Online Application

Have you ever applied here before? YES OR NO - If Yes, when?

Were you ever employed here? YES OR NO - If Yes, When?

Have you ever been arrested for any alleged law violation (except for minor traffic violation)? YES OR NO (If Yes, for each arrest state the nature of the offense, date and whether the arrest resulted in a conviction)

Are you now, or do you except to be engaged in any other business or employment?*

YESNO

First Name:

Middle Name:

Last Name:

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Are you 18 years of age or older? (If you are hired, you may be required to submit proof of age)*

YESNO

Social Security Number (optional)

If hired, can you furnish proof you are eligible to work in the U.S?*

YESNO

Job Applied for:

Today’s Date:

Are you seeking

FULL-TIMEPART-TIMETEMPORARY

When you are available for work?

When can you start work?

Highest Grade Completed

High School or GED:

Name of School

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Diploma/Degree/Certificates - Subjects Studied:

College/University:

Name of School

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

College/University Yrs Completed:

Diploma/Degree/Certificates - Subjects Studied::

Vocational or Technical:

Name of School

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Vocational or Technical Yrs Completed:

Diploma/Degree/Certificates - Subjects Studied:

What skills or additional training do you have that are related to the job for which you are applying for?

What machines or equipment can you operate that are related to the job for which you are applying for?

How many days of work have you missed during the past year?(Exclude absences due to disability or those covered by FMLA)

For Driving Jobs Only: Do you have a valid Texas Drivers License?

YesNo

Driver’s License Number/Class of License:

Have you had your drivers license suspended or revoked in the last three years? YES OR NO - If Yes, give details

List professional, trade, business or civic activities and offices held:

(Exclude labor organizations and memberships which reveal race, color, religion, national origin, sex, age, disability or other protected status.)

HISTORY OF EMPLOYMENT

List names of employers in consecutive order with the present or last employer listed first. Account for all periods of time including military service and any periods of unemployment. If self-employed, give firm name and supply business references.

Name of Employer 1:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Position Held & Duties

Supervisors name

From (Month/Year)

To (Month/Year)

Pay

Reason for leaving

Name of Employer 2:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Position Held & Duties

Supervisors name

From (Month/Year)

To (Month/Year)

Pay

Reason for leaving

Name of Employer 3:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Position Held & Duties

Supervisors name

From (Month/Year)

To (Month/Year)

Pay

Reason for leaving

REFERENCES

Have you worked or attended school under any other names? YES OR NO - If Yes, give name:

Are you presently employed? YES OR NO - If Yes, whom do you suggest we contact?

Have you ever been fired from a Job or asked to resign? YES OR NO - If Yes, please explain:

Give Three (3) References, not relatives or former employers:

Reference 1

Name

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference 2

Name

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

Reference 3

Name

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Area CodePhone Number

AFFIDAVIT

PLEASE READ EACH STATEMENT CAREFULLY BEFORE SIGNING

I certify that all information provided in this employment application is true and complete. I understand that any false information or omission may disqualify me from further consideration for employment and may result in my dismissal if discovered at a later date.

I understand that the employer may request an investigative consumer report from a consumer reporting agency. This report may include information as to my character, reputation, personal characteristics and mode of living obtained from interviews with neighbors, friends, former employers, schools and others. I understand I have a right to make a written request within a reasonable time for the disclosure of the name and address of the consumer reporting agency so that I may obtain a complete disclosure of the nature and scope of the investigation.

I authorize the investigation of any or all statements contained in this application. I also authorize whether listed or not, any person, school, current employer, past employers and organizations to provide relevant information and opinions that may be useful in making a hiring decision. I release such persons and organizations from any legal liability in making such statements.

I understand that if I am extended any offer of employment it may be conditioned upon my successfully passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying.

I understand I may be required to successfully pass a drug screening examination. I hereby consent to a pre- and/or post-employment drug screen as a condition of employment.

I UNDERSTAND THAT THIS APPLICATION OR SUBSEQUENT EMPLOYMENT DOES NOT CREATE A CONTRACT OF EMPLOYMENT NOR GUARANTEE EMPLOYMENT FOR ANY DEFINITE PERIOD OF TIME IF EMPLOYED, I UNDERSTAND THAT I HAVE BEEN HIRED AT THE WILL OF THE EMPLOYER AND MY EMPLOYMENT MAY BE TERMINATED AT ANY TIME, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT NOTICE.

I understand that Max Fine Furniture and Appliances, Inc., utilizes and Alternative Disputed Resolution (ADR) policy that requires Mandatory Arbitration of employment disputes. I agree to be bound to the policy of mandatory arbitration under the Federal Arbitration Act and hereby waive any right to a jury or bench trial in conformity with Max Fine Furniture and Appliances, Inc.’s ADR Policy in order to be considered for any/or offered employment.

I have read, understand, and by my signature consent to the statements.

Signature/Date:*

Please verify that you are human*

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