APPLICATION FOR EMPLOYMENT
PERSONAL INFORMATION
Position Applying for:
Date of Application:
-
Month
-
Day
Year
Date
Name:
First Name
Middle Initial
Last Name
Current Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional addresses in the last 3 years?:
Yes
No
If yes, how many?:
(Please attach details.)
Contact Information:
Format: (000) 000-0000.
Mobile Phone
Format: (000) 000-0000.
Email
example@example.com
General Information
How did you learn about our company?:
Available Start Date:
-
Month
-
Day
Year
Date
Currently Employed?:
Yes
No
Are you eligible to work in the United States?:
Yes
No
Are you capable of repetitively lifting at least 50 pounds?:
Yes
No
Can you provide your own transportation to and from work?:
Yes
No
If applying to be a driver, are you at least 18 years old?:
Yes
No
n/a
Circle the following areas in which you have past experience:
Clerical
A/P
A/R
Admin
Management
Driving
Whse
Which of the following computer programs are you experienced with?:
Excel
Word
Outlook
Other
Work Preferences / Misc.
What type of employment do you prefer?:
Full Time
Part Time
Do you have any scheduling restrictions (Monday - Saturday)?:
Do you have experience in the Landscape / Irrigation Industry?:
Yes
No
If yes, in which area (circle)?:
Distribution
Contractor
Manufacturer
Other
Do you have a commercial drivers license (not required)?:
Yes
No
Do you have any drivers license restrictions?:
Yes
No
Other
Education
Education
Rows
Name & Location
Graduate
Column 4
High School
College or University
Specialized Training, Trade Schools, etc...
Other Education
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CONTINUED FROM PAGE 1
Former Employers / Previous Experience (Last 3 Years)
Please list beginning from most recent (Attach any additional info. on a separate sheet)
Dates Employed
Company Name
Location (City, State)
Role / Title
Ending Wage:
Job notes, tasks performed and reason for leaving
Dates Employed
Company Name
Location (City, State)
Role / Title
Ending Wage:
Job notes, tasks performed and reason for leaving
Dates Employed
Company Name
Location (City, State)
Role / Title
Ending Wage:
Job notes, tasks performed and reason for leaving
References
Please provide three persons, not related to you, whom you have known at least one year.
References Please provide three persons, not related to you, whom you have known at least one year.
Rows
Name
Address
Phone
# Yrs Known
1
2
3
As an applicant for employment, I understand and agree to the following:
> All information is subject to verification by Sprinkler Supply Company, Inc.
> I agree that any misrepresentation or falsification of information requested herein will be cause for rejection of this
application or for subsequent discipline up to and including my dismissal from employment.
> I agree that if my application for employment is accepted, the effective date of my employment shall be the time I
actually begin to work.
> If I am employed, I agree to be bound by the safety and health rules and regulations of the Company, including the
drugs and alcohol policies, and the testing and procedures program, and to be bound by the Personnel Policies and
Practices Handbook of the company (Employee Manual).
> I agree to abide by the company's no smoking policy while on the Company premises.
> I understand that I am employed at-will and agree that my employment is not guaranteed for any term and that my
employment may be terminated by the Company or by myself for any reason at any time.
> I agree that no management official or officer is authorized to make an oral assurance or promise of continued
employment other than employment at will at any time.
> If employed, I agree that my employment will be subject to the conditions of any applicable orientation period
established by company policy.
> I authorize investigation of all statements contained in this application.
> I agree that I have no health impairments or deficiencies which will prevent me from performing the work for which I
am being employed with reasonable accommodation.
> For unhired applicants, I agree that this application will be considered active for only 60 days, at which time it will terminate.
Signature:
Date:
-
Month
-
Day
Year
Date
Print Name:
Note: If you are applying for a driving position, continue with the application on page 3; otherwise, this section completes
the application form.
(Attached forms?:
Yes
No
Sprinkler Supply Company, Inc will not discriminate against any employee or applicant for employment because of age (as defined by applicable law), religion, sex, race, color, national origin, or because they are handicapped, a
disabled veteran or a Vietnam era veteran. Answers to application questions will be utilized for applicable, job-related information only.
Internal Use - Do not write below this point.
Interviewed By:
Date:
-
Month
-
Day
Year
Date
Notes:
Page 2
END OF GENERAL APPLICATION. IF THIS IS A DRIVER'S APPLICATION, CONTINUE ON NEXT PAGE...
Rev. 3.22.11a
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CONTINUED FROM PAGE 2 - REQUIRED FOR DRIVER APPLICANTS ONLY.
DRIVER SPECIFIC INFORMATION
Driver's License Information: List all licenses held within the previous 3 years
License Number:
Class:
State:
Exp. Date:
-
Month
-
Day
Year
Date
License Number:
Class:
State:
Exp. Date:
-
Month
-
Day
Year
Date
License Number:
Class:
State:
Exp. Date:
-
Month
-
Day
Year
Date
Have you ever had any driver's license denied, suspended, revoked, or canceled by any state agency?:
Yes
No
If yes, provide state of issuance and explanation of the circumstances:
If additional space is needed, please attach on a separate sheet. Additional information attached?:
Yes
No
Driving Experience
Driving Experience
Rows
(Truck, Tractor/Trailer, Tank, etc.)
From
To
(Total)
1
2
3
4
5
List all traffic violation convictions for previous 3 years. (write NONE, if none)
Rows
Date
Location (City, State)
Violation
Commercial Vehicle
1
2
3
4
5
6
7
List all accidents for the previous 3 years. (write NONE, if none)
Rows
Date
Nature of Accident
# Fatalities
# Injuries
1
2
3
4
5
6
7
Page 3
CONTINUE ON NEXT PAGE...
Rev. 3.22.11a
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Should be Empty: