Solid Surface Craftsman::. Wholesale Manufacturers of DuPont®, Corian®, Zodiaq®

Employment Application page for Solid Surface Craftsman

APPLICATION FOR EMPLOYMENT

Date:
Name:(Last Name First)
Soc. Sec. No.	ex. 123-34-6898
Address:
Telephone:	ex. 518-355-2345
What kind of work are you applying for?
What qualifications do you have?
Are you 18 years or older?	Yes No
Are you either a U.S. citizen or an alien authorized to work in the United States?	Yes No
Do you have a clean valid driver's license?	Yes No

DO NOT ANSWER ANY OF THE QUESTIONS IN THIS FRAMED AREA UNLESS THE EMPLOYER HAS CHECKED A BOX PRECEDING A QUESTION, THEREBY INDICATING THAT THE INFORMATION IS REQUIRED FOR A BONA FIDE OCCUPATIONAL QUALIFICATION, OR DICTATED BY NATIONAL SECURITY LAWS, OR IS NEEDED FOR OTHER LEGALLY PERMISSIBLE REASONS.

Height____Feet____Inches

Weight____Lbs.

Are you a U.S. citizen Yes___ No___

Have you been convicted of a felony or misdemeanor within the last 5 years? Yes No
If Yes Describe:

I understand and agree that I may be required to take one or more: physical examination;lie detector test(s), as a condition of hiring or continued employment. I agree to consent to take such test(s) at such time as designated by the Company and to release the Company, its directors, officers, agents or employees from any claim arising in connection with the use of such test(s).Yes No

I have been advised that lie detector tests, as a condition of hiring or continued employment, are prohibited by law. Yes___ No____

* You will not be denied employment solely because of a conviction record, unless the offense is related to the job for which you have applied.

MILITARY SERVICE RECORD
Branch of Service:	Discharge Date:	Rank:
Present membership in National Guard or Reserves:		Date obligation ends:

EDUCATION
SCHOOL	*No.YRS ATTENDED	NAME of SCHOOL	CITY	COURSE	*DID YOU GRADUATE?
GRAMMER					Yes No
HIGH					Yes No
COLLEGE					Yes No
OTHER					Yes No
* The Age Discrimination in Employment Act of 1967 prohibits discrimination on the basis of age with respect to individuals who are at least 40 years of age.

EXPERIENCE
NAME/ ADDRESS of COMPANY	DATE FROM - TO	LIST your DUTIES	STARTING SALARY	FINAL SALARY	REASON for LEAVING

BUSINESS REFERENCES
NAME	ADDRESS	OCCUPATION

*	By checking this box, I hereby state: The information that I have provided in this application is true, and I authorize Solid Surface Craftsman to verify it's contents.