MONTALBANO LUMBER
APPLICATION FOR EMPLOYMENT 								                         

(PLEASE PRINT CLEARLY)					

POSITION APPLIED FOR ___________________________   DATE OF APPLICATION _____________

REFERRAL SOURCE   ___ Advertisement           ___ Employee           ___ Relative         ___ Walk-in
		         	___ Employment Agency   ___ Government Employment Agency   ___ Other

		         Name of Source (if applicable) _________________________________________

MONTALBANO LUMBER does not discriminate on any employment practice on the basis of race, religion, color, sex, age, national origin, marital status, veteran’s status, the presence of a non-job-related medical condition, or disability.  No question on this application is intended to secure information which could be of a discriminatory nature.	
		
Name:		
	Last	First	Middle		
Present Address:		
	Street	City	State	Zip Code		
Telephone Numbers:	(              )	(              )		
	Home	Work		
Previous Address:					
	Street	City	State	Zip Code		
Social Security Number:	

Were you previously employed by us? yes ____  no ____  If yes, when? __________________________________

Have you ever applied for employment with us before? yes ___ no ___  If yes, when? _____________________

Are you legally eligible to work in the United States?		yes		no

Are you currently employed?				yes		no

Can you travel if the job requires it?				yes		no

Have you ever been bonded?				yes		no

Have you ever been convicted of, plead guilty, or no contest to a felony offense?	yes		no

	If yes, please explain. ___________________________________________________________________

Were you in the U.S. Armed Forces?    yes ____  no ____  If yes, what branch? ____________________________

Are you available to work    ___ full time   ___ part time   ___ temporary   ___ shift work   ___ overtime

If an employment offer were made, on what date would you be available for work? ________________________

	RECORD OF EMPLOYMENT
(Please list most recent employment first.)
	Name and Address of Company
	and Type of Business		FROM		TO		Monthly
	Starting 
	Salary		Monthly
	Last
	Salary		Reason for
	Leaving 	Name of
Supervisor	
	Mo.	Yr.	Mo.	Yr.					
							
	Title/Job duties:	
		
Telephone		

	Name and Address of Company
	and Type of Business		FROM		TO		Monthly
	Starting 
	Salary		Monthly
	Last
	Salary		Reason for
	Leaving 	Name of
	Supervisor	
	Mo.	Yr.	Mo.	Yr.					
							
	Title/Job duties:	
		
Telephone		

	Name and Address of Company
	and Type of Business		FROM		TO		Monthly
	Starting 
	Salary		Monthly
	Last
	Salary		Reason for
	Leaving 	Name of
	Supervisor	
	Mo.	Yr.	Mo.	Yr.					
							
	Title/Job duties:	
		
Telephone		

	Name and Address of Company
	and Type of Business		FROM		TO		Monthly
	Starting 
	Salary		Monthly
	Last
	Salary		Reason for
	Leaving 	Name of
	Supervisor	
	Mo.	Yr.	Mo.	Yr.					
							
	Title/Job duties:	
		
Telephone		
	
 (Please note if you have worked under a different name for any of these employers.)
I hereby give my permission to contact the employers listed above concerning my prior work experience.

	Signed ______________________________________________________________

Please indicate any employers you do not wish us to contact. ________________________________________________

Describe the skills and aptitudes you possess that would qualify you for a position with MONTALBANO LUMBER ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
RECORD OF EDUCATION
	SCHOOL		Name and Address of School	Course of Study	Dates Attended	Circle last year completed	List diploma or degree	

	High School/
	Prep School		
	N/A	
	N/A	
	1 2 3 4	
	N/A	

	Trade/
	Business School		

	1 2 3 4		

	College		
			
	1 2 3 4		

	Graduate Work/
	Other (Specify)				
	1 2 3 4		

Foreign Languages  					(Please Circle)			Fluency Level
Language   _______________________________	Speak	Read	Write			Good	Fair
Language   _______________________________	Speak	Read	Write			Good	Fair

	PERSONAL REFERENCES
Please list three references who are not former employers or relatives.
	Name and Occupation		Address		Telephone		Years Known	
1.				
2.				
3.				

