Employment Application

Section 1: Personal Info

Name (Last, First Middle)*

Street Address 1*

Street Address 2

City, State, Zip*

How long at this address?*

Your Email*

Cell Phone Number*

Driver's License Number*

Position you are applying for*

Desired Salary*

Can you travel if required?*
YesNo

Are you under 18 years of age?
YesNo

If under 18, can you provide a work permit?
YesNoDoes Not Apply

Applying for:
Full TimePart TimeTemporary

Are you currently employed?
YesNo

If employed, why do you wish to change?

Have you applied for employment here before?
YesNo

Have you ever been employed here before?
YesNo

Do you have experience in the building materials industry?
YesNo

On what date would you be available to start work?

How did you learn about this company?
advertisementfriendrelativeemployment agencycurrent employeeother

May we contact your present and previous employers?
YesNo

Have you been convicted of a felony in the last 7 years?
YesNo

To comply with laws concerning the employment of illegal aliens, can you provide proof of employability?
YesNo

Section 2: Education

High School Last Attended

High School Name

High School Location

Major Field of Study

Did you graduate?
YesNo

College

College Name

College Location

Major Field of Study

Did you graduate?
YesNoDoes Not Apply

Other

Other Name

Other Location

Major Field of Study

Did you graduate?
YesNoDoes Not Apply

Activities and Other Involvement

List professional, trade, business, or civic activities and offices held. You may exclude membership which would reveal sex, race, religion, national origin, age, ancestry, or handicap or any other protected status.

Section 3: Military Status

Branch of Service

Rank Upon Entry

Rank Upon Release

Nature of Duties

What specialized training did you receive?

Do you have any reserve or National Guard obligation?
YesNoDoes Not Apply

If yes, please describe:

Section 4: Employment History

If records are under a different name, please provide name for reference purposes, starting with present or last employer. List all employment including part-time or temporary positions.

Employer 1

Employer

Phone

Start Date

End Date

Address (include city, state, & zip)

Beginning Salary

Ending Salary

Name of Supervisor

Reason for Leaving

Title and Duties

Employer 2

Employer

Phone

Start Date

End Date

Address (include city, state, & zip)

Beginning Salary

Ending Salary

Name of Supervisor

Reason for Leaving

Title and Duties

Employer 3

Employer

Phone

Start Date

End Date

Address (include city, state, & zip)

Beginning Salary

Ending Salary

Name of Supervisor

Reason for Leaving

Title and Duties

Section 5: Special Skills & Qualifications

Please list your skills and qualifications that you think would be valuable in this position:

Section 6: Disclosures

Note to Applicants: Do not answer yes or no to this question unless you have been informed about the requirements of the job for which you are applying

Are you capable of performing in a reasonable manner, the essential functions involved in the job or occupation for which you have applied?
YesNoDoes Not Apply

A description of the job functions involved in this job or occupation will be given to you upon receipt of this completed application.

You are not required to disclose information about physical or mental limitations that you believe will not interfere with your capability to do the job. However, if you want the employer to consider special arrangements to accommodate a physical or mental impairment, you may identify that impairment in the space provided below and suggest the kind of accommodation that you believe to be appropriate.

Section 7: Agreements

I understand that, if hired, my employment will be "at will" and that either I or the company may terminate the employment relationship at any time with or without cause and with or without notice. I further understand that this employment relationship may not be modified by verbal statements, customs, practices, or written documents unless such modification is in writing and signed by an authorized representative of the company.
Yes, I understandNo

In connection with my application for employment, I authorize this prospective employer to contact any or all previous employers to discuss my employment history, including reasons for termination of past employment. I also authorize this prospective employer to obtain a copy of my driving record from the Secretary of State or from the Secretary of State’s office in those states in which I held previous employment. I also authorize this prospective employer to confirm any or all information contained in this employment application. I certify that all information on this application is true and complete to the best of my knowledge, and I understand that falsification of any information on this application will be grounds for immediate discharge.

Enter your name if you agree with this statement: