Builder's Hardware
Builder's Hardware
Employment Application DQF1
Applicant Information
Applicant Name______Home Phone______
Current Address______
______
Social Security Number______Date of Birth______
Date Application Submitted: ______Driver’s License #______
How were you referred to this Company?______
Employment Positions
Position(s) applying for:______
If applying for backyard man/driver, you must submit a current DMV record from the license bureau and be willing to complete a DOT physical. Hiring of applicant may be contingent on the results of both DMV record and physical.
Are you applying for:
:Temporary work – such as summer of holiday work ( ) Yes ( ) No
: Regular part-time work? ( ) Yes ( ) No
: Regular full-time work? ( ) Yes ( ) No
What days and hours are you available to work?______
When will you be available for work?______
Salary desired: $______
Personal Information:
Have you ever applied to / or worked for the Company before ( ) Yes ( ) No
Do you have any friends or relatives who work for the Company ( ) Yes ( ) No
Are you over the age of 18? ( ) Yes ( ) No
If hired, would you be able to present evidence of you United States citizenship or be able to give proof of your legal right to work in the United States? ( ) Yes ( ) No
If hired, are you willing to submit to & pass a controlled substance test? ( )Yes ( ) No
Are you able to perform the essential functions of the job for which you are applying either with / without reasonable accommodation? ( ) Yes ( ) No
Have you ever been convicted of a criminal offense felony or misdemeanor?( )Yes ( )No
If yes, please describe the nature of the crime(s), when and where convicted and disposition of the case.______
Employment History for Past 3 years
Employer Name:______Employed from:______to:______
Address:______Position :______
______Salary:______
Contact:______Phone:______Reason for leaving______
Were you subject to the Federal Motor Carrier Safety Regulations while employed with this employer? Yes No
Was your position “safety sensitive” requiring Part 40 drug & alcohol testing? YesNo
Employer Name:______Employed from:______to:______
Address:______Position:______
______Salary:______
Contact:______Phone:______Reason for leaving______
Were you subject to the Federal Motor Carrier Safety Regulations while employed with this employer? Yes No
Was your position “safety sensitive” requiring Part 40 drug & alcohol testing? YesNo
Employer Name:______Employed from:______to:______
Address:______Position:______
______Salary:______
Contact:______Phone:______Reason for leaving______
Were you subject to the Federal Motor Carrier Safety Regulations while employed with this employer? Yes No
Was your position “safety sensitive” requiring Part 40 drug & alcohol testing? YesNo
Education, Training and Experience
High School:
School Name:______
Address:______
______
Number of years completed:______
Did you graduate? ( ) Yes ( ) No
Degree/diploma earned:______
College/University
School name:______
Address: ______
______
Number of years completed:______
Did you graduate? ( ) Yes ( ) No
Degree/Diploma earned? ______
Vocational School
Name: ______Address:______
Number of years completed?______
Did you graduate? ( ) Yes ( ) No
Degree/Diploma earned?______
Previous Addresses for the Last three years (most recent first)
Street City State Zip How Long?
1.______
2.______
3.______
List all driver’s licenses for the last three years?
State Number Expiration Date
1.______
2.______
3.______
List the nature and extent of your experience operating different types of motor vehicles?
Type (bus, truck, trailer) Experience in Years
1.______
2.______
3.______
List all motor vehicle accidents in which you were involved in the last 3 years?
Date City/State Nature of Accident Fatalities Injuries
1.______
2.______
3.______
List all violations (other than parking) for which you were convicted or forfeited bond/ collateral during the last three years
Date City/State Charge Penalty
1.______
2.______
3.______