Please list professional, trade, business, or civic associations and any offices held.  (Exclude organizations which would reveal sex, race, religion, national origin, age, disability, veteran or other protected status.)
	Organization		Offices Held	

		
List special accomplishments, publications, awards. (Exclude information which would reveal sex, race, religion, national origin, age, disability, veteran or other protected status.)
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

PLEASE READ CAREFULLY BEFORE SIGNING THE APPLICATION

I certify that answers given herein are true and complete to the best of my knowledge.  I authorize the Company to investigate all statements in this application and to secure any necessary information from all my employers, references and academic institutions.  I authorize the Company to investigate criminal court records and as a result I will be requested to complete an Authorization to Obtain Consumer and Investigative Consumer Report form.

I understand that any offer of employment is contingent upon receipt of a satisfactory report concerning my credit, academic credentials, and employment references.  Because of amendments to the Fair Credit Reporting Act in 2013, I understand that extra procedures are required of the Company. Thus, I will be notified as to those procedures if my application for employment necessitates a credit report. I further understand that any false information, misleading statements or omission of facts will be sufficient cause for rejection of my application if the Company has not employed me and for immediate dismissal if the Company has employed me. 

In the event of my employment with the Company, I will comply with all rules, regulations, and policies set forth in the Company's policy manual or other communications distributed by the Company.  I understand the Company promotes an alcohol/drug free workplace.  I agree to abide by the guidelines set forth in the Company's alcohol/drug abuse policy. 

Further, I understand that I must immediately notify the Company if I am convicted of, receive deferred adjudication in, or otherwise plead guilty or no contest to a felony, or any criminal offense involving dishonesty or a breach of trust or money laundering, while my application is pending or during my tenure as an employee of the Company.

I understand that nothing in this employment application, in the Company's policy statements or personnel guidelines, or in my communications with any Company official is intended to create an employment contract between the Company and me.  I also understand that the Company has the right to modify any of its policies without giving notice of the changes to me.  No promises of employment have been made to me.  I acknowledge that the Company employs individuals under the employment-at-will doctrine and that this is not subject to any changes.  I understand that if an employment relationship is established, I have the right to terminate my employment at any time for any reason. I also understand that the Company retains the right to terminate my employment at any time for any reason.

I hereby acknowledge that I have read and understand the preceding statements.

_______________________________________________________________   _________________________
             Signature of Applicant						             Date

FOR PERSONNEL DEPARTMENT USE ONLY
	Interviewer Name		Comments	

		

		

		

Employed:	YES	NO	Date of employment _________________________      

Position ________________________________________ Department ______________________________________

Monthly Salary ______________________________
Notes:

EMPLOYMENT DATA RECORD

MONTALBANO LUMBER is subject to Federal regulations requiring reporting of certain information on applicants for employment.  To assist in this effort, all applicants are requested to complete this form.  Your cooperation is strictly voluntary.  This form will be kept separate from your employment application and the information contained will be kept confidential.  It will not be available to personnel involved in the hiring process. The information given will be used only for reporting purposes in accordance with Federal laws and regulations.

If you do not wish to provide this information, please print your name, the date and please indicate such fact in the appropriate space below.  Your decision in this regard will not affect your application.
____ I do not wish to provide the information requested below.
(Please Print)

SECTION 1 (To be completed pre-offer)

Date_________________________ Position applied for _____________________________

Name ________________________________________________________________________

Address______________________________________________________________________

City______________________________________________State_________________Zip___

Social Security Number ________________________________________________________

____ Male     ____ Female

Race/Ethnic Categories :( Check One)

____ White
____ Hispanic or Latino						
____ Black or African American (not Hispanic or Latino)	
____ Asian (not Hispanic or Latino)
____ Native Hawaiian or Other Pacific Islander (not Hispanic or Latino)
____ American Indian/Alaskan Native (not Hispanic or Latino)
____ Two or More Races

SECTION 2 (To be completed post-offer)

Check if any of the following are applicable:

____ Vietnam Era Veteran			____ Special Disabled Veteran	
____ Other Protected Veteran		____ Disabled Individual
____ Newly Separated Veteran

If you wish to be considered disabled for purposes of our Affirmative Action Program, please identify your disability and what accommodations, if any, you may need to successfully perform your work.