Bunzl Application for Employment

Transcription

1 Bunzl Application for Employment We are an EEO/AA employer. Prospective employees will receive consideration without regard to age, race, color, religion, sex, national origin, disability, disabled or Vietnam Veteran status, or other status as protected by applicable law. Please Print All Responses Except Your Signature Name (Last) (First) (Middle) Social Security # Application Date Home Address (Number and Street) State Zip Code Home Telephone (Area Code and Number) Business Telephone Date Available Are you 21 years or older? Yes No Position Applying For: Necessary work permit? Yes No Can you perform the essential functions of the job, with/without reasonable accommodations? Yes No Have you ever worked under a different name? Yes No If yes, please state: Type of employment seeking? How were you referred to us? Do you have any restrictions working overtime? Can you travel if required to? Yes No Part Time Full-time Yes No Are you willing to relocate? Yes No *WORK SCHEDULES VARY WITHIN DEPARTMENTS AND WILL BE EXPLAINED BY THE DEPARTMENT SUPERVISOR *OVERTIME IS REQUIRED DURING PEAK SEASONS WHEN SHIFT SCHEDULES MAY BE EXTENDED If hired, can you provide proof that you are eligible to work in the United States? Yes No Have you ever been convicted of a felony? Yes No If yes, give details (a conviction does not automatically disqualify employment) EDUCATION Circle Highest Grade Completed High School GED Course of Study Did you Graduate? Circle Years Completed Vocational Schools, Technical institutes Course of Study Average Grade & Junior Colleges Circle Years Completed University Degree and Major G.P.A. / Scale Attending Advanced Completed Degrees Degree and Major G.P.A. / Scale MILITARY SERVICE Have you ever served in the U.S. Armed Forces? Yes Special Training: TRAINING No Date: From to Branch: List any other special courses, training or certification, professional/trade groups or organizations, scholastic honors and other pertinent experience or honors you consider relevant your ability to perform the job for which you applied (omit any reference to race, age, sex, national origin or ancestry, religion, sexual orientation, disability, political persuasion or other protected class).

2 Employment History: List all previous positions held within the last ten (10) years. If you do not have enough space, use additional paper. Accuracy of dates and addresses is essential. This section must be completed even if submitting resume. MOST RECENT EMPLOYER SECOND MOST RECENT EMPLOYER THIRD MOST RECENT EMPLOYER FOURTH MOST RECENT EMPLOYER Telephone Number May we contact your present supervisor/employer? Yes No List the issuing state, number and expiration date of each unexpired commercial motor vehicle operator's license or permit that has been issued to you (use additional paper if necessary).

3 USE THIS SHEET FOR ADDITIONAL EMPLOYMENT HISTORY INFORMATION Employment History: List all previous positions held within the last ten (10) years. If you do not have enough space, use additional paper. Accuracy of dates and addresses is essential. This section must be completed even if submitting resume. FIFTH MOST RECENT EMPLOYER SIXTH MOST RECENT EMPLOYER SEVENTH MOST RECENT EMPLOYER EIGHTH MOST RECENT EMPLOYER

4 List the addresses at which you have resided during the last 3 years (use additional paper if necessary) Street Address:, State Zip Code: Street Address:, State Zip Code: Street Address:, State Zip Code: Street Address:, State Zip Code: Equipment operated: box truck truck tractor semi-trailer pole trailer other Describe nature and extent of your experience: Have you been involved in an accident during the past 3 years? Yes No If yes, explain (use additional paper if needed: Dates Nature of Accident (give brief description) Fatalities Injuries Last Accident Second Accident Third Accident Have you ever had any license, permit or privlege to operate a motor vehicle denied, revoked or suspended? Yes No If yes, explain in detail the facts and circumstances of each instance (use additional paper if needed: List traffic convictions and forfeitures for the past 3 years other than parking violations (use additional paper if nescessary). Location Date Charge Penalty Employment References: List three persons whom we can contact who are able to evaluate your professional experience. Name Title Company Address Telephone Number

5 CERTIFICATION: This certifies that this application was completed by me, and that all entities on it and information in it are true and complete to the best of my knowledge. SIGNATURE DATE APPLICATION FOR EMPLOYMENT DISCLAIMER (please read carefully before signing): I certify before signing): I certify the information provided by me in this application is factual and subject to verification by BUNZL. I understand misrepresentation of any material fact by me in this application can result in denial of employment or, upon subsequent discovery, immediate termination of employment. I understand that employment, if offered, is contingent upon my providing proof of identity and employment eligibility required by immigration Reform & Control Act of 1986 (Form I-9). BUNZL is strongly committed to maintaining a Drug-Free work environment. All applicants who receive a conditional offer of employment, will be required to pass a drug screening test. I authorize investigation of all statements contained in this application including former employers, schools, persons and other organizations referenced in this application to provide BUNZL with any and all information concerning my previous employment, education or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application, and hereby release all such parties from all liability from any damages which may result for furnishing such information. Should I be hired, I agree to be governed by all company rules and regulations. I understand and agree that if I am employed, my employment shall be at the will of BUNZL and may be terminated at any time with or without cause and with or without notice by either myself or BUNZL and no company policy or guidelines shall create any obligation on the part of the company with regard thereto. I acknowledge that I have read all the above statements and that I understand them. SIGNATURE DATE