dons_mercantile_employment

Employment Application

Each question should be answered completely and accurately.

No action will be taken on this application until all questions have been answered and the application has been signed and dated. To protect the interest of this company and a safe work environment verification of eligibility to work in the U.S. may be required if an employment offer is made.

Full Name

First NameLast Name

Phone Number

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

E-mail

Confirmation Email

Position(s) applying for

Hourly wage expectations

Referral source

Are you 21 years old?

Are you eligible to work in the United States?

Are you fluent in a foreign language?

If yes, what language(s)?

Are you currently employed?

Date available for work

MonthDayYear

Are you available to work? (check all that apply)

Have you applied here before?

If yes, give date:

Have you been convicted of a felony/misdemeanor (other than traffic violations)?

If so, provide the location, date and result/outcome for each conviction:

Will you consent to criminal background check?

EDUCATION

Highest level of education completed:

Please complete the appropriate sections

Rows	Name & Location of School	Number of Years Attended	Did You Graduate?	Degree or Certification
GED / High School
Trade School
College
Graduate

WORK HISTORY

Please list your four most recent employers, list the most recent first

1. Employer

Employer's Name (Most current)

Address & location of business

Your title

May we contact this employer?

Supervisor's name

First and Last Name

Phone number

Area CodePhone Number

Hourly wages START:

Wages END:

Work performed:

Reason for leaving

2. Employer

Employer's Name (Second most recent)

Address & location of business

Your title

May we contact this employer?

Supervisor's name

First and Last Name

Phone number

Area CodePhone Number

Hourl wages START:

Wages END:

Work performed:

Reason for leaving

ADDITIONAL INFORMATION

Do you have a U.S. military service record?

Click to edit

If yes, branch of service

Discharge date and rank

List job-related accomplishments, projects, and awards.

List any additional information you would like us to consider:

REFERENCES

List three personal or professional, (business or work, not relatives) that you have known for at least one year. List at least one previous supervisor.

1. Full Name

First NameLast Name

Company

Best phone number to reach them

Area CodePhone Number

Years acquainted

Relationship

2. Full Name

First NameLast Name

Company

Best phone number to reach them

Area CodePhone Number

Years acquainted

Relationship

3. Full Name

First NameLast Name

Company

Best phone number to reach them

Area CodePhone Number

Years acquainted

Relationship

AUTHORIZATION

I understand that Hurth & Hurth Holding LLC is making no employment offer at this time. I certify that the information in this application is correct to the best of my knowledge. I understand that any misrepresentation or omission of any fact in my application, resume, or any other materials, or during interviews is grounds for disqualification from further consideration for employment or for termination if employed.

I authorize Hurth & Hurth Holding LLC to contact any company, institution, or individual it deems appropriate to investigate my employment history, character, qualifications, credit history, driving record, and other relevant information, if job-related. I give my full consent for all contacted individuals, including former employers, to provide information concerning this application, and I waive my right to bring any cause of action against these individuals for any liability for damages arising from furnishing the requested information to Hurth & Hurth Holding LLC. I acknowledge that a facsimile and/or photocopy of this form is as valid as the original.

I understand that this application is current for 60 days. After this time, if I have not heard from Hurth & Hurth Holding LLC and still wish to be considered for employment, it will be necessary to complete a new application.

I understand that if hired, employment is at-will, regardless of the employer, and may be terminated by myself, the employer or Hurth & Hurth Holding LLC at any time, with or without cause or notice, for any reason or no reason.

By entering your name, you agree to accept the terms of the above document with an electronic signature.

You must agree to accept the terms of the document in order to submit an application.

Type signature

Date

MonthDayYear

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