Quote Form

It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, or other protected classification.
Date

MonthDayYear
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Enter a phone number to contact youFormat: (000) 000-0000.
Email Address
example@example.com
Which location are you applying for? Check all that apply.
How did you learn of this opening?
Example: online listing, word of mouth, etc.
Have you worked at Payless Building Supply before?
Why are you interested in working at Payless Building Supply?
Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?
Are there any days or hours you cannot or will not work?
What type of employment do you desire? Choose all that apply.
Are you willing to work overtime as required?
Have you ever been fired or discharged?
If you answered "Yes," please explain briefly:
Employment

Education History

Rows	Name of Institution You Attended	Diploma/Degree Earned (Yes or No)
High School
College/University
Technical/Other

In addition to your work history, what other experiences, skills or qualifications would especially fit you for work with our company?
What position are you applying for?
Wage or salary desired?
When can you start?
Work History

List most recent employment first, including summer or temporary jobs.
1. Employer Information
Description of duties:
May we contact this employer?
2. Employer Information
Description of duties:
3. Employer Information
Description of duties:
Driving Record
Do you have a valid driver's license?
State issued by:
Driver's license number:
Expiration Date:
MM/YY format - Ex: 09/22
Explain any restrictions on your driver's license:
Applicant's Certification and Agreement
I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Company to make an investigation of any of the facts set forth in this application.

I understand that employment at this Company is "at will," which means that either I or the Company can terminate the employment relationship at any time, with or without prior notice, and for any reason not prohibited by statute. I further agree to perform the job duties as outlined in the job description and I understand that if I am employed, such employment is not a contract for personal services and that the Company can change wages, benefits and conditions at any time.
BY CHECKING THIS BOX, YOU AGREE THAT YOU HAVE READ AND UNDERSTAND THE AGREEMENT AND AUTHORIZE THE SUBMISSION OF THE APPLICATION
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Employment

Work History

Driving Record

Applicant's Certification and Agreement