Quality Hardwoods, Inc

APPLICATION FOR EMPLOYMENT
Careful and thoughtful completion of the application is an important step in our consideration of individuals for employment. Please complete the entire application. Your application must also specify the position for which you are applying. Stating that you will do "anything" is indefinite and may result in your application not being accepted by the employer. Your application will be considered active for sixty (60) days.

Today's Date:	20-05-2012 05:10 am
Name
First:
Middle:
Last:
Email:
Current Address
Street:
City:
State:
Zip:
Length of Time at this Address:
Previous Address
Street:
City:
State:
Zip:
Length of Time at this Address:
Telephone:
Driver's Licence Number:
Job(s) applied for:
Job 1:	Rate of Pay Expected: $ per
Job 2:	Rate of Pay Expected: $ per
Do you want to work full-time or part-time?	full-time part-time If applying only for part-time, what days and hours?
Have you ever applied for work with us before?	yes no If yes, when?
List anyone you know who works for us:
Do you have any skills, qualifications or experiences which you feel would especially fit you for work with us?
U.S. Armed Forces Service
Did you serve in the U.S. Armed Forces?	yes no
If so, when?	From: To:
Branch of service:
Duties:
Rank or rating at time of enlistment:
Rating at time of discharge:
Were you dishonorably discharged?	yes no If yes, explain:
Are you able to do the job(s) for which you are applying?	yes no If not, please explain:
Are you 18 years of age or older?	yes no
Have you ever been convicted of a crime?	yes no If yes, explain when, where, and the nature of the offense:
Are there any felony charges pending against you now?	yes no If yes, describe:
Are you authorized to work in the United States?	yes no
If hired, when can you start?
Education - Grammar School
School Name:
Number of years attended:
City/State
Course
Date you graduated
Education - High School
School Name:
Number of years attended:
City/State
Course
Date you graduated
Education - College
School Name:
Number of years attended:
City/State
Course
Date you graduated
Education - Other
School Name:
Number of years attended:
City/State
Course
Date you graduated
Prior Work Experience
(Please list your most recent employment first, use additional space below if necessary to list all prior employers.)
Employer #1
Name & address of employer:
Dates of employment:	From: To:
Type of work done
Starting pay:
Final pay:
Reason for leaving:
Employer #2
Name & address of employer:
Dates of employment:	From: To:
Type of work done
Starting pay:
Final pay:
Reason for leaving:
Employer #3
Name & address of employer:
Dates of employment:	From: To:
Type of work done
Starting pay:
Final pay:
Reason for leaving:
Employer #4
Name & address of employer:
Dates of employment:	From: To:
Type of work done
Starting pay:
Final pay:
Reason for leaving:
Employer #5
Name & address of employer:
Dates of employment:	From: To:
Type of work done
Starting pay:
Final pay:
Reason for leaving:
Employer #6
Name & address of employer:
Dates of employment:	From: To:
Type of work done
Starting pay:
Final pay:
Reason for leaving:
Business References
Business #1
Name:
Address & phone
Occupation:
Business #2
Name:
Address & phone
Occupation:
Business #3
Name:
Address & phone
Occupation:
Business #4
Name:
Address & phone
Occupation:
Other
Is there anything else you'd like us to know?
APPLICANT'S CERTIFICATION AND AGREEMENT PLEASE READ CAREFULLY: 1. Certification of Truthfulness. I certify that all statements on this Application for Employment are made truthfully and without evasion, and further understand and agree that such statements may be investigated and if found to be false will be sufficient reason for not being employed, or if employed may result in my dismissal. 2. Authorization for Employment/Educational Information. I authorize the references listed in the Application for Employment and any prior employer, educational institution, or any other persons or organizations to give this Company any and all information concerning my previous employment/educational accomplishments, disciplinary information or any other pertinent information they may have. I understand that such information may contain my social security number. I release all parties from all liability for any damage that may result from furnishing that information to this Company. In addition, I hereby waive written notice that employment information is being provided by any person or organization. 3. Employment at Will. If I am hired, in consideration of my employment, I agree to abide by the rules and policies of the Company, including any change made from time to time, and agree that my employment and compensation can be terminated with or without cause, and with or without notice, at any time, at the option of either the Company or myself. I understand that no manager or other representative of the Company, other than the Personnel Director, has any authority to enter into any agreement for employment for any specific or indefinite period of time, or to make any agreement contrary to the foregoing. Any such agreement made by the Personnel Director must be made in writing to be effective. 4. Authorization to Work. If I am selected for hire, I will be offered employment provided I verify that I am authorized to work as requested by the Immigration Reform and Control Act of 1986. 5. Limitation on Claims. I agree that any action or suite against the Company arising out of my employment or termination of employment, including but not limited to claims arising under State or Federal civil rights statutes, must be brought within 180 days of the event giving rise to the claim or be forever barred. I waive any statute of limitations to the contrary. 6. Need for Accommodation. If I am a handicapper who requires an accommodation to perform the job, I must notify the Company of that need within 182 days after I knew or reasonably should have known that an accommodation was needed. Failure to do so will bar me from alleging that the Company has not accommodated me as required by law. 7. Criminal Records Check. I agree to execute an authorization for this employer to secure criminal conviction history from the appropriate law enforcement agency, should the Company determine it is necessary to do so. 8. Release of Medical Information. I authorize every medical doctor, physician or other healthcare provider to provide any and all information, including but not limited to, all medical reports, laboratory reports, X-rays or clinical abstracts relating to my previous health history or employment in connection with any examination, consultation, test or evaluation. I hereby release every medical doctor, healthcare personnel and every other person, firm, officer, corporation, association, organization or institute which shall comply with the authorization or request made in this respect from any and all liability. I understand that this release will not be sent to my physician or other healthcare provider until a job offer has been made. 9. Physical Exam and Drug and Alcohol Testing. I agree to take a physical exam and authorize the Company or its designated agent(s) to withdraw specimen(s) of my blood, urine or hair for chemical analysis. One purpose of this analysis is to determine or exclude the presence of alcohol, drugs or other substances. I understand the decisions concerning my employment will be made as a result of this test. 10. Protected Disability. I also understand that if I have a protected disability that affects my ability to do the job I seek, I may ask the Company to attempt to make a reasonable accommodation for it. I must make my request in writing to the personnel department as soon as possible after the date I know that accommodation is needed. 11. Driving Records Check. If applying for a position that requires driving a company vehicle, I authorize the Company and its agents the authority to make investigations and inquiries of my driving record. 12. Fringe Benefits. In accepting employment with the Company, I agree to accept all fringe benefits when eligible as provided now or in the future. I understand that it is my responsibility to provide documentation for verification of eligibility for fringe benefits as well as information regarding mailing address, telephone numbers or contact arrangements, withholding exemptions and dependent information. The Company shall rely on the most recent information for all purposes. 13. Consideration Of Employment. I understand that my application will be considered pursuant to the Company's normal procedures for a period of sixty (60) days. If I am still interested in employment thereafter, I must reapply. I have read and understand items one through thirteen above, and acknowledge that with my signature below.
Dated:
Signature: (type name here)