Application For Employment

Give employment history, starting with your present employer. For any unemployed or self-employed period, show dates and location.

Name of Employer

Employer Address

Employer Phone

Dates of employment. From

Starting Wage

Type of Business

Ending Wage

Your Position/Title

Supervisor

Briefly describe your duties and responsibilities

Name of Employer

Employer Address

Employer Phone

Dates of employment. From

Starting Wage

Type of Business

Ending Wage

Your Position/Title

Supervisor

Briefly describe your duties and responsibilities

Name of Employer

Employer Address

Employer Phone

Dates of employment. From

Starting Wage

Type of Business

Ending Wage

Your Position/Title

Supervisor

Briefly describe your duties and responsibilities

Education

Select you highest level of education completed

High School Attended

College Attended

Other graduate, business, or vocational school, or other training skills

Describe any job-related training received in the United States Military.

Questionnaire

Are you 18 years or older?

Yes No

Are you currently employed?

Yes No

If so, may we contact your employer?

Yes No

Position applied for

Salary Desired

Date you can start

Name of last supervisor?

Are you prevented from lawfully becoming employed in this country because of Visa or immigration status? * Proof of citizenship or immigration status will be required upon employment.

Yes No

Personal / Professional References (do not include family members)

Give the names and addresses of three people (no relatives) you have worked with and to whom we may refer for a reference if necessary. We may also check with other sources at our discretion.

Reference 1 Name

Phone

Best time to call

Occupation

Reference 2 Name

Phone

Best time to call

Occupation

Reference 3 Name

Phone

Best time to call

Occupation

GENERAL INFORMATION

List Outside Interests (Clubs, Organizations, Sports, Hobbies) and how they will relate to the job for which you are applying.

(Need not list any interests which would indicate your religious, ethnic, or political background/affiliation.)

What business machines do you operate?

(Calculator, cash register, computer, etc.)

What prompted you to apply at our company?

(Newspaper, Agency, Window Sign, Rabio, referral by current employee)

Authorization

"I verify that all of the information on this application and exhibits and resumes is true, correct and complete. I have not withheld any information requested by Plymouth Furniture. I understand that false, misleading, incomplete or omitted information will result in rejection of my application or termination from employment, whenever discovered."

I authorize Plymouth Furniture and its agents to confirm all information provided on this application, exhibits and resumes and to investigate my suitability for employment. I agree to furnish additional information if requested. I release Plymouth Furniture and all persons and companies from any claims, liabilities or damages from obtaining or furnishing information about me. I understand that I will be provided a supplemental notification and authorization if Plymouth Furniture elects to conduct a consumer report about me under the Fair Credit Reporting Act.

This application is not a job offer or employment contract with Plymouth Furniture for any specific time period. I understand that if hired, my employment will be for an indefinite time period and I may resign or be terminated at any time without notice or requirement of cause. I also understand that if employed, I will be required to complete a federal I-9 form and provide verification of my identity and right to work in the United States.

Any conditional offer of employment by Plymouth Furniture is subject to successful completion of all employment requirements, including but not limited to verifying employment / personal references, criminal record, license / certification, driving record (where appropriate), testing for the illegal use of drugs, and a post offer, pre-hire physical.

If employed, I agree to comply with all policies, rules and procedures of Plymouth Furniture.

Authorized

Yes, process my application. No, do NOT process my application.

Please type your name in the signature box below:*

Contact Information

Employment Information

Education

Questionnaire

Personal / Professional References (do not include family members)

GENERAL INFORMATION

Authorization