Tri-Ko Employment Application

We consider applicants for all positions without regard to race, religion, color, sex, sexual orientation, parental status, disability, national origin, age, family medical history or genetic information, political affiliation, military service, other non-merit based factor(s), or any other legally protected status.

TRI-KO, INC. considers all applicants for employment without regard to race, color, religion, sex, national origin, age, marital or veteran status, medical condition or handicap. TRI-KO, INC. complies with applicable state and local laws prohibiting discrimination in employment. TRI-KO, INC. also provides “reasonable accommodations” to qualified individuals with disabilities, in accordance with the Americans With Disabilities Act (ADA) and applicable state and local laws. If you need any accommodations, please let us know.

List your experience with any of the following below:

 

Straight Truck: (include type, date range of operation, approx. number of total miles driven)

Tractor & Semi Trailer: (include type, date range of operation, approx. number of total miles driven)

Other: (include type, date range of operation, approx. number of total miles driven)

Please list any accidents for the past three years, including the nature of the accident (ex: head-on, rear-end, upset, etc):

Ex.

Accident 1  - DATE - Nature of accident - Fatality (Y/N) - Injury (Y/N) - Non-injury (Y/N)

Accident 2  - DATE - Nature of accident - Fatality (Y/N) - Injury (Y/N) - Non-injury (Y/N)

As part of the selection and hiring process, this company engages in drug testing of all otherwise qualified applicants for employment.


These tests are highly sophisticated and capable of detecting trace amounts of various drugs for up to 60 (sixty) days following use.


If you have used drugs in the last 60 (sixty) days, please do not waste our time and yours by applying for work with this company.


Test results which indicate the presence of drugs in your body will bar further hiring consideration.


If you are selected for an interview, you will be required to provide the following documents at the time of interview:

  1. Driver’s License
  2. Social Security Card (original, not a copy)
  3. High School Diploma or GED Certificate


-or-


College Transcript/Diploma as required for position


The following screening forms will also be completed at the time of interview:

  1. Kansas Department for Aging and Disability Services
  2. Kansas Bureau of Investigation
  3. State of Kansas Department for Children and Families
  4. National Sex Offenders Public Website
  5. Kansas Department of Motor Vehicle
  6. Office of the Inspector General
  7. National Crime Information Center
  8. United States Immigration Services – I-9
  9. Request for Information from Previous Employer
  10. Alcohol and Controlled Substance Test Information Release

301 FIRST STREET - OSAWATOMIE, KANSAS 66064
please read carefully

TRI-KO, INC. provides services to and promotes opportunities for developmentally disabled and handicapped persons in their living and working environments assisting them in becoming more independent and supporting their choices in life.

  • I understand that I must have the ability to read and write to an acceptable level of proficiency commensurate to the position for which you I am applying.
  • For direct-care positions, I should be able to adequately document behaviors, understand and implement plans for persons served, and pass training including, but not limited to, First Aid and CPR, Mandt, and Medication Administration (where applicable).
  • I understand that possession of a personal telephone is necessary for employment communication.
  • I understand that I must not have a history or record of abuse, neglect or exploitation of persons unable to protect themselves.
  • I understand that most positions require the ability to operate TRI-KO, INC. vehicles, and my motor vehicle record will be a factor in employment. Tri-Ko’s insurance carrier must be able to insure each employee on its policy.
  • Any offer of employment received from TRI-KO, INC. is conditional upon successful completion of the company’s total employment screening process, including satisfactory references and satisfactory results of any other employment background checks such as motor vehicle records, drug/alcohol screening, Kansas Department for Children and Families, Adult and Child Abuse and Neglect Central Registry, Kansas Bureau of Investigation records, Health and Human Services Office of Inspector General, Kansas State Board of Nursing, Kansas Nurse Aide Registry, National Criminal data base, or other screening deemed appropriate for the position for which I have applied.
  • In processing my application for employment, I understand that TRI-KO, INC. may verify information provided by me concerning my prior employment, education, military record, character, general reputation, motor vehicle record and criminal record.
  • I understand that I will be required to pass a drug/alcohol screening as a condition of employment and thereafter I may be randomly tested throughout my employment with TRI-KO, INC. I understand that employees may be required to submit to post-accident or reasonable suspicion drug/alcohol testing.


I have read and understand the statements and conditions of employment above. Falsification of information contained within this application for employment may prevent employment or cause for termination of employment.

Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, disabilities or other protected status

Please give employment details below.

Please give employment details below.

Please add additional work experience in the space below.

 

Please include additional work experience below.

Employer Name:

 Employer Address:

Employer Phone Number:

Supervisor Name:

Job Title/Position:

Dates Employed:

Work Performed:

Starting and ending pay rate/salary

Please list the Name/Address of School, Course of Study, Years Completed and Diploma/Degree received

Describe any specialized training, apprenticeship, skills and extra-curricular activities. Please summarize special job-related skills and qualifications acquired from employment or other experience. List professional, trade, business or civic activities and offices held. State any additional information you feel may be helpful to us in considering your application.

This certifies that this application was completed by me, and that all entries on it are true and complete to the best of my knowledge. I authorize investigations and inquiries of my personal, employment, financial or medical history and other related matters as may be necessary in arriving at an employment decision. (Generally, inquiries regarding medical history will be made only if and after a conditional offer of employment has been extended.) I hereby release employers, health care providers and other persons from all liability in responding to inquiries and releasing information in connection with my application.


This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time.


I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an “at will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this “at will” employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.


In the event of employment, I understand that false, misleading, or incomplete information given in my application or interview(s) may result in discharge. I also understand that the results of some background screenings may not be available until after I actively begin employment. All offers of employment are contingent upon satisfactory results of background screens, both received prior to and after employment is begun.
I understand, also, that if employed, I will be required to abide by all rules and regulations of the Employer.