Employment Application Form

Gary Pack Lumber and Flooring is an Equal Opportunity Employer.

All questions and statements must be answered in full or your application will not be processed.

Fill out online, Print the form and mail or bring with you to Gary Pack Lumber and Flooring.

PERSONAL INFORMATION

*Name:

Last   First   Middle

*Address:

Street

 

City      Zip

 

Country

*Phone:

Day

  Evening

E-mail:

*Are you over 18 years of age? yes    no

If required for the position, do you hold a valid driver's license? yes    no

*Are you legally authorized to work in the United States? yes    no

If yes, date started, position, and location:

*Have you ever been employed by Gary Pack Lumber in the past? yes    no

If yes, your name (if different), date started and left, position:

*Have you ever been convicted of a crime other than a minor traffic violation? yes    no
Convicted means you were declared guilty by a judge or you pleaded guilty in court. A conviction may have even taken place if you did not pay a fine or spend time in jail or in prison. A conviction could have been for either a misdemeanor or a felony. A minor traffic violation is an infraction for which you would be ticketed. Driving while under the influence, driving on a suspended license, reckless driving, leaving the scene of an accident and vehicular homicide are not minor traffic violations. Answering yes to this question does not automatically disqualify you for employment; however, information obtained from the investigation will be used in the employment review process.

If yes, it is mandatory that you complete this section. List each offense: date, charge, city, state.


 

*EDUCATION

 

Name:

City, State:

Highest Grade Completed:

Graduated

Major/Degree and year attained:

High School or GED

yes    no

 

Trade/Technical School or College

yes    no

 

EMPLOYMENT INFORMATION

What type of work will you accept?

Full Time

Part Time

Temporary/Seasonal

Driver-Delivery

Yardman

Sales

Other - please specify

 

*Work History: List your work history for at least the past seven years. Begin with the most recent position.

#1

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#2

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#3

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#4

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

#5

From: To:   

Name of Firm:

Address:   Supervisor:

Duties Involved:

Salary:   Reason for Leaving:

Special Skills

Special skills/certifications/licenses:


Special equipment/computer hardware or software/industrial machinery:

 

APPLICANT STATEMENT & SIGNATURE

Please read and sign the following statement:

All offers of employment, oral and written, shall include the following statement: "This offer is contingent on the Gary Pack Lumber verification of credentials and other information required by state law."

I certify that all information provided in all my application material is true. I understand that any false statement made herein is sufficient reason for rejection of this application or termination of subsequent employment regardless of date of discovery. I authorize the Gary Pack Lumber to investigate all statements made in my application material for employment. I authorize such educational institutions and employers and others (and their agents or employees) to respond to questions concerning information given in this application material and I further release from liability such former employers, institutions, or persons providing such information to the Gary Pack Lumber.

Gary Pack Lumber complies with the Drug-Free Workplace Act of 1988. The unlawful manufacture, sale, distribution, dispensation, possession or use of a controlled substance (usually referred to as illegal drugs listed under the federal Controlled Substances Act) and alcohol is prohibited on Gary Pack Lumber property, or in the course of a Gary Pack Lumber activity, and may result in employee discipline up to and including termination of employment.

*Signature:_________________________________________________   *Date: ___________________________

By signing you signify that all the information you have provided is true and that you have read and understand the Applicant's Statement.

All questions and statements must be answered in full or your application will not be processed.

PRINT this form and mail or bring with you to Gary Pack Lumber and Flooring.