Deacon Industrial Supply Co Inc Application For Employment Please

deacon industrial supply co., inc. application for employment please print equal access to programs, services and employment is avail

Deacon Industrial Supply Co., Inc.
Application for Employment
Please print
Equal access to programs, services and employment is available to all
persons. Those applicants requiring reasonable accommodation to the
application and/or interview process should notify a representative of
the Human Resource Department.
Name ______________________________________________________Social
Security # _______-______-_______
Last First Middle
Address
________________________________________________________________________________________
Street City State Zip Code
Telephone #( )______________________________Mobile/Beeper/Other #(
)___________________________
Email Address _________________________________________Date of
Application _________________________
Position(s) applied for
_____________________________________________________________________________
Referral Source (Please check the appropriate category and name the
source.)
□ Walk-in ______________________________________ □ School
____________________________________
□ Employee ____________________________________ □ Job Fair
___________________________________
□ Advertisement _________________________________ □ Staffing Agency
_____________________________
□ Company’s Website ____________________________ □ Gov’t/Employment
Agency ____________________
□ Other Internet _________________________________ □ Other
______________________________________
* If necessary, best time to call you at home is __________
* May we contact you at work? □ Yes □ No
If yes, work number and best time to call:
( ) __________________________________
* If you are under 18 and it is required, can you furnish a work
permit? □ Yes □ No
If no, please explain_______________________
* Have you submitted an application here before?□Yes □No
If yes, give date(s) and position(s)
_______________________________________________
* Have you ever been employed her before? □ Yes □ No
If yes, give dates __________________________
* Are you legally eligible for employment in this country?
□ Yes □ No
* Date available for work __________________________
* What is your desired salary range or hourly rate of pay?
_______________________________________________
* Type of employment desired: □ Full-time □ Part-Time
□ Educational Co-Op □ Seasonal □ Temporary
* Will you relocate if job requires it? □ Yes □ No
* Will you travel if job requires it? □ Yes □ No
* If they have been explained to you, are you able to
meet the attendance requirements of the position?
□ N/A □ Yes □ No
* Will you work overtime if required? □ Yes □ No
If no, please explain
______________________________________________________________________________________
* Driver’s License number required if driving may be required in the
job for which you are applying:
___________________________ State ___________
* Have you ever been bonded? □ Yes □ No
Answering “yes” to the following question does not constitute an
automatic bar to employment. Factors such as date of the offense,
seriousness and nature of the violation, rehabilitation and position
applied for will be taken into account?
* Have you ever pled “guilty” or “no contest” to or been convicted of
a crime? □ Yes □ No
If yes, please provide date(s) and details
_________________________________________________________________________________________________________________________________
An Equal Opportunity Employer
Employment History (Starting with your most recent employer, provide
the following information.)
Employer Telephone #
Dates employed
Compensation (Starting)
Street Address City State
Hourly Salary
$ per
Starting job title/final job title
Commission/Bonus/Other Compensation $
Compensation (Final)
Immediate supervisor and title(for most recent position held)
May we contact for reference? Yes No Later
Hourly Salary
$ per
Why did you leave?
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Employer Telephone #
Dates employed
Compensation (Starting)
Street Address City State
Hourly Salary
$ per
Starting job title/final job title
Commission/Bonus/Other Compensation $
Compensation (Final)
Immediate supervisor and title(for most recent position held)
May we contact for reference? Yes No Later
Hourly Salary
$ per
Why did you leave?
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Employer Telephone #
Dates employed
Compensation (Starting)
Street Address City State
Hourly Salary
$ per
Starting job title/final job title
Commission/Bonus/Other Compensation $
Compensation (Final)
Immediate supervisor and title(for most recent position held)
May we contact for reference? Yes No Later
Hourly Salary
$ per
Why did you leave?
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Employer Telephone #
Dates employed
Compensation (Starting)
Street Address City State
Hourly Salary
$ per
Starting job title/final job title
Commission/Bonus/Other Compensation $
Compensation (Final)
Immediate supervisor and title(for most recent position held)
May we contact for reference? Yes No Later
Hourly Salary
$ per
Why did you leave?
