Seacoast Mills Building Supply

APPLICATION FOR EMPLOYMENT
Pre-Employment Questionnaire - An Equal Opportunity Employer

Personal Information
Complete the below form and press submit to complete application.

First Name

Last Name

Street

City

State

Zip

Are you prevented from lawfully becoming employed in this country because of visa or immigration status?
yes No

Phone

Are you 18 years or older?
yes No

Employment Desired

Position

Date you can start

Salary Desired

Are you employed now?

If so may we inquire of your present employer?

Ever applied to this company before?

Where?

When?

Referred By

Education

Grammer School	Location of School	# Years Attended	Did you Graduate?	Subjects Studied?
High School	Location of School	# Years Attended	Did you Graduate?	Subjects Studied?
College	Location of School	# Years Attended	Did you Graduate?	Subjects Studied?
Trade School	Location of School	# Years Attended	Did you Graduate?	Subjects Studied?

General

Subjects of special study or research work

Special Skills

Activities: (Civic, Athletic, Etc.)

Exclude Organizations, The Name of Which Indicates the Race, Creed, Sex, Age, Marital Status, Color or Nation or Origin of its Members.

U.S. Military or Naval Service

Rank?

Presently in Nation Guard or Reserves

Former Employers
List below last three employers, starting with last one first

Start Date	End Date	Employer Name	Salary	Position	Reason for Leaving
Start Date	End Date	Employer Name	Salary	Position	Reason for Leaving
Start Date	End Date	Employer Name	Salary	Position	Reason for Leaving

Which of these jobs did you like the best?

What did you like most about this job?

References
Give the name of three persons not related to you, whom you have known at least one year

Name	Address	Business	Years Acquainted
Name	Address	Business	Years Acquainted
Name	Address	Business	Years Acquainted

Please read below and enter signature and date

"I certify that all the information submitted by me on this application is true and complete, and I understand that if any false information, omissions, or misrepresentations are discovered, my application may be rejected and, if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company's rules and regulations, and I agree that my employment and compensation can be terminated, with or without cause, and with or without notice, at any time, at either my or the company's option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause, and with or without notice, at any time by the company. I understand that no company representative, other than its President, and then only when in writing and signed by the President, has any authority to enter into any agreement for employment for any specific period of time, or to make any agreement contrary to the foregoing."

Date

Signature

Complete above form and press submit to complete application.