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Applicant Information

Date of Birth


e.g. High School Diploma, Bachelors Degree, Graduate Degree
Education Address
From (Start Date)
To (End Date)

Professional Reference

Please list two professional references. These references should know your work style/habits well enough to provide information about you. These persons should also be aware that they may be contacted by UCS as a part of the application process.
Reference Name #1
Reference Name #2

Previous Work Experience

Company Address
From (Start Date)
To (End Date)

Military Service

Machinery/Equipment Operating Skills

Special Skills/Qualifications

Click or drag a file to this area to upload.

Declaration and Certificate of Understanding and Permission to Obtain Information

I understand that if I’m employed any false or misleading information or in an interview, will be sufficient cause for cancellation of this application or immediate discharge form the employer’s service, when its discovered. I also understand that I am required to abide by the rules and regulations of UCS LLC.

I give UCS LLC (hereafter referred to an employer) the right to contact and obtain information from all references, current and former employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I herby release employers, school, healthcare providers, and all other persons from all liability in responding to inquires and releasing information in connection in connection to my application.

I authorize you to make sure investigations and inquiries to my personal employment, financial or medical history and other related matters as may be necessary on arriving at an employment decision.

I understand that the employer does not unlawfully discriminate in employment and no questions on this application will be used for the purpose of limiting or excusing any application from consideration for employment on a basis prohibited by local, state, or federal law.

I understand that this application is current for only 90 calendar days. At that time, if I have not heard from the employer and still wish to be considered from employment, I will be required to fill out a new application.

If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice. I also understand that the employer reserves the same right to terminate my employment at any time, with or without cause, and without prior notice, except s may be required by law. This application does not constitute an agreement or contact for employment for any specified period or defined duration. I understand that no representative of the employer, other than an authorized officer, has the authority to make any assurances to the contrary. I further understand that such assurances must be in writing and signed by authorized officer.

I understand that it is this company’s policy no to refuse to hire qualified individual with a disability because of that person’s need for a reasonable accommodation as required by ADA. I also understand that f I need some form of accommodation to complete this application, I am obligated to request that accommodation from the employer.

I also understand that if I am offered a position with the employer, I will be required to provide proof of identity, legal work authorization, and pass pre-employment drug test, and a non-discriminatory physical assessment screen as a condition precedent to my employment by employer.

I represent and warrant that I have fully read, and fully understand the foregoing and seek employment under these conditions.

“I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49CFR 391.23(d) and(e). I understand that I have the right to:

  • Review information provided by current/previous employers
  • Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; and
  • Have a rebuttal statement attached to the alleged erroneous information, if the previous employer(s) and I cannot agree on the accuracy of the information.”