DSI General Application

DSI General Application

**DO NOT USE THIS APPLICATION FOR DRIVING POSITIONS**
Thank you for applying for employment at DSI. This is a multipage on-line form and will require approximately 30 minutes to complete. Upon completion of each section you will be required to review the information that you provided. Please make sure that all information is submitted to the best of your knowledge and is accurate. Falsification of an employment application could be used as a reason from not gaining employment or grounds for termination.

PLEASE READ BEFORE COMPLETING THIS APPLICATION

AS A CONDITION OF EMPLOYMENT AND FOR THE PURPOSES OF CONDUCTING EMPLOYMENT BACKGROUND CHECK, I give permission for Distribution Solutions Inc, d.b.a., DSI to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries, child abuse and criminal history records. I understand that, if hired, my position is conditional upon Distribution Solutions Inc, d.b.a. DSI, receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability Distribution Solutions Inc, d.b.a. DSI, the officers or it's employees, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, Distribution Solutions Inc, d.b.a. DSI, is not obligated to offer or fill an employment position. I understand that, prior to the termination of my employment, I am subject to suspension by the company management and removal for violation of Distribution Solutions Inc, d.b.a. DSI, policies and procedures.
Checkboxes*

CLICK HERE TO AGREE WITH THE ABOVE WRITTEN STATEMENT
TODAYS Date*

MonthDayYear
Date
Position Applying for:*
Name*

First NameMiddle NameLast Name
Contact Phone Number*
Please enter a valid phone number.
Email address:*
example@example.com
Social Security Number - Please include dashes*
Date of Birth - Please include dashes*

Please list ALL residences from the last 3 years. Leave them blank if you have lived at the same residence for more than 3 years. Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address #2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address #3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Please list experience you have gained for the position you are applying for.*
General Knowledge
Please list any education/training you have received. (Microsoft Office Products, Certifications, ASE Master Technician, etc.)*
Education / Training
Please list all employers for the past 10 years.
Employer 1 - Company Name (last or current employer)*
Last or Current Employer
Supervisors Name*
Dates of Service*
Month & Year (May 1989 to June 2022)
Position Held*
Rate of Pay*
Position Responsibilities:*
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone Number*
Please enter a valid phone number. Employer 1
Reason for Leaving*

Employer 2 - Company Name
Employer #2 - Company Name
Supervisors Name
Dates of Service
Month & Year (May 1989 to June 2022)
Position Held
Rate of Pay
Position Responsibilities:
Company Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone Number
Please enter a valid phone number. Employer 2
Reason for Leaving

Employer 3 - Company Name
Employer #3
Supervisors Name
Dates of Service
Month & Year (May 1989 to June 2022)
Position Held
Rate of Pay
Position Responsibilities:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COMPANY Phone Number
Please enter a valid phone number. - Employer 3
Reason for Leaving

If you need additional space for Employment History, please use the following paragraph to list your previous positions for the last 10 years - You may also copy and paste your resume in the space provided.
Employment History
I have been informed by this company that the previous employment information I have given for the preceding ten (10) years will be investigated by contacting my previous employers for the purpose of obtaining my employments history as required by federal, state or local

Distribution Solutions Inc, d.b.a. DSI is an Equal Employment Opportunity Employer.

This company has advised me, during the application process, that I have the following due process rights regarding information received from previous employers as a result of these investigations conducted performance history. I have been advised that I have the right to review information provided by previous employers; I have the right to have errors in the information corrected by the previous employer and for that previous employer to re-send the corrected information to the prospective employer; I have the right to have a rebuttal statement attached to the alleged erroneous information, if the previous employer and I cannot agree on the accuracy of the information. I have been informed that my previous employment history in the previous three (3) years can be reviewed by me by submitting a written request to the prospective employer, which may be done at any time, including when applying, or as late as 30 days after being employed or being notified of denial of employment. This company has advised me that within five (5) business days after receiving my request or within five (5) business days of receiving the information they will supply the information to me. This company has advised me that if I have not arranged to pick up or receive the requested records within thirty (30) days of making them available, this company may consider I have waived the request to review the records. All information obtained is to be used in the decision making for employment with this company.
By Electronically signing this document this certifies that this application was completed by me, and that all entries on it and information in it are true to the best of my knowledge.

I also understand that in addition to this online application, I will also have several other background checks performed electronically for the National and State Sex Offenders Registry as well as a Widescreen Criminal Back Ground Check as well as Motor Vehicle Record Check.
YesNo
Name*

First NameLast Name
805 Cottonwood Road #4, Harrison, AR 72601

870-743-6222; Fax: 870-743-6441
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