Employment ApplicationStep 1 of 520%Lebanon Paint & Decorating / LaValley Building Supply is an Equal Opportunity Employer. We consider applicants for all positions without regard to age, race, creed, religion, color, handicap, marital status, sex, sexual orientation, national origin, ancestry, arrest record, conviction record or membership in the National Guard, state defense force or any other reserve component of the military forces of the United States.Please fill in your first and last name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone number*Cell phone numberEmail address* Position Desired?*What date are you available to start?* Date Format: MM slash DD slash YYYY Are you capable of lifting 50lbs or less?*Have you ever filed an applicatoin with us before?*YesNoIf Yes, give month and yearHave you ever been employed with us before?*YesNoIf Yes, give month and yearWe work on a full-time schedule. Is that a problem?*if this is a problem, what hours can you work?We occasionally work more than eight (8) hours per day and on holidays. Will this be a problem?*YesNoIf employed and you are under 18, can you furnish a work permit?*YesNoCan you perform the essential functions of the job you have applied for?*YesNoIf No, please inidicate which function(s) and give us any suggestions you have as to how we might accommodate you:Please check the box below acknowleging that you understand our drug policy.* I understand that Lebanon Paint is a DRUG FREE & TOBACCO-FREE FACILITY AND WORK PLACE.Driver's License & Driving InformationDo you have a valid driver's license?* Yes NoIf you don't have a driver's license, why?*Employer 1 Information ( most recent employer)Employer 1 Name* Employer 1 - Address*Please fill in all information about your most recent employer. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer 1 - Phone Number*Employer 1 -How did you end your employment with this company?* I resigned I was terminated I am currently still employed here I am a seasonal employeeEmployer 1- Please state reason for your employment ending*Employer 1 - Job title*Employer 1 - Starting pay*Employer 1 - Ending pay?*Employer 1 - Start date?* