Fields marked with an * are required Position Information Position Information Which position are you applying for? * Delivery Warehouse Office Merchandising Sales Second Shift Warehouse Other Position Type Part Time Full Time Divider Personal Info Personal Information First Name Middle Name Last Name Phone Email Address Address Line 2 (optional) City State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip Code Divider Disclosures DISCLOSURES Are you at least 21 years of age? [The Company complies with child labor laws.] Yes No Are you legally entitled to work in the United States? Yes No Have you ever been terminated or asked to resign from a job? Yes No If you answered "Yes" to the question above, please share the identity of the employer and the reason: Are you under any contractual or other restriction(s) to any previous employer, including but not limited to non-compete, confidentiality, or other similar agreement? Yes No If you answered "Yes" to the question above, please explain: If driving a vehicle is an essential function of the job you have applied for, do you hold a valid Drivers License? Yes No If driving a vehicle that weighs over 26,000 pounds is an essential function of the job you have applied for, do you hold a valid Commercial Drivers License (CDL)? Yes No Divider Work Experience Work ExperienceBegin with your current job and work backward in order, listing your current and previous two employers including all full time and part time employment. All time must be accounted for including military service, self employment, and periods of unemployment. Job 1 Present/Last Employer Type of Business Address Phone Number Start Date Leave Date Salary Reason for Leaving Job Title Supervisor and Title Description of job and duties: May we contact? Yes No Add Job Divider Education and Training EDUCATION AND TRAINING Education/Training 1 Type of School High School College Graduate School Other Training Name of School Location of School Name of Degree Earned Major and Minor Fields of Study If you selected "Other Training" as the type, please explain: Add Education Additional Qualifications ADDITIONAL QUALIFICATIONS What specific knowledge, special skills, and/or individual capabilities do you have which especially prepares you for the job you have applied for? Divider Copy References REFERENCESAdditional references from individuals best acquainted with your work performance and/or academic achievement including colleagues, teachers, professors, company employees, and supervisors. Please do not include casual acquaintances, relatives, or minors. Reference 1 Name Job Title How do you know & from where? Company Name City & State Daytime Phone Number Evening Phone Number Add Reference Divider Application Certification APPLICATION CERTIFICATIONPlease read the following statements. By checking the corresponding checkboxes, you acknowledge that you understand these statements and agree to be bound by their terms: 1. Information from third parties 1. Information from third parties: I understand I may be subject to a background and driving check as part of the application process. 2. Truthfulness of information furnished 2. Truthfulness of information furnished: I affirm that information I have furnished on this application is true and complete, and I understand that any misrepresentation or omission will be sufficient cause for not being employed or for dismissal if employed, regardless of when a misrepresentation or omission is discovered. 3. Employment at will 3. Employment at will: I understand that if employed, my employment will be at will. In other words, I will have no employment contract, express or implied, and my employment may be terminated at any time at the will of the Company or myself. 4. Company Rules 4. Company Rules: I will learn about the Company's rules and policies and I agree these policies may be established and changed at the sole discretion of the Company. 5. Confidentiality 5. Confidentiality: I agree to protect, and to not disclose without permission, all confidential information about the Company and its businesses. 6. Harassment 6. Harassment: I promise that if I believe I am being sexually harassed or in any way discriminated against, or if I see another worker being sexually harassed or discriminated against while working for the Company, regardless of the location, I will immediately tell either the Business Manager or General Manager about this violation of Company policy. 7. Pre-employment Drug Test 7. Pre-employment Drug Test: I understand that the company is a drug free workplace and I agree to take a pre-employment drug test as a condition of being hired, if I receive a job offer. I understand that, should I refuse to submit a drug test, any conditional offer of employment made to me will be revoked. Divider Copy Addresses in the 7 years prior to completing this application: Addresses in the 7 years prior to completing this application (starting with the most recent): Previous Address 1 Address Address Line 2 (optional) City US States - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC Zip Add Address spacer To the best of my knowledge, the information provided in this application and any attachments thereto is true and complete. I understand that any falsification or omission of information may disqualify me for this position and/or may serve as grounds for the severance of my employment with Working Distributors Inc. Divider Signature SIGNATURE Please type your full name * If you are a human seeing this field, please leave it empty.
