Online Application Form

Please Note: To be considered an applicant for a specific job, you must complete this form; a resume may also be attached to SUPPLEMENT the application’s contents. Each question should be fully and accurately answered. No action can be taken on this application until an available JOB has been indicated.

Last 4 digits of your Soc. Sec. #

If under 18 years of age; your birth date

Last Name

First Name

Middle Name

Address

City, State, Zip

Telephone #

Alt. Phone #

Email

Home/Business Website

RECORD OF EMPLOYMENT

1. Name of Current/Most Recent Employer

Address

Telephone

Date Employed

Job Title

Reason for Leaving

Supervisor’s Name

2. Name of Current/Most Recent Employer

Address

Telephone

Date Employed

Job Title

Reason for Leaving

Supervisor’s Name

3. Name of Current/Most Recent Employer

Address

Telephone

Date Employed

Job Title

Reason for Leaving

Supervisor’s Name

4. Name of Current/Most Recent Employer

Address

Telephone

Date Employed

Job Title

Reason for Leaving

Supervisor’s Name

GENERAL INFORMATION

Are you seeking:

What is your expected Salary/Hourly Rate: $

When are you available to start, date:

Have you ever been employed by Bender Lumber:

If “Yes”, please explain:

Do you have any Family that has been employed by Bender Lumber?

If “Yes”, please explain:

Are you on Layoff or subject to an employment recall?

If “Yes”, please explain:

Have you ever been arrested for or convicted of a crime that has not been sealed or expunged by the court?

(A conviction will not necessarily disqualify an applicant)

If “Yes”, please explain:

Are you legally eligible for employment in the U.S.A?

(Federal Law requires proof of identity and employment authorization for all new employees.)

Do you have a valid driver’s license?

If “Yes” what type of license do you have:

Has your driver’s license ever been suspended or revoked?

If “Yes”, please explain:

Do you have experience in our industry, products, or something transferable:

If “Yes”, please explain and/or list skills or training you feel relevant to the job you are applying:

EDUCATION

(Mark last year completed)

High School

SCHOOL NAME

MAJOR SUBJECTS

(Mark last year completed)

College

SCHOOL NAME

MAJOR SUBJECTS

(Mark last year completed)

Other

SCHOOL NAME

MAJOR SUBJECTS

Degree Received?

Type of Degree:

OTHER EDUCATION, TRAINING, SKILLS / QUALIFICATIONS (not listed above):

REFERENCES

Please list the names of at least three (3) persons not related to you.

Name

Address

Telephone

Is this a work-related or personal reference?

Name

Address

Telephone

Is this a work-related or personal reference?

Name

Address

Telephone

Is this a work-related or personal reference?

CERTIFICATION (Please Read)

My signature below, and/or reply by postal mail, email, or fax, certifies that all information in this application is correct and complete to the best of my knowledge and belief. I understand and agree that any falsification of information, or omission of such, would be grounds for dismissal. I understand and agree that under the terms of employment with Bender Lumber that the employment relationship is terminable “at will” by either party without notice or cause, unless set out in writing, dated, and executed by both parties.

I understand that any offer of employment may be contingent upon my ability to comply with INS, State, and Federal regulations establishing my identity and right to work in the United States. I understand that a pre-employment drug / alcohol screen may be part of the application process – failure to take, falsification of information, or omission of such, would be grounds for resending an offer of employment , or termination of employment.

I understand that this form will be forwarded to the prospective leadership / managers within Bender Lumber, but it does not guarantee that I will be granted an interview, and that this application does not constitute an employment contract. Furthermore, I understand that this application will be retained by us for a reasonable period of time, as directed by State and Federal guidelines, and you will be contacted in the event our employment needs should change. I have read and understand the foregoing statements and accept the same as condition of employment.

Applicant’s Signature



Date

(Acceptance is by you typing or signing your name here and sending via: email, postal mail, or Fax)

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