Thank you for your interest in our Company!
To help us set up your account quicker, please tell us the following:
Yes, I would like to apply for a job with Exacta!

* Required

YOU:
Name: *
Phone: *
Alt. Phone:
Email: *
Best Time to Reach You:
Street Address, Apt. No.:
City:
State:    Zip


Are you at least 18 years old?: YES     NO    


Education:


Valid CA Driver's License?: YES     NO    
Exp. Date:     License Type

VEHICLE INFORMATION:
What type of vehicle do you own: Car     SUV     Pickup     Van     Other
In the last three years, have you had?: Accident or TicketsYES     NO    
DUI or DWIYES     NO    
If "yes", please explain:
If "yes", was it on the job?: YES     NO    
Do you have a valid DMV registration?: YES     NO    
How much auto liability insurance to you carry? Minimum $100,000/$300,000
Other  

JOB INFORMATION:
What position are you seeking?:
What is your availability?: Full-Time     Part-Time     Either    
What days are you available?: Mon, Tues, Wed, Thurs, Fri, Sat, Sun, Nights, Holidays
When would you be available to start?:
Do you have Delivery Industry experience?: Yes     No    
Do you have any special skills?:

EMPLOYMENT HISTORY:
MOST RECENT EMPLOYER:
Company Name:
Dates: From:    To: 
Contact: Supervisor: 
Phone: 
Duties:
2ND MOST RECENT EMPLOYER:
Company Name:
Dates: From:    To: 
Contact: Supervisor: 
Phone: 
Duties:
3RD MOST RECENT EMPLOYER:
Company Name:
Dates: From:    To: 
Contact: Supervisor: 
Phone: 
Duties:

HOW DID YOU LEARN ABOUT US:
Referred By:
Marketing Materials: Print Ad
Publicity Materials
Business Cards
Website Link:
Search Engine or Internet Ad:
Other:
Please enter additional comments below:

    
We respect your privacy and do not share personal information with any third party.

Return to Site