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) Name of Supervisor Reason for Leaving Title and Duties Employer 2 Employer Phone Start Date End Date Address (include city, state, & zip) Name of Supervisor Reason for Leaving Title and Duties Employer 3 Employer Phone Start Date End Date Address (include city, state, & zip) 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: