Davidsons Online Employee Application.pdf



Employment Application

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Personal Information

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|Last Name |First Name |Middle Initial |

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|Other names by which you have been known (for date verification and reference checking purposes) |Other Social Security # |

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|Home Phone |Business Phone |Email Address |

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|Permanent Address |City |State |ZIP Code |

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|Previous Address (If at current address less than 5 years) |

|How did you hear about this | Your College | Advertisement (specify publication below) |

|career opportunity? |Open House |Employee Referral (specify below) |

| |Internet website (specify below) |Walk-ln |

| |Job Recruiter (specify below) |Other (specify below) |

|Name of Referral Source: |[pic] |

An Equal Opportunity Employer

We are an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose.

|Have you ever been employed by Davidsons? Yes No Full-Time Temp/Part Time |[pic] |though |[pic] |

| |If so, when? |

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|What position did you hold? |Manager |

Employment Interest

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Position Desired Salary Desired Date Available

|Have you interviewed for another position at Davidsons? |[pic] |[pic] |If so, when? |[pic] |

Education and Training

|Indicate last level completed: |High School: |[pic] |[pic] |[pic] |[pic] |

| |College or University: |[pic] |[pic] |[pic] |[pic] |

| |Graduate School: |[pic] |[pic] |[pic] |[pic] |

|Name of High School, Technical School, |City, State |Major |Degree |Month/Year |

|College or University | | | |Degree |

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Additional education, vocational, professional, military, or other information you feel may be helpful to us in considering your application:

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Employment Record

Starting with present or most recent, list all previous employers. Include self-employment and summer and part-time jobs. If more space is required, please continue on a separate sheet. You may attach a resume, but complete this application as well.

Employment History

Please list most recent employer first

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Company Name Street Address

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City State Zip Code

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Starting Job Title Final Job Title

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Supervisors Name and Title Phone

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Reason for Leaving

|Job Duties: | Dates of Employment: |

|[pic] |From: [pic] To: [pic] |

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| | Starling Rate of Pay($) Ending Rate of Pay($) |

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Company Name Street Address

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City State Zip Code

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Starting Job Title Final Job Title

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Supervisors Name and Title Phone

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Reason for Leaving

|Job Duties: | Dates of Employment: |

|[pic] |From: [pic] To: [pic] |

| |[pic] [pic] |

| | Starling Rate of Pay($) Ending Rate of Pay($) |

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Company Name Street Address

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City State Zip Code

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Starting Job Title Final Job Title

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Supervisors Name and Title Phone

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Reason for Leaving

|Job Duties: | Dates of Employment: |

|[pic] |From: [pic] To: [pic] |

| |[pic] [pic] |

| | Starling Rate of Pay($) Ending Rate of Pay($) |

Business Reference Data

Please list at least one present or former manager.

Name Email Address Phone Business Relationship

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Outside Activities

(Exclude those indicating race, color, religion, sex, national origin, age, or handicap.)

Professional memberships, certificates, or licenses held

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Past and present civic or cultural activities -- include offices held

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Principal hobbies:

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Special Skills

|To be completed by applicant for Administrative/Sales position: |To be completed by applicant for warehouse position: |

|Keyboard Skills: |[pic] [pic] |Words per minute: [pic] |Type of machines operated and years experience |

|Computer skills: | |[pic] |

|Hardware: |[pic] | |

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|Software: | | |

Please list other skills and/or equipment/language experience you have acquired List other shop/production skills:

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Military Record

|Branch of service: |[pic] |From: |[pic] |To: |[pic] |

|Present military affiliation: |[pic] [pic][pic] |

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|Kinds of training and duty while in |[pic] |

|service: | |

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I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company's service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself.

Date Signature

If any of your educational or employment records are under other than the above name, please provide other names.

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VOLUNTARY SELF-IDENTIFICATION

(CONFIDENTIAL-FOR STATISTICAL USE ONLY)

We are an equal opportunity employer and do not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or any other classification protected by federal, state or local law. The information below will be used only in the compilation of data for affirmative action reporting.

Completion of this data is voluntary and will not affect your opportunity for employment or terms or conditions of employment, if hired. Identification can be declared at any time prior to or, if applicable, after hire. Please return this page with your application.

PLEASE COMPLETE IN FULL:

|Date: |[pic] |Position applied for: |[pic] |

|Name: |[pic] |Social Security #: |[pic] |

|Sex: |[pic] [pic] |

|Date of Birth: |[pic] |Applicant's zip code: |[pic] |

RACE/ETHNICITY:

(Please check one of the descriptions below corresponding to the ethnic group with which you most identify.)

|[pic] |Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. |

|[pic] |White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. |

|[pic] |Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa. |

|[pic] |Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific |

| |Islands. |

|[pic] |Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, |

| |including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. |

|[pic] |American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including |

| |Central America), and who maintain tribal affiliation or community attachment. |

|[pic] |Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races. |

|[pic] |Race missing or unknown - Applies to Applicants only, where a resume or application that is screened is received without any racial or ethnic identification|

| |and no further contact is made with the applicant. |

VETERAN STATUS:

(Please check one if it describes your veteran status *)

|[pic] |PECIAL DISABLED VETERAN: Means (A) a veteran who is entitled to compensation (or who, but for the receipt of military retired pay, would be entitled to |

| |compensation) under laws administered by the Department of Veteran Affairs for a disability rated at 10 or 20 percent in the case of a veteran who has been|

| |determined to have a serious employment disability or (B) a person who was discharged or released from active duty because of a service-connected |

| |disability. |

|[pic] |VIETNAM ERA VETERAN: A Vietnam Era veteran is a person who (1) served on active duty for a period of more than 180 days, any part of which occurred between|

| |August 5, 1964, and May 7, 1975, and was discharged or released with other than a dishonorable discharge; (2) was discharged or released from active duty |

| |for a service connected disability if any part of such active duty was performed between August 5, 1964, and May 7, 1975; or (3) served on active duty for |

| |more than 180 days and served in the Republic of Vietnam between February 28, 1961, and May 7, 1975. |

*Veteran status may only be requested after a job offer is made.

Personal and Confidential

This page contains sensitive information, store in secure "Affirmative Action Forms" files, separately from personnel records!

EEOC-v1.0

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