Application for Employment

BEST SUPPLY, INC. is an Equal Opportunity Employer and does not discriminate on the basis of race, religion, color, national origin, age, ancestry, sec, gender, disability, HIV status, or any other characteristics protected by law.

Position Applying for*

Position Location*

Introductory Information

First Name*

Last Name*

Street Address*

City*

State/Region*

Postal Code*

Email*

Phone Number*

Have you applied to this company before?*

Yes

Type of work desired

Date Available

Month/Day/Year

If hired can you provide documents required to establish your eligibility to work in the U.S.?*

Yes

How were you referred to Best Supply, Inc.?

Have you ever been convicted of, or plead guilty or no contest to, a crime other than a minor traffic violation?*

Yes

If yes, please explain in detail and include the date of final disposition of the case and nature of the offense. This information will not necessarily disqualify you for employment but false or misleading information will.

Are you currently employed?

Yes

Current Position

Education

Military Experience

Branch of Service

Length of Service

Highest Rank

Special Training/Experience

Type of Discharge

Employment Record (List employers starting with the most recent)

Employer #1 Name

Employer #1 Telephone Number

Employer #1 Job Title

Employer #1 Supervisor

Employer #1 Start Date

Month/Day/Year

Employer #1 End Date

Month/Day/Year

Employer #1 Start Rate

Employer #1 End Rate

Employer #1 Duties

Employer #1 Reason for Leaving

Employer #2 Name

Employer #2 Telephone Number

Employer #2 Job Title

Employer #2 Supervisor

Employer #2 Start Date

Month/Day/Year

Employer #2 End Date

Month/Day/Year

Employer #2 Start Rate

Employer #2 End Rate

Employer #2 Duties

Employer #2 Reason For Leaving

Employer #3 Name

Employer #3 Telephone Number

Employer #3 Job Title

Employer #3 Supervisor

Employer #3 Start Date

Month/Day/Year

Employer #3 End Date

Month/Day/Year

Employer #3 Start Rate

Employer #3 End Rate

Employer #3 Duties

Employer #3 Reason For Leaving

Employer #4 Name

Employer #4 Telephone Number

Employer #4 Job Title

Employer #4 Supervisor

Employer #4 Start Date

Month/Day/Year

Employer #4 End Date

Month/Day/Year

Employer #4 Start Rate

Employer #4 End Rate

Employer #4 Duties

Employer #4 Reason For Leaving

Work Related References (Do Not Include Relatives)

Reference #1 Name

Reference #1 Occupation

Reference #1 Years Known

Reference #1 Contact Information

Reference #2 Name

Reference #2 Occupation

Reference #2 Years Known

Reference #2 Contact Information

Reference #3 Name

Reference #3 Occupation

Reference #3 Years Known

Reference #3 Contact Information

STATEMENT PLEASE READ STATEMENT CAREFULLY BEFORE SIGNING THIS APPLICATION

I understand that employment with Best Supply is on an AT WILL basis, meaning I and Best Supply have the right to terminate employment at any time, or for any or no reason consistent with applicable state or federal law.

I authorize Best Supply to conduct a thorough background investigation of my work and personal history, and verify all data given on this application and during interviews. I herby release Best Supply, and their representatives or agents, from any liability that might result from such an investigation. I authorize all individual, schools and firms named to provide any requested information and release them from all liability for providing the requested information.

I understand that Best Supply may require the successful completion of a drug and/or alcohol test as a condition of employment. I also understand this application will be active for a period of 90 days; after that time, if I wish to be considered for employment, I must submit a new application. I certify that all the statements in this completed application are true and understand that any falsification of willful omission shale be sufficient cause for dismissal or refuse to hire.

By checking this box, you are agreeing to the terms and conditions of Best Supply.

Applicant Signature*