Porter Hardware Application for Employment

Application for Employment
APPLICANT INFORMATION
Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date Available

MonthDayYear
Date
Desired Pay
Are you a citizen of the United States?

YesNo
If no, are you authorized to work in the U.S.?

YesNo
Have you ever worked for this company?

YesNo
If so, when?
Have you ever been convicted of a felony?

YesNo
If yes, explain:

MILITARY SERVICE
Have you served in the U.S. military?

YesNo
If you have selected 'Yes' please provide the following information:
Branch
From

MonthDayYear
Date
To

MonthDayYear
Date
Rank at Discharge?
Type of Discharge?
If other than honorable, explain:

EDUCATION
High School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start

MonthDayYear
Date
End

MonthDayYear
Date
Did you graduate?

YesNo
College/University
Degree
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Start

MonthDayYear
Date
End

MonthDayYear
Date
Did you graduate?

YesNo

PREVIOUS EMPLOYMENT

List the last three employers, starting with current or most recent:

Employer #1
Company
Job Title
Supervisor/Manager
Phone Number
Please enter a valid phone number.
To

MonthDayYear
Date
From

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for Leaving
May we contact your previous employer?

YesNo

Employer #2
Company
Job Title
Supervisor/Manager
Phone Number
Please enter a valid phone number.
To

MonthDayYear
Date
From

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for Leaving
May we contact your previous employer?

YesNo

Employer #3
Company
Job Title
Supervisor/Manager
Phone Number
Please enter a valid phone number.
To

MonthDayYear
Date
From

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Reason for Leaving
May we contact your previous employer?

YesNo

OTHER APPLICABLE EXPERIENCE OR SKILLS; INCLUDE VOLUNTEER EXPERIENCE

REFERENCES

Please list three professional references.
Name

First NameLast Name
Company
Relationship
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Company
Relationship
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Company
Relationship
Phone Number
Please enter a valid phone number.

JOB SPECIFIC INFORMATION*
Are you able to work weekends?

YesNo
If no, explain:
Are you able to lift up to 50 lbs.?

YesNo
*NOTE: Porter Hardware & Rental is an Equal Opportunity Employer and does not discriminate based on your answers to these questions

DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.
Signature

Clear
Date

MonthDayYear
Date
Should be Empty: