Contact Information
Full Name
*
First Name
Last Name
Date of Application
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Miscellaneous
Have you filed an application with Petersburg Hardware before?
*
Yes
No
Are you currently employed?
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Yes
No
Are you a U.S Citizen? If no, are you authorized to work in the United States?
*
Yes
No
Have you been convicted of a felony in the last 7 years?
*
Yes
No
If hired, on which date would you be able to start working?
*
-
Month
-
Day
Year
Date
What position/s are you interested in?
*
Cashier
Loader
Customer Service
Delivery Driver
Sales
Management
Service Technician
All of the Above
What is your age group?
15 Years of Age
16-17 Years of Age
18-20 Years of Age
21 Years of Age or Older
Please select all that you are comfortable with lifting:
80lb Concrete
Paving/Landscaping Stones
50lb Dog Food
Gallon of Paint
Water Heater (with Dolly)
Appliances (with Dolly)
Bags of Soil/Mulch
5 Gallon Paint Bucket
4x4x8 Treated Post
Straw Bale
All of the Above
None of the Above
Education
Are you currently enrolled in school?
*
No
High School
Home School
College
Other
Highest Level of Education:
*
High School/GED
Bachelor's or other 4-year Degree
Trade School
Master's or Higher
Desired salary:
*
Please select your availability for all time slots:
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Mornings: 8am - 12pm
Afternoons: 12pm - 4pm
Evenings: 4pm - 7pm
Work Experience
Job Title:
*
Company Name:
*
Date Employed From:
*
-
Month
-
Day
Year
Date
Date Employed To:
*
-
Month
-
Day
Year
Date
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Worked Performed:
*
Reason/s for Leaving:
*
Additional Work Experience
Job Title:
*
Company Name:
*
Date Employed From:
*
-
Month
-
Day
Year
Date
Date Employed To:
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Performed:
*
Reason/s for Leaving:
*
Military
Have you ever been in the Armed Forces?
*
Yes
No
Are you Currently a Member of the National Guard?
*
Yes
No
Driving History
Do you have a valid Driver's License?
*
Yes
No
Do you have transportation to Work?
*
Yes
No
Have you had any accidents in the last 3 years?
*
Yes
No
Have you had any moving violations in the last 3 years?
*
Yes
No
Do you have a Commercial Driver's License?
*
Yes
No
Do you have any Experience Operating any of the Following?
*
Tow Motor/Forklift
Lawn Mowers
Front End Loader
Box Truck
All of the Above
Other
Miscellaneous Job Requirements
Are you able to stand on your feet for 6 or more hours?
*
Yes
No
Have you handled money on the job?
*
Yes
No
Operated a fax/printer/copier?
*
Yes
No
Are you able to lift 30lbs repetitively without injury?
*
Yes
No
Are you able to lift 50lbs repetitively without injury?
*
Yes
No
Are you able to assemble products by following instructions?
*
Yes
No
Have you operated a cash register before?
*
Yes
No
Are you able to operate a computer?
*
Yes
No
What have you used a computer for?
*
Please list any additional skills that would make you a good fit at Petersburg Hardware:
*
Personal References
Name:
*
First Name
Last Name
Relationship:
*
Years Known:
*
Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number:
*
Please enter a valid phone number.
Email:
*
example@example.com
Name:
*
First Name
Last Name
Relationship:
*
Years Known:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email:
*
example@example.com
Phone Number:
*
Please enter a valid phone number.
Release of Information
Please Read Carefully*
I understand that I have been asked to furnish information for use in reviewing my background and qualifications. In this regard, I hereby authorize Petersburg Hardware (hereinafter the "Company") to investigate my past or present work, character, education, military, and police records to ascertain any and all information that may be pertinent to my employment qualifications. The release, either verbal or written, of any and all information by any reference listed on my employment application is authorized regardless of whether such information is of record. I do hereby release all persons, firms, agencies, or companies whomsoever from any damages resulting from furnishing such information and shall not hold them liable in any respect if a job offer is not extended to me. In consideration of my employment, I agree to conform to the Company's rules and regulations, and I agree that my employment and compensation can be terminated with or without cause, and with or without notice at any time at either my or the Company's option. I also understand and agree that the Company may change terms and conditions of my employment at any time, with or without notice. I understand that no Company representative other than it's President, and then only when in writing and signed by the President, has any authority to enter into any agreement contrary to the forgoing. I certify that all of the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected, and, if I am employed, my employment may be terminated at any time.
*
Yes
No
Signature:
*
Date:
*
-
Month
-
Day
Year
Date
Equal Opportunity Employer
Petersburg Hardware is an equal opportunity employer and does not discriminate against applicants or employees on the basis of sex, race, color, religion, national origin, ancestry. or age. In addition, the company does not discriminate against qualified individuals with disabilities.
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