PDF Wayne Densch, Inc.

WAYNE DENSCH, INC.

Wholesalers of Anheuser-Busch Beers

An Equal Opportunity Employer

APPLICATION FOR EMPLOYMENT

PERSONAL INFORMATION

DATE

NAME

LAST

PRESENT ADDRESS

NUMBER

FIRST STREET

MIDDLE

HOME OR NEAREST PHONE

PREVIOUS ADDRESS

IF AT PRESENT ADDRESS LESS THAN ONE YEAR

CITY NUMBER

CITY

STREET

STATE

ZIP

STATE

ZIP

SOCIAL SECURITY NUMBER

ARE YOU OVER THE AGE OF 18?

YES

NO

APPLICATION ATTESTATION

I declare and affirm under penalty of perjury that I am, (check the appropriate box):

A citizen or national of the U.S.

An alien authorized to work in the United States under the U.S. Immigration and Nationality act.

An alien lawfully admitted for U.S. permanent residence.

Position applied for:

How soon could you report to work?

Is there anything that will prevent you from performing the essential functions of the position or positions for which you are applying with or

without reasonable accommodation?

Yes

No

If yes, please explain:

Type of employment desired?

Full Time

Have you ever applied to this company before?

Have you ever been previously employed by this company before?

Part Time Yes

Yes

Salary desired? No If yes, give date: No If yes, when, where, and in what position:

Are you willing to work:

Nights?

Yes

No

Weekends?

Yes

No

Shift Work?

Yes

No

Who do you know that works for this company? 1.

2.

Have you ever been convicted of a crime?

Yes

No

If yes, please explain:

Have you ever been discharged from or requested to resign from a position?

Yes

No

If yes, please explain:

Are you currently employed?

Yes

No

If yes, why do you want to make a change?

Have you ever held a position of trust (handling money or confidential material)?

Yes

No

TYPE OF SCHOOL ELEMENTARY

SCHOOL NAME

EDUCATIONAL INFORMATION

SCHOOL LOCATION

DATES ATTENDED

GRADUATION DATE

HIGH SCHOOL/GED

TECHNICAL OR VOCATIONAL

JUNIOR COLLEGE

COLLEGE OR UNIVERSITY GRADUATE

SCHOOL

OTHER, INCLUDE

MILITARY SCHOOLS

PLEASE LIST MACHINES YOU CAN OPERATE OR JOB RELATED SKILLS YOU ARE PROFICIENT IN:

MACHINE OR SKILL

YEARS EXPERIENCE

MACHINE OR SKILL

YEARS EXPERIENCE

VEHICLE OPERATOR LICENSE INFORMATION

VEHICLE

ISSUE

OPERATOR STATE

LICENSE NUMBER

CDL LICENSE NUMBER

LICENSES

HELD

YOU MUST COMPLETE THIS SECTION IF THE POSITION APPLIED FOR REQUIRES USE OF A COMPANY VEHICLE

PRIVATE VEHICLE LICENSE NUMBER

EXPIRATION DATE

VEHICULAR EQUIPMENT YOU HAVE OPERATED

YOU MUST COMPLETE THIS SECTION IF THE POSITION APPLIED FOR REQUIRES USE OF A COMPANY VEHICLE

HAVE YOU BEEN DRIVING PROFESSIONALLY FOR THE PAST FIVE YEARS?

YES

NO

TICKETS YOU HAVE HAD (MOVING VIOLATIONS ONLY)

YOU MUST COMPLETE THIS SECTION IF THE POSITION APPLIED FOR REQUIRES USE OF A COMPANY VEHICLE

CITY/STATE

DATE OF INFRACTION

INFRACTION (DESCRIBE)

PENALTY YOU RECEIVED

ACCIDENTS YOU HAVE BEEN INVOLVED IN (PAST FIVE YEARS)

YOU MUST COMPLETE THIS SECTION IF THE POSITION APPLIED FOR REQUIRES USE OF A COMPANY VEHICLE

DATES

CITY/STATE WHERE ACCIDENT OCCURRED

WHAT HAPPENED IN THIS ACCIDENT?

WERE YOU CHARGED?

LIST ALL EMPLOYERS IN ORDER WITH THE LAST OR PRESENT EMPLOYER(S) LISTED FIRST

INCLUDE PART-TIME EMPLOYERS (ATTACH ADDITIONAL SHEET IF NECESSARY OR INCLUDE RESUME IN ADDITION TO INFORMATION BELOW)

DATES

NAME, ADDRESS AND PHONE NO. OF EMPLOYER

RATE OF PAY

SUPERVISOR'S NAME AND TITLE REASON FOR LEAVING

FROM

START

TO

FINISH

JOB TITLE

MAY WE INQUIRE OF THIS EMPLOYER

YES

NO

DESCRIBE IN DETAIL THE WORK OR JOB YOU PERFORMED

ARE YOU ELIGIBLE FOR REHIRE BY THIS EMPLOYER

YES

NO IF NO, WHY?

