Layman Distributing Job Application Form

Desired Position

Driver Location

Desired Hourly Rate*

Desired Shift

Available Start Date*

Date

Have you applied with us before? If so, what position?*

Are you legally authorized to work in the U.S.?

Full Name*

First NameMiddle NameLast Name

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

example@example.com

Phone Number*

How did you hear that we're hiring?*

Referred by

Are you able to work overtime, if necessary?

Are you over the age of 18?*

YesNo

Driver's License Number or SSN*

Driver's License State*

Driver's License Expiration Date

Number of moving violations in the last 3 years

Have you ever been convicted of a felony?*

Has your driver's license ever been suspended or revoked?*

If Yes, please explain

You are not required to disclose expunged or sealed convictions.

Click the Plus (+) to add additional schools*

List any other qualifications and skills (for example: computer skills, maintenance or repair, CDL)

Have you served in the U.S. Armed Forces?

If so, did you acquire any job-related skills during your military service?

PROFESSIONAL REFERENCES

Please provide a minimum of three (3) references. Click the Plus (+) sign to add additional references. *

Not currently employed

Current Employer Information

Your responsibilities

May we contact?

YesNo

Previous Employer Information #1

Date Employed

Date

Date Separated

Date

Your responsibilities

May we contact?

YesNo

Previous Employer Information #2

Date Employed

Date

Date Separated

Date

Your responsibilities

May we contact?

YesNo

Previous Employer Information #3

Date Employed

Date

Date Separated

Date

Your responsibilities

May we contact?

YesNo

Upload Your Resume

This system accepts PDF, DOC, DOCX, and RTF files.

I certify that all of the information and documents submitted by me in connection with this application (collectively "Application") are true and accurate to the best of my knowledge, and I understand that any misrepresentation of such information or any false statements made by me in this Application may result in denial of employment or discharge. I further understand that any offer of employment and continued employment is contingent upon my ability to provide documentation evidencing citizenship or right-to-work status.

I grant Layman Distributing or any subsidiary or affiliated company (collectively, "Company") permission to check the information submitted by me in connection with this Application and to make a thorough investigation of my past employment, education, and activities. I authorize the employers and references listed in this Application, unless otherwise indicated above, to give the Company any and all information concerning my previous employment and other pertinent information they may have, personal or otherwise. I release the Company and all persons or entities supplying such information to the Company from any liability for any damage which may result from furnishing information to the Company.

Additionally, I understand and agree that nothing contained in this Application or in the granting of an interview is intended to create an employment contract between the Company and me and no promises regarding employment have been made to me. If an employment relationship is established between me and the Company, the Company's written and unwritten policies, practices, procedures, and employee handbooks shall not in any way constitute an express or implied contract of employment, and shall not in any way modify the at-will status of my employment.

I acknowledge that I have read, understood, and voluntarily agreed to the terms listed above. *

Job Application

APPLICANT INFORMATION

EDUCATION & TRAINING

MILITARY SERVICE

CURRENT EMPLOYMENT

PREVIOUS EMPLOYMENT