Employment Application

Name*
First Middle Last
Present Address*
Street Address City State ZIP Code
Phone*
Email*
Position Desired*
Date Available*
If under 18, please list age
Salary Expected (hourly or monthly)*
Education
Grammer School
Name & Location of School # of Years Completed Major & Degree
High School
Name & Location of School # of Years Completed Major & Degree
College
Name & Location of School # of Years Completed Major & Degree
Business or Trade School
Name & Location of School # of Years Completed Major & Degree
Please list your work experience for the past four years beginning with your most recent job held. If you were self-employed, give firm name.
Employer #1
Name of Employer
Phone
Address
Street Address City State ZIP Code
Name of Last Supervisor
First Last
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Starting Pay/Salary
Final Pay/Salary
Your Last Job Title
Reason for Leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Employer #2
Name of Employer
Phone
Address
Street Address City State ZIP Code
Name of Last Supervisor
First Last
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Starting Pay/Salary
Final Pay/Salary
Your Last Job Title
Reason for Leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Employer #3
Name of Employer
Phone
Address
Street Address City State ZIP Code
Name of Last Supervisor
First Last
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Starting Pay/Salary
Final Pay/Salary
Your Last Job Title
Reason for Leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Employer #4
Name of Employer
Phone
Address
Street Address City State ZIP Code
Name of Last Supervisor
First Last
Employed From
Date Format: MM slash DD slash YYYY
Employed To
Date Format: MM slash DD slash YYYY
Starting Pay/Salary
Final Pay/Salary
Your Last Job Title
Reason for Leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Memberships, Interests, Activities
Memberships, Interests, Activities
Exclude any memberships, interests, or activities, the name or character of which relates to race, religion, national origin or any other protected category.
References
Give three references not related to you.
Reference #1*
Name Address Phone
Reference #2*
Name Address Phone
Reference #3*
Name Address Phone
Skills
Warehouse Skills
- Shipping
- Receiving
- Fork Truck
- Order Filling
- Other
Office Skills
- Adding Machine
- Calculator
- Key Punch
- Data Processing Equipment
- Shorthand
- Typing
- Transcribing Machine
- Dimension Switchboard
Check machines you have operated
General Information
Please note other facts or skills in your background that might be helpful in evaluating your qualifications:
Do you have any additional work which will continue if employed by us?
Have you previously applied for work with us?
Application Form Waiver
I certify that the answers I have given in this application are true and accurate to the best of my knowledge, and I understand that any false or misleading answers or any omission or concealment of facts will disqualify me from consideration for employment or will result in my immediate discharge.

In making this application for employment it is understood that an investigation may be made whereby information is obtained from former employers and others. I hereby authorize all former employers, educational institutions which I have attended, credit agencies and references, to give Hardware Hank any and all information concerning my previous employment and any pertinent information they may have (personal or otherwise). I hereby release all parties from all liability for any damage that may result from furnishing same to you. I understand that if such investigation should reveal a false statement or derogatory reports, I will be disqualified from employment or will be subsequently dismissed.

I agree to conform to the rules and regulations of the company and, if employed, I understand and agree that my employment is at will. I also understand and agree that my employment may be terminated at any time with or without cause. Any agreement contrary to the above must be in writing, must expressly state that it is a contract for a specified term, and must be signed by the president of the company.

I am willing to take a pre-employment physical which does include drug/alcohol testing and agree that my initial or continued employment may be contingent on the results.

By placing my name below, I certify and acknowledge that I have read the above, understand it, and agree to it.
Name*
Date*
Date Format: MM slash DD slash YYYY
This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.

Name & Location of School	# of Years Completed	Major & Degree

Name & Location of School	# of Years Completed	Major & Degree

Name & Location of School	# of Years Completed	Major & Degree

Name & Location of School	# of Years Completed	Major & Degree

Employment Application

Education

Employer #1

Employer #2

Employer #3

Employer #4

Memberships, Interests, Activities

References

Skills

General Information

Application Form Waiver