Employment Application

Application Information: The following information must be provided and will be held in the strictest confidence.
*Req. = Requested information must be provided

Personal Information
Date:
First Name: *Req.
Last Name: *Req.
Social Securiy #: *Req.
Present - Address: *Req.
Present - City: *Req.
Present - State: *Req.
Present - Zip Code: *Req.

Permanent - Address:
Permanent - City:
Permanent - State:
Permanent - Zip Code:

Tel. # : *Req.
Referred By:

Employment Desired
Position
Date You Can Start
Salary Desired
Are you employed?
If so, may we inquire of your present employer?
Ever applied to this company before?
Where?
When?

Education History
Grammar School -
Name:
Location:
Years attended:
Did you graduate?
Subjects Studied?
High School -
Name:
Location:
Years attended:
Did you graduate?
Subjects Studied?
College -
Name:
Location:
Years attended:
Did you graduate?
Subjects Studied?
Trade, Business or Correspondence School -
Name:
Location:
Years attended:
Did you graduate?
Subjects Studied?

General Information
Subjects of Special Study/Research Work or Special Training/Skills:
U.S. Military of Naval Service:
Rank:

Former Employers (list below last four employers, starting with last one first)
Employer-1 - Name:
Employer-1 - Address:
Employer-1 - City:
Employer-1 - State:
Employer-1 - Zip Code:
Employer-1 - Tel. #:
Employer-1 - Date Worked From:
Employer-1 - Date Worked To:
Employer-1 - Salary:
Employer-1 - Position:
Employer-1 - Reason For Leaving:

Employer-2 - Name:
Employer-2 - Address:
Employer-2 - City:
Employer-2 - State:
Employer-2 - Zip Code:
Employer-2 - Tel. #:
Employer-2 - Date Worked From:
Employer-2 - Date Worked To:
Employer-2 - Salary:
Employer-2 - Position:
Employer-2 - Reason For Leaving:

Employer-3 - Name:
Employer-3 - Address:
Employer-3 - City:
Employer-3 - State:
Employer-3 - Zip Code:
Employer-3 - Tel. #:
Employer-3 - Date Worked From:
Employer-3 - Date Worked To:
Employer-3 - Salary:
Employer-3 - Position:
Employer-3 - Reason For Leaving:

Employer-4 - Name:
Employer-4 - Address:
Employer-4 - City:
Employer-4 - State:
Employer-4 - Zip Code:
Employer-4 - Tel. #:
Employer-4 - Date Worked From:
Employer-4 - Date Worked To:
Employer-4 - Salary:
Employer-4 - Position:
Employer-4 - Reason For Leaving:

References (Give below the names of three persons not related to you, whom you have know at least one year)
Reference-1 - Name:
Reference-1 - Address:
Reference-1 - City:
Reference-1 - State:
Reference-1 - Zip Code:
Reference-1 - Business:
Reference-1 - Years Known:

Reference-2 - Name:
Reference-2 - Address:
Reference-2 - City:
Reference-2 - State:
Reference-2 - Zip Code:
Reference-2 - Business:
Reference-2 - Years Known:

Reference-3 - Name:
Reference-3 - Address:
Reference-3 - City:
Reference-3 - State:
Reference-3 - Zip Code:
Reference-3 - Business:
Reference-3 - Years Known:

Authorization
" I certify that the facts contained within this application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and any pertinant information they may have, personal or otherwise, and release the company from all liability for any damage that may result from utilization of such information. I also understand and agree that no represenative of the company has any athority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

Your Name: *Req.
I agree with the above statement: *Req.

Email Address: *Req.
Confirm Email Address: *Req.

Please click [Submit] button only once please

Location - Shagbark Lumber & Feed Supply 1 Mount Parnassus Rd East Haddam, CT 06423 Phone - 860.873.1946 Fax - 860.873.3425	Hours of operation - 7 AM to 6 PM Monday through Friday 8 AM to 4 PM Saturday 8 AM to 1 PM Sunday Dec.1 - Mar.1 - (Winter Hours) 7 AM to 5 PM Monday through Friday

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sales@shagbarklumber.com