Full Name:
Address:
Phone:
How long have you live in
this area?
Drivers License #:
Pay/Salary Desired $
Date available to start:
High School Attended:
College attended:
Major:
Trade School attended:
Any special courses/classes
that may help in this position?
Armed Services:
Do you have any hobbies?
Do you have any conditions
that may preclude you from performing any work for which you are being
considered?
If so, please answer
the following: Do you, or have you had, Hernia? :
Other or Explain:
Have you had any
serious injury or illness in the last 3 years?
Do you have any impairment
of: Hearing?
Do you currently
have your own transportation?
If so, explain:
In the past 4 years
I have received tickets for: (How many?)
Are you willing to
supply us with a recent criminal and DMV report?
Do you know how to
drive a stick-shift vehicle?
Would you mind occasionally performing job functions that differ from those you were hired for?
Do you have any objections
to occasionally working on weekends or at night?
Do you have any objections
to working in a smoke-free environment?
Do you have any objections
to a physical and/or drug testing at our expense?
Do you have, or have
you had, any prior problems with alcohol or drugs?
Do you have any objections
to us performing a credit search on you?
Do you have any objections
to signing a non-compete employment contract (1-1/2 years-150 mile)
as a condition of employment?
Have you ever applied
to our company before?
How did you learn
of this job opening?
employment history...
(List most recent
employment first)
Company:
From:
Did you
have Health Insurance?
Did you
have Profit Sharing?
# days
missed last year worked:
employment history...
(List most recent
employment first)
Company:
From:
Did you
have Health Insurance?
Did you
have Profit Sharing?
# days
missed last year worked:
employment history...
(List most recent
employment first)
Company:
From:
Did you
have Health Insurance?
Did you
have Profit Sharing?
# days
missed last year worked:
(Please
complete information under all fields listed below, even if you
are not applying for that position...)
CONCRETE
CUTTERS : Place an X if you have or have had:
Are you
or have you been a Trade Union member?
Place
an X if you have experience in
OFFICE/CLERICAL
POSITIONS : Place an X by applicable skills and complete speed under
WPM & SPM
SALES :
Indicate
preference Outside?
Pay on
Commission?
List
any Awards Earned: (Date, Company & Reason)
MECHANICS :
Indicate
Experience
***ALL
APPLICANTS MUST READ AND COMPLETE THE FOLLOWING...***
I authorize
Merlin Stelzer Sales Co., Inc. to investigate and acquire pertinent
documentation in order to verify that all statements and information
presented on this application are true and correct and I hereby release
Merlin Stelzer Sales and any supplying source from any liability as
a result of such information. I understand that misrepresentation or
falsification of the information given on this form will be just cause
for dismissal. Further, I understand and agree that if hired, my employment
will be for no definite period of time, and may, regardless of the
date of payment of my wages and/or salary, be terminated "At Will",
at any time, and without notice. All employment offered will be conditional
on an employment contract being accepted; the taking of an employment
physical and drug screening; and the understanding that all employment
is on a 90 day initial trial period, which once successfully completed,
will make benefits available to me per the conditions of the Company
Policy and any written agreements upon hiring. Only written promises
made by the employer will be enforceable. Should employment be terminated
prior to my 90 day trial period, I agree to allow a payroll deduction
for the costs of my physical and drug test.
Submittal
of this electronic application give the above authorization:
