EMPLOYMENT APPLICATION FORM - AFFLINK



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OSCEOLA SUPPLY, INC.

EMPLOYMENT APPLICATION

|PLEASE PRINT ALL INFORMATION |

|This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, |

|sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends |

|solely on your qualifications. |

| |

|Please email this completed employment application to Margo Rogers – mrogers@ |

| |Date: |

|Name: |

|Last First Middle Maiden |

|Present Address: |

|Number Street City State Zip |

|How Long: |Social Security No.: |

|Telephone: |

|If under 18, please list age: |

|Are you legally eligible for hire in the United States? _____ Yes _____ No (Proof of eligibility will be required |

|upon hire) |

|Have you ever been convicted of a crime? _____ Yes _____ No |

|If yes, please explain: |

|(A conviction will not necessarily disaqualify you from consideration for employment) |

|Position Applied For: |Days/Hours Available to Work: |

| | |

| |No Pref Thur |

| |Mon Fri |

| |Tue Sat |

| |Wed Sun |

| | |

| |Can you work nights? |

| |_____ Yes _____ No |

|Salary Desired: | |

|Please list any additional information that relates to your ability to perform the job for | |

|which you have applied, such as special training, machine operations, hobbies, languages, | |

|etc. | |

|_____________________________________________________________________________________________| |

|_____________________________________________________________________ | |

| |

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|EDUCATION: School and Location Degree Received Subjects Studied |

| |

|High School: ________________________________________________________________________________ |

| |

|College: ________________________________________________________________________________ |

| |

|Trade, Business |

|Or Correspondence |

|School: ________________________________________________________________________________ |

|EMPLOYMENT HISTORY (Please list last three employers, starting with most recent/current) |

| |

|Employer: __________________________________________________________________________________ |

| |

|Address: __________________________________________________________________________________ |

| |

|City, State, Zip Code: _________________________________________________________________________ |

| |

|Supervisor’s Name: ___________________________________ Phone Number: ________________________ |

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|Employment Dates: (Beginning date) ___________________________ (End date) _______________________ |

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|Job Responsibilities: _________________________________________________________________________ |

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|Starting Salary: $____________________ Ending Salary: $___________________ |

| |

|Reason for Leaving: __________________________________________________________________________ |

| |

|Were you terminated: _____ Yes _____ No. If yes, explain: _________________________________________ |

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|May we contact your supervisor for a reference? _____ Yes _____ No |

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|Employer: __________________________________________________________________________________ |

| |

|Address: __________________________________________________________________________________ |

| |

|City, State, Zip Code: _________________________________________________________________________ |

| |

|Supervisor’s Name: ___________________________________ Phone Number: ________________________ |

| |

|Employment Dates: (Beginning date) ___________________________ (End date) _______________________ |

| |

|Job Responsibilities: _________________________________________________________________________ |

| |

|Starting Salary: $____________________ Ending Salary: $___________________ |

| |

|Reason for Leaving: __________________________________________________________________________ |

| |

|Were you terminated: _____ Yes _____ No. If yes, explain: _________________________________________ |

| |

|May we contact your supervisor for a reference? _____ Yes _____ No |

| |

| |

|Employer: __________________________________________________________________________________ |

| |

|Address: __________________________________________________________________________________ |

| |

|City, State, Zip Code: _________________________________________________________________________ |

| |

|Supervisor’s Name: ___________________________________ Phone Number: ________________________ |

| |

|Employment Dates: (Beginning date) ___________________________ (End date) _______________________ |

| |

|Job Responsibilities: _________________________________________________________________________ |

| |

|Starting Salary: $____________________ Ending Salary: $___________________ |

| |

|Reason for Leaving: __________________________________________________________________________ |

| |

|Were you terminated: _____ Yes _____ No. If yes, explain: _________________________________________ |

| |

|May we contact your supervisor for a reference? _____ Yes _____ No |

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| |

| |

|If applying for a position that requires a Valid Driver’s License, do you have one? _____ Yes _____ No |

|Driver’s License Number: State of issue: |

|( Operator ( Commercial (CDL) ( Chauffeur |

|Expiration Date: |

|Have you had any accidents during the past three years? |How many? |

|Have you had any moving violations during the past three years? |How Many? |

|If applying for a clerical position: |

| |

|Typing ( Yes 10-key ( Yes Word ( Yes |

|( No _____ WPM ( No Processing ( No _____ WPM |

|Personal ( Yes PC ( |Other Skills: |

|Computer ( No Mac ( | |

|Please list two references other than relatives or previous employers. |

|Name: |Name: |

|Position: |Position: |

|Company: |Company: |

|Address: |Address: |

| | |

|Telephone: |Telephone: |

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|EMPLOYMENT ACKNOWLEDGEMENTS |

|PLEASE SIGN AND INITIAL |

|I understand that this Company is an equal employment opportunity employer which adheres to a policy of making employment decisions without regard to race, |

|color, religion, sex, sexual orientation, national origin, citizenship, age or disability. I further understand that my opportunity for employment with |

|this Company depends solely on my qualifications. ______ (initials) |

| |

|In exchange for the consideration of my job application by Osceola Supply, Inc. (hereinafter called “the Company”), I agree that: |

| |

|Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any |

|other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist |

|from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an |

|employee of Osceola Supply, Inc., or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that |

|relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Osceola |

|Supply, Inc. may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may |

|unilaterally change or revise their benefits, policies and procedures with or without notice, and such changes may include reduction in wages and/or |

|benefits. ______ (initials) |

| |

|I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause|

|for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise |

|indicated), references, and others, and hereby release the Company from any liability as a result of such contract. ______ (initials) |

| |

|I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an |

|investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. |

|Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, |

|as required by the Fair Credit Reporting Act. ______ (initials) |

| |

|I further understand that in accordance with Florida Statute 443.131(3)(a)(2), my employment with the Company shall be probationary for a period of ninety |

|(90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any |

|reason by either party. I further understand that, if I am terminated for unsatisfactory work performance within the ninety (90) day period, the Company |

|may seek to contest any unemployment benefits applied for as a result of such termination. ______ (initials) |

| |

|I understand that if during my employment the Company becomes aware that any information provided in this application is false, it is grounds for immediate |

|termination. ______ (initials) |

|Signature of Applicant Date: |

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|PERSONS TO CONTACT IN CASE OF EMERGENCY |

|Name: |Relationship: |Telephone: |Address: |

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|TO BE COMPLETED BY EMPLOYER |

|Date of Employment: |Job Title: |Dept.: |

|Location: |Rate of Pay: |( Full-time ( Part-time ( Salaried |

|Applicant’s signature acknowledging above information |

| |

|Name of Person Verifying Information: |

|Name of Person Authorizing Employment: |

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© Copyright Biztree Inc. 2010. All rights reserved. Protected by the copyright laws of the United States & Canada and by international treaties. IT IS ILLEGAL AND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL BE SUED IN A COURT OF LAW.

© Copyright Biztree Inc. 2010. All rights reserved. Protected by the copyright laws of the United States and Canada and by international treaties. IT IS ILLEGAL AND STRICTLY PROHIBITED TO DISTRIBUTE, PUBLISH, OFFER FOR SALE, LICENSE OR SUBLICENSE, GIVE OR DISCLOSE TO ANY OTHER PARTY, THIS PRODUCT IN HARD COPY OR DIGITAL FORM. ALL OFFENDERS WILL AUTOMATICALLY BE SUED IN A COURT OF LAW.

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