DATES

NAME, ADDRESS AND PHONE NO. OF EMPLOYER

FROM

TO

JOB TITLE DESCRIBE IN DETAIL THE WORK OR JOB YOU PERFORMED

RATE OF PAY

SUPERVISOR'S NAME AND TITLE

START

FINISH MAY WE INQUIRE OF THIS EMPLOYER

REASON FOR LEAVING

YES

NO

ARE YOU ELIGIBLE FOR REHIRE BY THIS EMPLOYER

YES

NO IF NO, WHY?

DATES

NAME, ADDRESS AND PHONE NO. OF EMPLOYER

FROM

TO

JOB TITLE DESCRIBE IN DETAIL THE WORK OR JOB YOU PERFORMED

RATE OF PAY

SUPERVISOR'S NAME AND TITLE

START

FINISH MAY WE INQUIRE OF THIS EMPLOYER

REASON FOR LEAVING

YES

NO

ARE YOU ELIGIBLE FOR REHIRE BY THIS EMPLOYER

YES

NO IF NO, WHY?

DATES

NAME, ADDRESS AND PHONE NO. OF EMPLOYER

FROM

TO

JOB TITLE DESCRIBE IN DETAIL THE WORK OR JOB YOU PERFORMED

RATE OF PAY

SUPERVISOR'S NAME AND TITLE

START

FINISH MAY WE INQUIRE OF THIS EMPLOYER

REASON FOR LEAVING

YES

NO

ARE YOU ELIGIBLE FOR REHIRE BY THIS EMPLOYER

YES

NO IF NO, WHY?

PLEASE EXPLAIN BELOW ALL GAPS IN YOUR EMPLOYMENT WHICH HAVE EXCEEDED ONE (1) MONTH FROM THE DATE YOU BEGAN YOUR MOST RECENT JOB TO THE PRESENT

HAVE YOU WORKED UNDER A DIFFERENT NAME FOR ANY OF THESE EMPLOYERS?

YES

NO

IF "YES", PLEASE IDENTIFY THE EMPLOYER AND STATE THE NAME:

PERSONAL REFERENCES (DO NOT INCLUDE FORMER EMPLOYERS, SUPERVISORS, OR RELATIVES)

NAME

PHONE # H

W

OCCUPATION

NAME

PHONE # H

W

OCCUPATION

NAME

PHONE # H

W

OCCUPATION

This application provides information which enables us to determine whether an applicant has the qualifications and experience to be given additional consideration for employment. In most cases, circumstances will prevent a preliminary interview; therefore, the conscientious completion of this form is necessary inasmuch as it will supply much of the information normally covered in such a session. At the appropriate time you will be required to prove your citizenship or, if not a citizen, your eligibility for employment. All statements made by applicants for employment on this application form will be carefully checked for accuracy. Wayne Densch, Inc. offers equal employment opportunities to all persons without regard to race, color, religion, age, sex, marital status, national origin, disability or veteran status. The use of this application does not indicate the availability of positions at nor obligate Wayne Densch, Inc. in any way. The application shall remain in an active file for a period of six months from the date of this application. I certify and affirm that all of the information furnished on this application is true, complete and correct. I understand and agree that any falsification, misrepresentation, misleading statement, or omission of fact on either this application or, during the pre-employment process shall be sufficient cause for; (1) my not being offered employment, or; (2) my dismissal at any time if I am employed. I authorize Wayne Densch, Inc. to verify all information on this application including but not limited to; employment history, educational background, credit records and motor vehicle records, and to acquire any and all criminal history record information pertaining to me which may be in the files of any Federal, State, or Local criminal justice agency in Florida or any other States. I understand and agree that because of the nature of the business conducted by Wayne Densch, Inc., that all information whether written, spoken, or otherwise communicated to me or obtained by me; and any information in any and all files and records of any and every description, relating to the business of Wayne Densch, Inc. or to any person, persons, company or corporation with whom Wayne Densch, Inc. has dealings, shall constitute privileged matters and shall be treated by me in a strictly confidential manner. I fully understand and agree that, if employed by Wayne Densch, Inc., I am not authorized to and shall not at any time communicate and/or reveal any business information, records, or files or any other matters relating to the business of Wayne Densch, Inc. to any person or persons within Wayne Densch, Inc. or to any person, persons, company or corporation outside Wayne Densch, Inc. I also understand and agree that any violation of this confidentiality shall constitute grounds for termination.

I understand and agree that if employed by Wayne Densch, Inc., I shall comply with all rules and regulations as set forth in Wayne Densch, Inc., policy manual and any other communication distributed to employees by Wayne Densch, Inc. I understand and agree that employment by Wayne Densch, Inc. may be conditioned upon an acceptable fitness for duty medical and health evaluation which may include a physical examination paid for by Wayne Densch, Inc. and conducted by a physician and/or medical organization selected by Wayne Densch, Inc. I understand and agree that employment by Wayne Densch, Inc. may be conditioned upon an acceptable drug and/or alcohol screening test result, such screening to be conducted by a physician and/or medical organization selected by Wayne Densch, Inc. I further agree to submit, at any reasonable time during my employment, and without prior notice, to a drug and/or alcohol screening test. I understand and agree that refusal on my part to take a requested drug and/or alcohol screening test may result in my immediate discharge. I further understand and agree that a positive drug and/or alcohol screening test may result in my immediate discharge.

I authorize Wayne Densch, Inc. to supply my employment record, in whole, or in part, to any prospective employer, government agency, and/or other party with a legal interest, and I release and hold harmless any and all such parties from any and all liability for direct or consequential damages resulting from such release and/or disclosure. I understand that nothing in this employment application, in Wayne Densch, Inc.'s statements or personnel guidelines, or in my communication with any Wayne Densch, Inc. official is intended to create an employment contract between Wayne Densch, Inc. and me. I also understand that Wayne Densch, Inc. has the right to modify its policies without giving me any notice of the change(s). No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon Wayne Densch, Inc. unless it is made in writing and signed by a Wayne Densch, Inc. officer. I understand that if an employment relationship is established, I have a right to terminate my employment at any time. I also understand that Wayne Densch, Inc. retains the right to terminate my employment at any time.

I have read and, understand the foregoing, and by my signature below, accept the foregoing terms and conditions for employment, if offered such a position. I attest also by my signature below that all the information I have provided on this application is true and complete.

Please make sure you have completed each section.

DATE

SIGNATURE OF APPLICANT PRINTED NAME OF APPLICANT

Equa l Employment Opportunity Self ID Survey

Ap p lic a nts a nd emp lo yees a re trea ted w ithout reg a rd to ra c e, c o lor, religion, sexua l orienta tion, g end er, na tiona l orig in, c itizenship sta tus (unless req uired b y a g overnment c ontra c t), a ge , ma rita l or vetera n st a tus, p hysic a l or menta l d isa b ility, or a ny other le ga lly p rotec te d sta tus d uring eve ry a sp ec t o f the e mp lo yment p roc ess.

So lely to he lp us c o mp ly with c erta in g overnme nta l rec o rd keep ing a nd rep orting req uirements fo r the a d ministra tion of c ivil rig hts la w s a nd reg ula tions, p lea se c omp le te the surve y b elow . Sub mission o f this informa tion is volunta ry a nd refusa l to p rovid e it will not sub jec t you to a ny a d verse trea tme nt. This info rma tion w ill not b e used for hiring , p la c eme nt, or o ther d ec isions rela ted to the te rms a nd c o nd itions o f emp loyment. This d o c ument w ill b e ke p t in a c onfid entia l file, sep a ra te from a p p lic a nt a nd p erso nnel files. When rep orted , d a ta will no t id entify a ny sp ec ific ind ivid ua l.

YOUR COOPERATION IS VOLUNTARY

INCLUSION OR EXCLUSION OF ANY DATA WILLNOTAFFECTANY EMPLOYMENTDECISION Plea se c omp lete the follow ing informa tion. Plea se p rint.

Last Na me:

First Na me:

Da te:

Job Title:

Gender Ma le

Fema le

Ethnic ity - Are you Hisp a nic or La tino? (A person of Cub a n, Mexic a n, Puerto Ric a n, South or Centra l Americ a n, or other Sp a nish c ulture or origin, rega rd less of ra c e.)

Ye s

No

Ra c e - If you a re not Hisp a nic or Latino, p lea se selec t the a p p rop ria te ra c e c a tegory.

White (Not Hisp a nic or La tino) - A p erson ha ving origins in a ny of the origina l p eoples of Europ e, the Mid d le Ea st, or North Afric a .

Bla c k or Afric an Americ a n (Not Hispa nic or La tino) ? A p erson ha ving origins in a ny of the Bla c k ra c ia l group s of Afric a .

Na tive Haw a iia n or Other Pa c ific Island er (Not Hisp a nic or La tino) - A p erson ha ving origins in a ny of the origina l p eoples of Ha w a ii, Gua m, Sa moa , or other Pa c ific Island s.

Asia n (Not Hisp a nic or La tino) - A p erson ha ving origins in any of the origina l p eop les of the Fa r Ea st, Southea st Asia, or the India n sub c ontinent inc lud ing, for exa mp le, Ca mb od ia , China , Ind ia , Ja p an, Korea , Ma la ysia , Pa kista n, the Philip p ine Isla nd s, Tha ila nd , a nd Vietna m.

Americ a n Ind ia n or Ala ska Na tive (Not Hisp a nic or La tino) - A p erson ha ving origins in a ny of the original p eop les of North a nd South Americ a (inc lud ing Centra l Americ a ), a nd w ho ma inta ins trib a l a ffiliation or c ommunity a tta c hment.

Two or More Ra c es (Not Hisp a nic or La tino) - p ersons who id entify w ith more tha n one of the a b ove five ra c es.

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download