Petersburg Hardware Job Application

Contact Information
Full Name*

First NameLast Name
Date of Application*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Miscellaneous
Have you filed an application with Petersburg Hardware before?*

YesNo
Are you currently employed?*

YesNo
Are you a U.S Citizen? If no, are you authorized to work in the United States?*

YesNo
Have you been convicted of a felony in the last 7 years?*

YesNo
If hired, on which date would you be able to start working?*

MonthDayYear
Date
What position/s are you interested in?*

CashierLoaderCustomer ServiceDelivery DriverSalesManagementService TechnicianAll of the Above
What is your age group?

15 Years of Age16-17 Years of Age18-20 Years of Age21 Years of Age or Older
Please select all that you are comfortable with lifting:

80lb ConcretePaving/Landscaping Stones50lb Dog FoodGallon of PaintWater Heater (with Dolly)Appliances (with Dolly)Bags of Soil/Mulch5 Gallon Paint Bucket4x4x8 Treated PostStraw BaleAll of the AboveNone of the Above
Education
Are you currently enrolled in school?*

NoHigh SchoolHome SchoolCollegeOther
Highest Level of Education:*

High School/GEDBachelor's or other 4-year DegreeTrade SchoolMaster's or Higher
Desired salary:*

Please select your availability for all time slots:*

Rows	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:*

MonthDayYear
Date
Date Employed To:*

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Worked Performed:*
Reason/s for Leaving:*
Additional Work Experience
Job Title:*
Company Name:*
Date Employed From:*

MonthDayYear
Date
Date Employed To:*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Performed:*
Reason/s for Leaving:*
Military
Have you ever been in the Armed Forces?*

YesNo
Are you Currently a Member of the National Guard?*

YesNo
Driving History
Do you have a valid Driver's License?*

YesNo
Do you have transportation to Work?*

YesNo
Have you had any accidents in the last 3 years?*

YesNo
Have you had any moving violations in the last 3 years?*

YesNo
Do you have a Commercial Driver's License?*

YesNo
Do you have any Experience Operating any of the Following?*

Tow Motor/ForkliftLawn MowersFront End LoaderBox TruckAll of the AboveOther
Miscellaneous Job Requirements
Are you able to stand on your feet for 6 or more hours?*

YesNo
Have you handled money on the job?*

YesNo
Operated a fax/printer/copier?*

YesNo
Are you able to lift 30lbs repetitively without injury?*

YesNo
Are you able to lift 50lbs repetitively without injury?*

YesNo
Are you able to assemble products by following instructions?*

YesNo
Have you operated a cash register before?*

YesNo
Are you able to operate a computer?*

YesNo
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 NameLast Name
Relationship:*
Years Known:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Email:*
example@example.com
Name:*

First NameLast Name
Relationship:*
Years Known:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
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.*

YesNo
Signature:*
Date:*

MonthDayYear
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.
Should be Empty:

Contact Information

Miscellaneous

Education

Work Experience

Additional Work Experience

Military

Driving History

Miscellaneous Job Requirements

Personal References

Release of Information

Equal Opportunity Employer