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Employment Form

First Name:*

Last Name:*

Middle Initial:

Home Phone:*

Work Phone:

Current Address

Current Address:*

Current City:*

Current State:*

Current Zip Code:*

Prior Address

Prior Address:

Prior City:

Prior State:

Prior Zip Code:

Applicant Note

This application is intended for use in evalulating your qualifications for employment. This is not an employment contract. Please answer all appropriate questions completely and accurately. False or misleading statements during the interview or on this form are grounds for terminating the application process or, if discovered after employment, terminating employment. All qualified applicants will receive consideration without discrimination because of sex, marital status, race, color, age, creed, national origin, sexual orientations, military reserve membership, ancestry, religion, height, weight, use of a guide or support animal because of blindness, deafness or physical handicap, or the presence of disabilities. Additional testing of job-related skills are for the presence of drugs and alcohol in your body may be required prior to employment.

Referred By

Referred By:

Friend's Name:

Other:

Availability

For which position are you applying?*

What date can you start?*

What category would you prefer?*

Full-time
Part-time
Temporary

For which schedules are you available?*

Security

Have you been convicted of a crime in the past seven years? If so, please describe in the boxes below. Conviction will not necessarily be a bar to employment. (In accordance with the company policy and applicable state and federal laws, factors such as age at time of the offense, remoteness of the offense, time since last conviction, nature of the job sought and rehabilitation effort will be reviewed.)*

Incident

City/State

Charge

Incident

City/State

Charge

Previous Employers

List all previous employers for the past 10 years, beginning with present or most recent position. Explain all gaps in employment. If you need more space, attach an additional sheet.
Please Note: Your application will not be considered unless every question in this section is answered. Since we will make every effort to contact previous employers, the correct telephone numbers of past employers are critical.

Most Recent Employer

Are you currently working for this employer?*

If yes, may we contact?*

Phone Number*

Fax Number

Company Name*

City*

State*

Start Date*

End Date*

Job Title*

Supervisor Name*

Duties*

Salary per hour/week/year (please specify)*

Reason for leaving*

Second Recent Employer

Are you currently working for this employer?

If yes, may we contact?*

Phone Number*

Fax Number

Company Name*

City*

State*

Start Date*

End Date*

Job Title*

Supervisor Name*

Duties*

Salary per hour/week/year (please specify)*

Reason for leaving*

Third Recent Employer

Are you currently working for this employer?

If yes, may we contact?*

Phone Number*

Fax Number

Company Name*

City*

State*

Start Date*

End Date*

Job Title*

Supervisor Name*

Duties*

Salary per hour/week/year (please specify)*

Reason for leaving*

Education

Please choose the highest grade completed.*

If your school records are listed under a different name than listed before, please enter that name

High School

High School Name

High School City/State

Did you graduate

With what degree?

College

College Name

College City/State

Did you graduate

With what degree?

Other Institution

Other Name

Other City/State

Did you graduate

With what degree?

Employment Form

Applicant Note

Referred By

Availability

Security

Previous Employers

Education

Bath & Shower Colors

Wall Surround Colors

Tile Patterns