	State
	Zip Code	Phone #	Supervisor's Name
		From	To
	Dates Employed:
	Reason for Leaving?

	Company Name	Your Job	Last Pay Rate
	Address	City	State
	Zip Code	Phone #	Supervisor's Name
		From	To
	Dates Employed:
	Reason for Leaving

	Company Name	Your Job	Last Pay Rate
	Address	City	State
	Zip Code	Phone #	Supervisor's Name
		From	To
	Dates Employed:
	Reason for Leaving?

Accident Record for Past 3 years (or more)

	Date of Last Accident:	Nature of Accident:	Injuries:	Fatalities:
	Last:
	Next Previous:
	Next Previous:

Traffic Convictions for Past 3 years (or more)

	Location:	Date:	Charge:	Penalty:
	Last:
	Next Previous:
	Next Previous:

Education: High-School DiplomaSome College2-Year Degree4-Year Degree  
Last School Attended: City:

Experiences and Qualifications - Drivers' Licenses

	State of License:	License Number:	Type:	Expiration:

Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo  
Has any license, permit or privilege been suspended or revoked? YesNo  
If Yes to either above, explain:

Driving Experience (if none, enter "none"):

	Class of Equipment:	Type of Equipment	Dates:		Approx. Number
	Straight Truck:	(van,tank,flat,etc):	From:	To:	of Miles Driven:
	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 ths company:

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

List special equipment or technical materials you can work with (other than 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.