Employment Application

Name*

First NameMiddle NameLast Name

Email

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

County*

Phone Number*

Please enter a valid phone number.

Have you ever been employed by Moss Supply Company?*

YesNo

If yes, give dates:

Who referred you to Moss Supply?

Are you legally eligible for employment in the U.S.A.? (If hired, you are required to submit proof of your eligibility to work in the U.S.A.)*

YesNo

Are you over the age of eighteen? (If no, hire is subject to verification that you are of minimum legal age.)*

YesNo

Position(s) you are applying for?*

Are you able to work any shift?*

YesNo

If no, what are the hours you are available?

	Name and Location	Last Year Completed	Did you Graduate?	Diploma or Degree
High School
College
Other

Please list any special training, skills, and/or experience that will help us evaluate your potential within Moss Supply Company, including any equipment you can operate*

Have you ever been convicted of a Felony? (Note: A conviction itself does not prohibit employment and will be considered only as it relates to the job in question.)*

YesNo

If yes, give the convicted date and nature of the offense

Begin with the most recent employment*

	Name of Employer	Address of Employer	Start Date of Employment	End Date of Employment	Starting Salary	Ending Salary	Reason for Leaving
Most Recent
Employer 2
Employer 3

The requirements for employment with Moss Supply Company include the following, please select all that you can agree to:*

Ability to work every day (Monday through Friday - 1st shift) for 8 hours plus scheduled overtime ORAbility to work every day (Monday through Thursday - 2nd shift) for 10 hours plus scheduled overtimeAbility to lift 30 pounds repetitivelyAbility to do repetitive work, including lifting, bending, and assembly operations

I submit this application with the understanding that all applicants considered for an open position must take and pass a Substance Abuse Test, complete a Criminal Background Review, and Social Security Number Verification process.

I understand that this application is not an offer of employment and that by accepting this application, Moss Supply Company does not guarantee that I will be offered a position. I further understand that I will not be paid for time spent while applying for a position, taking a pre-employment substance abuse test, interviews, or any other processing prior to the beginning of employment.

I authorize and consent to my current and prior employers, educational institutions, and persons or organizations named in this application (or accompanying resume) to release any information to Moss Supply Company that may be required to make an employment decision.

The facts set forth in my application are true and complete. I understand that if employed, any misrepresentation, falsification of information, significant omissions, or volunteering information not asked for on this application will be cause for rejection of my application, or may result in my dismissal once employed.

I further understand that this application is not and is not intended to be a contract of employment, nor does this application obligate the employer in any way if the employer decides to employ me. I understand and agree that my employment is at-will and can be terminated by either party with or without notice, at any time, for any reason or no reason. No one other than an officer of Moss Supply Company has any authority to enter into an agreement for employment for any specified period of time or to make any agreement contrary to the foregoing and then only in writing signed by an officer.

Signature*

Date of Signature*

Date

Add Resume or Cover Letter (Optional)

Gender

FemaleMale

Race

Employment Application

Education

Skills

Personal Information

Employment History

Please Read and Sign Below:

Voluntary Supplemental Identification

Moss Supply Employment Application