APPLICATION FOR EMPLOYMENT – Falls City Lumber

Name *

First

Last

Date / Time

Date

Time

Email *

Phone No.

Position(s) Desired: (do not list "any" as one of your choices)

Referred by:

Date Available for Work

Phone Number

Street Address

Previous Address

Social Security Number

If younger than 18, state your age

Are you Legally entitled to work in the United States?

**Compliance with I-9 requirements is mandatory, upon employment

If convicted of a crime(s), explain here, or state "No convictions"

Have you ever been convicted of a moving traffic violation? If yes, list all instances.

Answer these questions for all positions requiring the use of a vehicle

Have your driving privileges ever been revoked or suspended? If yes List all instances.

Answer these questions for all positions requiring the use of a vehicle

Do you currently hold a Commercial driving license?

Answer these questions for all positions requiring the use of a vehicle

Education

List your highest level of education experience.

Name of the last school or training you attended, year attended and standing at completion

Grade Point Average, Major, Minor, Hours or credits completed, Degree or Certifications Received

Additional educational awards, honor and credentials

Awards, Honors, Leadership Roles, Degree or Certifications Received

Equipment skills or training applicable to the position you are applying for:

List here all equipment with which you have experience and training. (Examples: cash register, small tools, forklift, RAN, heavy machinery, safety equipment, computers or software, etc.):

Military Experience

If none, state "not applicable" List of service in U.S. Military: From state date to end date, Branch, Rank at Discharge, Military experience that may be applicable, MOS

Are you willing to relocate?

Salary Expected

Salary Expected________hour___ or week____ or state "No preference"

Availability

Number of hours you are available per week?_____ or state "No preference"

Employment Status Preferred

Type of Employment sought: regular full-time, regular part-time, temporary, seasonal, as needed

Which of the following are you available?

Are you available: Days, Nights, Weekends, Holidays, Shift Work, Other

Are you able and willing to perform the essential functions of the job for which you are applying (with or without accommodation), including travel, if necessary?

Yes, No, Not Sure, Need more training, Need special hours, Other, (explain accommodation needed if any)

Resume/Cover Letter File Upload

Click or drag a file to this area to upload.

EXPERIENCE: List below all present and past employment, beginning with your most recent employer

INSTRUCTIONS TO APPLICANT: Please read the following information carefully and complete all of the information requested. Be sure you sign and date this form. As a condition of employment with FALLS CITY LUMBER CO., I understand that consumer reports/investigative consumer reports, which may contain public record information, may be requested or made on me including financial, criminal, driving record, education, prior employer verification, and others. Further, I understand that you may be requesting information from records of various Federal, State, local and other agencies that contain my past activities. I hereby authorize without reservation, any party or agency contacted by this employer to furnish the above mentioned information and hold all of those involved in this process harmless for the information furnished and decisions made. I understand that I have the right to make a request of the third party that may be used in this investigation, and upon proper identification and the payment of any authorized fees, obtain copies of the findings in its files on me at the time of my request. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment.

Past Employer:

Address:

Starting Salary:

Include monthly, hourly or annual

Last Salary:

Include monthly, hourly or annual

Kind of Business:

Supervisor Name:

Job Title:

Reason for Leaving (Quit? Discharge? Retired? Laid Off?) :

Dates Employed:

For Job Reference, call (Full Name):

Job Reference Contact Information (Phone number)

Can we contact this employer? If no, why not?

Additional Past Employers

Please include the following: Employer: _ Starting Salary: _Address: _-Last Salary: _-Kind of Business: _-Supervisor Name:_ Job Title: _ Reason for Leaving (Quit? Discharge? Retired? Laid Off?) : _ Dates Employed: From _ For Job Reference, call (Full Name): _ at (Phone Number): _ Can we contact this employer?: _ If no, why not? _

FALLS CITY LUMBER PERMISSIBLE PURPOSE RELEASE FOR CREDENTIALING

INSTRUCTIONS TO APPLICANT: Please read the following information carefully and complete all of the information requested. Be sure you sign and date this form.

As a condition of employment with FALLS CITY LUMBER CO., I understand that consumer reports/investigative consumer reports, which may contain public record information, may be requested or made on me including financial, criminal, driving record, education, prior employer verification, and others. Further, I understand that you may be requesting information from records of various Federal, State, local and other agencies that contain my past activities.

I hereby authorize without reservation, any party or agency contacted by this employer to furnish the above mentioned information and hold all of those involved in this process harmless for the information furnished and decisions made. I understand that I have the right to make a request of the third party that may be used in this investigation, and upon proper identification and the payment of any authorized fees, obtain copies of the findings in its files on me at the time of my request. I further authorize ongoing procurement of the above-mentioned reports at any time during my employment.

I have read and agree to the terms in the "PERMISSIBLE PURPOSE RELEASE FOR CREDENTIALING" above. *

I agree
I do not agree
I agree, but I prefer to print and sign this form in person
I agree and I have uploaded the signed form with my resume or cover letter

Signature