Employment Application

1. Applicant Information

First Name *

Middle Name / Initial

Last Name (including suffix) *

Application Date

Street Address *

Apartment / Unit

City *

State *

ZIP Code *

Phone Number *

Email Address *

Date Available to Start

Desired Salary / Pay

Position Applied For *

Are you legally authorized to work in the United States? *YesNo

Have you previously worked for DSS Final Mile?YesNo

If yes, when did you work for DSS Final Mile?

Have you ever been convicted of a felony?YesNo

If yes, please explain (optional; subject to applicable employment law)

2. Education

High School

High School — School Name

High School — School Address

High School — From

High School — To

High School — Did you graduate?YesNo

High School — Diploma

College

College — School Name

College — School Address

College — From

College — To

College — Did you graduate?YesNo

College — Degree

Other Education / Training

Other Education / Training — School Name

Other Education / Training — School Address

Other Education / Training — From

Other Education / Training — To

Other Education / Training — Did you graduate?YesNo

Other Education / Training — Degree or Certificate

3. Professional References

Instructions

Please list three professional references.

Reference 1

Reference 1 — Full Name

Reference 1 — Relationship

Reference 1 — Company

Reference 1 — Phone

Reference 1 — Address

Reference 2

Reference 2 — Full Name

Reference 2 — Relationship

Reference 2 — Company

Reference 2 — Phone

Reference 2 — Address

Reference 3

Reference 3 — Full Name

Reference 3 — Relationship

Reference 3 — Company

Reference 3 — Phone

Reference 3 — Address

4. Previous Employment

Previous Employer 1

Employer 1 — Company

Employer 1 — Company Phone

Employer 1 — Company Address

Employer 1 — Supervisor

Employer 1 — Job Title

Employer 1 — Starting Salary

Employer 1 — Ending Salary

Employer 1 — Responsibilities

Employer 1 — Employment From

Employer 1 — Employment To

Employer 1 — Reason for Leaving

Employer 1 — May we contact your previous supervisor for a reference?YesNo

Previous Employer 2

Employer 2 — Company

Employer 2 — Company Phone

Employer 2 — Company Address

Employer 2 — Supervisor

Employer 2 — Job Title

Employer 2 — Starting Salary

Employer 2 — Ending Salary

Employer 2 — Responsibilities

Employer 2 — Employment From

Employer 2 — Employment To

Employer 2 — Reason for Leaving

Employer 2 — May we contact your previous supervisor for a reference?YesNo

Previous Employer 3

Employer 3 — Company

Employer 3 — Company Phone

Employer 3 — Company Address

Employer 3 — Supervisor

Employer 3 — Job Title

Employer 3 — Starting Salary

Employer 3 — Ending Salary

Employer 3 — Responsibilities

Employer 3 — Employment From

Employer 3 — Employment To

Employer 3 — Reason for Leaving

Employer 3 — May we contact your previous supervisor for a reference?YesNo

5. Military Service, Vehicle & Certification

Military Branch

Service From

Service To

Rank at Discharge

Type of Discharge

If discharge was other than honorable, please explain

Vehicle you own — Year, Make, Model

Instructions

Applicant Certification

I certify that my answers are complete and accurate to the best of my knowledge. I understand that providing false or misleading information in this application to DSS Final Mile (“Company”) or during an interview with DSS Final Mile representatives may result in rejection of my application or termination of employment.

Applicant Certification *I have read and agree to the certification above.

Electronic Signature — Type Your Full Legal Name *

Date Signed *

Links

Locations