Commission/Bonus/Other Compensation $
Summarize the type of work performed and job responsibilities
What did you like most about your position?
What were the things you liked least about the position?
Employment History (continued)
Explain any gaps in your employment, other than those due to personal
illness, injury or disability.
If not addressed on previous page, have you ever been fired or asked
to resign from a job? □ Yes □ No
If yes, please explain
Skills & Qualifications
Summarize any special training, skills, licenses and/or certificates
that may assist you in performing the position for which you are
applying.
Computer Skills (Check appropriate boxes. Include software titles and
years of experience.)
□
Word Processing
Years
□
Internet
Years
□
Spreadsheet
Years
□
Other
Years
□
Presentation
Years
□
Other
Years
□
E-mail
Years
□
Other
Years
Educational Background
Starting with your most recent school attended, provide the following
information.
School (include City & State)
Years Completed
Completed
GPA
Class Rank
Major/Minor
References
List name and telephone # of three business/work references who are
not related to you and are not previous supervisors. If not
applicable, list three school or personal references who are not
related to you.
Name
Title
Relationship to you
Telephone #
Years known
Related Information
To what job-related organizations (professional, trade, etc.) do you
belong?
Exclude memberships that would reveal race, color, religion, sex,
national origin, citizenship, age, mental or physical disabilities,
veteran/reserve national guard or any other similary protected status.
Organization
Offices Held
List special accomplishments, publications, awards, etc.
Exclude memberships that would reveal race, color, religion, sex,
national origin, citizenship, age, mental or physical disabilities,
veteran/reserve national guard or any other similary protected status.
In your current or prior job, have you ever written instructions or
directions to be followed by employees or customers?
□ Yes □ No □ Not Applicable
If yes, please explain:
Is there any other job-related information you want us to know about
you?
Applicant Statement
I certify that all information I have provided in order to apply for
and secure work with this employer is true, complete & correct.
I expressly authorize, without reservation, the employer, its
representatives, employees or agents to contact and obtain information
from all references (personal and professional), employers, public
agencies, licensing authorities and educational institutions and to
otherwise verify the accuracy of all information provided by me in
this application, resume or job interview. I hereby waive any and all
rights and claims I may have regarding the employer, its agents,
employees or representatives, for seeking, gathering and using
truthful and non-defamatory information, in a lawful manner, in the
employment process and all other persons, corporations or
organizations for furnishing such information about me.
I understand that this employer does not unlawfully discriminate in
employment and no question on this application is used for the purpose
of limiting or eliminating any applicant from consideration for
employment on any basis prohibited by applicable local, state or
federal law.
I understand that this application remains current for only 30 days.
At the conclusion of that time, if I have not heard from the employer
and still wish to be considered for employment, it will be necessary
for me to reapply and fill out a new application.
I understand that in the event that I am hired, I will be hired as an
at-will employee and I am free to resign at any time, with or without
cause and with or without prior notice, and the employer reserves the
same right to terminate any employment at any time, with or without
cause and with or without prior notice, except as may be required by
law. This application does not constitute and agreement or contract
for employment for any specified period of definite duration. I
understand that no supervisor or representative of the employer is
authorized to make any assurances to the contrary and that no implied
oral or written agreements contrary to the foregoing express language
are valid unless they are in writing and signed by the employer’s
president.
I also understand that if I am hired, I will be required to provide
proof of identity and legal authorization to work in the United States
and that federal immigration laws require me to complete an I-9 Form
in this regard.
I understand that any information provided by me that is found to be
false, incomplete or misrepresented in any respect, will be sufficient
cause to (i) eliminate me from further consideration for employment,
or (ii) may result in my immediate discharge from the employer’s
service, whenever it is discovered.
DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT.
I certify that I have read, fully understand and accept all terms of
the foregoing Applicant Statement.
Signature
Date