Universal Supply Company

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First Name Middle Last
Address City State Zip Code
Email Address
For what position
are you applying? 		How did you hear
about our company?
At which locations below are you interested in working?
Gloucester Vineland Cape May Court House Manahawkin Hammonton Central Distribution Hammonton Millwork Distribution Hammonton Kitchens Pleasantville Lakewood
Full Time Part Time Temporary or Summer Date available
Starting pay expected Shift Preferred    1st 2nd 3rd
Are you available for overtime? What limitations, if any?
Are you willing to travel? What limitations, if any?
Are you willing to relocate? Geographical Preference?
Have you previously applied for employment with our company? If so,
when?
Have you ever been employed by our company? If so,
when?
PERSONAL DATA
Phone # Home Work
Are you under 18 years of age? Are you a citizen of the United States?
If you are not a U.S. Citizen, do you have a
right to remain permanently in the U.S.?
Have you ever been convicted of a crime other than minor traffic violations?
If yes, type of conviction Date of conviction
Conviction of a crime does not necessarily exclude a candidate from employment.
(Answer only if operating a motor vehicle is required for the position for which you are applying)
Do you have a valid driver's license? License Number State
EDUCATION
Choose
Highest 		     
6 7 8      
9 10 11 12      
13 14 15 16      
17 18
Grade
Completed 		     
Elementary     
High School     
College     
Graduate
  Name Address Degree Major
High School
College
College
Other
Do you belong to any professional or service associations? IF SO, LIST
Extracurricular activities (exclude any indicating race, creed, sex, color or national origin)
List any additional skills, knowledge, experience or other qualifications such as licenses, puclications, business or personal achievements which support your applications
References/strong> (Do not use relatives)
Name
Address
Phone
Work History
List names and addresses of all former employers beginning with tpresent or most recent employer.
May we contact your present employer?
1. Company name
Address
City State ZIP CODE
Dates of employment from to
Salary - Weekly Monthly Starting pay Ending pay
Reason for leaving
Immediate supervisor's name and title
List positions held and describe duties, for sales positions, list sales vliuve in dollars.
2. Company name
Address
City State Zip code
Dates of employment from to
Salary - Weekly Monthly Starting pay Ending pay
Reason for leaving
Immediate supervisor's name and title
List positions held and describe duties, for sales positions, list sales volume in dollars.
3. Company Name
Address
City State Zip code
Dates of employment from TO
Salary - Weekly Monthly Starting pay Ending pay
Reason for leaving
Immediate supervisor's name and title
List positions held and describe duties, for sales positions, list sales volume in dollars.
4. Company name
Address
City State Zip code
Dates of employment from TO
Salary - Weekly Montly Starting pay Ending pay
Reason for leaving
Immediate supervisor's name and title
List positions held and describe duties, for sales positions, list sales volume in dollars.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER AND SUPPORT THE CIVIL RIGHTS ACT OF 1964 WHICH PROHIBITS DISCRIMINATION IN EMPLOYMENT BASED ON AGE, RELIGION, RACE, COLOR, SEX OR NATIONAL ORIGIN.
PLEASE READ CAREFULLY AND ENTER YOUR NAME AND INITIALS
I CERTIFY THAT ALL THE INFORMATION I HAVE GIVEN ON THIS APPLICATION IS CORRECT, AND I UNDERSTAND THAT IF I FALSIFY ANY OF THIS INFORMATION OR FAIL TO REPORT MATERIAL INFORMATION, I WILL NOT BE CONSIDERED FOR EMPLOYMENT OR I MAY BE DISCHARGED. I AUTHORIZE YOU TO MAKE AN INVESTIGATIVE REPORT VERIFYING INFORMATION ON THIS APPLICATION AND TO OBTAIN INFORMATION BY PREVIOUS EMPLOYERS. IT IS UNDERSTOOD THAT NOTHING CONTAINED IN THIS APPLICATION IS TO BE INTERPRETED AS OR IMPLIED TO BE A CONTRACT OF EMPLOYMENT. IF EMPLOYED, THE EMPLOYMENT RELATIONSHIP IS "AT WILL" AND MAY BE TERMINATED BY EITHER PARTY AT ANY TIME WITHOUT REASON. I UNDERSTAND MY EMPLOYMENT DEPENDS UPON MY PASSING A PHYSICAL EXAMINATION, WHICH MUST BE TAKEN AT THE REQUEST OF THE COMPANY.
ENTER YOUR FULL NAME DATE
IF YOU HAVE NOT LIVED AT THE ADDRESS GIVEN ON YOUR EMPLOYMENT APPLICATION FOR AT LEAST FIVE YEARS, PLEASE LIST BELOW ANY OTHER ADDRESSES WHERE YOU HAVE LIVED DURING THIS TIME.
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