Last Name
First Name
 MI
 SS Number
Address
 City
 State
 Zip
Birthday
 Phone Number
 Email Address
Position Applying For
Desired Salary
Do you have a valid drivers license?
 Yes
 No
Are you able to lift over 75lbs?
 Yes
 No
Are you able to make multiple trips up and
down stairs with boxes and/or furniture?
 Yes
 No
Can you safely drive a 26' straight truck?
 Yes
 No
Are you able to work on short notice?
 Yes
 No
How would you describe your driving
record?
Have you ever worked for another
moving company?
 Yes
 No
How often do you check your E-Mail?
Availability  
Please describe what days and hours you can work.
Education
Name of School
 Major
 Diploma/Degree
High
School
College
Trade/
Other
Special
Skills
Employment History
Employer #2
Employer #1
Address
Address
Supervisor                               Phone
Supervisor                               Phone
Position Held                            Last Day    
Position Held                            Last Day    
Duties
Duties
Salary                       Reason for Leaving
Salary                       Reason for Leaving
May we contact this
employer?
May we contact this
employer?
Yes
 No
Yes
 No
References (Non Family Members)
  Name                      Phone                  Relation
I CERTIFY THAT THE INFORMATION CONTAINED IN
THIS APPLICATION IS TRUE AND COMPLETE TO THE
BEST OF MY KNOWLEDGE AND UNDERSTAND THAT
ANY FALSE INFORMATION ON THIS APPLICATION
MAY BE GROUNDS FOR NOT HIRING ME.
Electronic Signature
Type full name in ALL CAPS
Date
Patt's Moving Center
17719 Storage Rd
Omaha, NE  68136
402-895-7288
Omaha Moving
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Job Application
©2009 Patt's Moving Center, LLC | 17719 Storage Rd, Omaha, NE  68136 | 402.895.7288
MC 570964| NPSC # M-14194 | DOT 1532580| Independent Mover for Interstate Moving