Application - Fred's Appliance

Personal Information

Name *

First

Middle

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Previous Addresses for the last 10 years *

Put none if that's the case

Email *

Primary Phone Number *

Alternative Phone Number

Driver's License Number *

List All Traffic Violations in the past 3 years *

Put none if that's the case.

Are you currently employed? *

Yes
No

Can you provide proof of authorization to work in the United States? *

Yes
No

Are you able, with reasonable accommodation, to physically and emotionally perform the job for which you are applying? *

Yes
No

This job requires some lifting and twisting as well as good driving skills and a good driver's record.

What, if any, special accommodations would you require if hired?

Are you currently on "lay-off" status and subject to recall? *

Yes
No

Do you fluently speak, read, or write any foreign languages? *

Yes
No

On what date would you be available to begin work? *

Are you at least 21 years of age? *

Yes
No

Hourly wage desired? *

Are you available to work - Full Time? *

Yes
No

Do you take any illegal drugs? *

Yes
No

Do you use alcohol to the extent that it would impair your job performance? *

Yes
No

Is there any reason why you would not be able to fully conform to all attendance requirements? *

Yes
No

Unemployment History *

Please account for any time you were not employed in the last 10 years. You do not need to list any periods of less than 30 days.

Have you ever been convicted of (or pleaded guilty (or "Nolo Contendere") to a crime? *

Yes
No

Have you ever been convicted of or charged with a felony? *

Yes
No

You are not required to list marijuana related misdemeanor convictions occurring more than two years ago or convictions for which the criminal record has been expunged, sealed or eradicated by the court, or misdemeanor convictions for which any probation has been completed and the case dismissed by the court.

Are you currently charged with any unresolved criminal charge – a charge which has not yet resulted in a plea, trial, or a dropping of the charge, or for which you are out on bail or on your own recognizance pending trial? *

Yes
No

A charge will not necessarily disqualify an applicant however it may delay a job until resolved.

Education

High School Education *

Include Name and City of School - Course of Study - Years - Diploma/Degree?

College Education

Include Name and City of School - Course of Study - Years - Diploma/Degree?

Trade School

Include Name and City of School - Course of Study - Years - Diploma/Degree?

Other

Include Name and City of School - Course of Study - Years - Diploma/Degree?

Previous Employment

Begin with your current or most recent employer (Military Service in the next section)

1st Company

Previous Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Start Date

End Date

Job Title

Supervisor

Work Performed and Reason for Leaving

2nd Company

Previous Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Job Title

Supervisor

Start Date

End Date

Work Performed and Reason for Leaving

3rd Company

Previous Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Job Title

Supervisor

Start Date

End Date

Work Performed and Reason for Leaving

4th Company

Previous Employer

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Job Title

Supervisor

Start Date

End Date

Work Performed and Reason for Leaving

Military Service

Have you ever served in the United States Military? *

Yes
No

Are you presently in the National Guard or Reserves? *

Yes
No

Relevant skills acquired during military service

Military Training Schools

References (No Relatives)

Reference 1 *

Include name, address, phone, email, and comments

Reference 2

Include name, address, phone, email, and comments

Reference 3

Include name, address, phone, email, and comments

Reference 4

Include name, address, phone, email, and comments

Detail any previous experience, educational or personal qualities which you feel make you qualified for this job. *

Important Authorizations

*Please read carefully and check each paragraph before signing.

“I declare under penalty of perjury that the facts contained in this application or any resume or other documentation submitted are true and complete to the best of my knowledge. I understand that any false information or significant omissions will disqualify me from further consideration for employment, and will be justification for my dismissal from employment if discovered at a later date.” *

I agree

“I understand that the company may be requesting an investigative report from a background checking agency concerning my social security number, motor vehicle operation history, criminal history, and other information to the extent permitted by law from various local, state, and federal agencies as well as other available public records.” *

I agree

“I understand that the above report may include information as to my character, general reputation, personal characteristics, mode of living, work habits, performance and experience along with reason for termination of past employment from previous employers. I voluntarily and knowingly authorize the release of all information requested by the agency for the purpose of preparing the report. I further understand that my application for employment with the company will not be complete until I have completed any additional paper work required by the agency for the purpose of preparing a report. I understand that I have the right to request that the agency provide a complete and accurate disclosure of the nature and the scope of the investigation requested, along with the information in my investigation file during normal business hours upon reasonable notice to the agency.” *

I agree

“I authorize the investigation of all statement contained in this application and any accompanying documentation, if any, and further authorize any person, school, current employer, past employer(s), and organization named in this application form to provide the company with record, information and opinions that may be useful in making a hiring decision. I release all informants from all liability for any damage that may result from furnishing information and opinions which are truthful and made in good faith to you”. *

I agree

“I give permission for a pre-employment drug/alcohol screening exam and if the company makes a conditional offer I give permission for a complete pre-employment physical and mental examination. I also consent to the appropriate release of any and all medical information as may be deemed necessary.” *

I agree

“I understand that if hired I may not hold other employment, nor engage in all other activities that create a conflict of interest with my position with the company unless given permission in writing by the company.” *

I agree

“I agree to immediately notify the company if I am charged with or convicted of any crime while my job application is pending or during my period of employment if I am hired.” *

I agree

AGREEMENT FOR AT-WILL EMPLOYMENT

If I become employed, in consideration of my employment, I agree that my employment will be “at-will” and may be terminated, with or without cause and with or without notice, at any time at the option of myself or the company. Only the President of the company has the authority to enter into and employment agreement for a specified period of time, or for termination only for cause, and any such agreement must be in writing, I understand that this constitutes the enter agreement between me and the company regarding the term of my employment and supersedes any other oral or written agreements.” *

I agree

COMPLIANCE WITH RULES

“If I become employed, in consideration of my employment, I agree to comply with the rules, regulations, policies and procedures of the company.” *

I agree

Date this application was filled out *

Employee Application

Personal Information

Education

Previous Employment

1st Company

2nd Company

3rd Company

4th Company

Military Service

References (No Relatives)

Important Authorizations

AGREEMENT FOR AT-WILL EMPLOYMENT

COMPLIANCE WITH RULES