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Online Employment Application

Being sent to: Steve Buller

Read and complete all questions completely. All information will be kept strictly confidential.
Use the <Tab> key to move from field to field. The <Enter> or <Return> key will submit your application.

Required fields are displayed in green.

Personal Data

Name:   (First, Middle Initial, Last)
Address:   (Number and Street)
City:   State:    Zip: 
Home Phone:
Alternate Phone: ext.
Position(s) Desired:
Monthly Salary Desired ($):
Hours Desired: Full-Time  Part-Time
How were you referred? Name of Referrer:
Are you free to travel? Yes No
Do you have the legal right to be employed in the U.S.? Yes No
 

Education
Name(s) used on school records: (if different from above)
 
School Name and Address of School Dates Attended Degree or Highest Grade Completed Major
From (Month/Year) To (Month/Year)
High School     Graduated?
Yes
 No		  
College(s)
Graduate School
Technical, Business or Other
 
Are you now attending: Undergraduate School Graduate School Neither
% Completed:
 

Special Qualifications
List any Job oriented organizations of which you are a member:
 
List all relevant equipment you have exprience operating:
 
(e.g. forklift)
What computer experience do you have? List software you use regularly and your skill level:
 
(Beginner, Intermediate, Advanced)
Professional and/or Personal Development courses:
 
Special Qualifications:
(any additional strengths or skills that you feel would be an asset to the company)
 

Employment History

Job #1 (Most Recent)
Dates of Employment: From: To: (Month, Year)
Position:
Monthly Salary:
Firm Name:
Type of Business:
Address:   (Number and Street)
City:   State:    Zip: 
Phone:
Name under which you were employed (if different):
Name & Title of immediate supervisor:
Responsibilities:
Reason for leaving:
If still employed, may we contact your present employer? Yes No

Job #2
Dates of Employment: From: To: (Month, Year)
Position:
Monthly Salary:
Firm Name:
Type of Business:
Address:   (Number and Street)
City:   State:    Zip: 
Phone:
Name under which you were employed (if different):
Name & Title of immediate supervisor:
Responsibilities:
Reason for leaving:

Job #3
Dates of Employment: From: To: (Month, Year)
Position:
Monthly Salary:
Firm Name:
Type of Business:
Address:   (Number and Street)
City:   State:    Zip: 
Phone:
Name under which you were employed (if different):
Name & Title of immediate supervisor:
Responsibilities:
Reason for leaving:
 

References

Reference #1
Name:
Title:
Company:
City:   State:    Zip: 
Phone:

Reference #2
Name:
Title:
Company:
City:   State:    Zip: 
Phone:

Reference #3
Name:
Title:
Company:
City:   State:    Zip: 
Phone:
 

Additional Personal Data
Are you able to perform the essential functions of the job for which you have applied with or without reasonable accommodation?
  Yes No
If no, please explain:
Have you been convicted of a felony within the last five years?
  Yes No
If yes, please explain:
If you are under 18, do you have a work permit? Yes No N/A

Please Read Carefully

I certify that the statements indicated herein are true and correct to the best of my knowledge and I understand that falsification or omission of any information could result in termination of my employment.

I acknowledge the fact that this Application for Employment will be active for 60 days; after this time period, I must reapply for further consideration.

I also understand that any offer of employment may be contingent upon a satisfactory credit and criminal record.

This Application for Employment is not a contract and cannot create a contract. If employed by Doug Ashy Building Materials, I agree to abide by its rules and regulations.

I understand that my employment would be "at-will" and could be terminated at any time by either party, with or without cause and with or without notice.

This understanding supersedes all prior agreements and representations, and any subsequent understanding which affects this arrangement must be in writing and signed by the Chief Administrative Officer of Doug Ashy Building Materials.

Please enter your e-mail address in case we have questions about your application:

Please check this box to indicate that you have completed this applicaton: Yes, I have completed this application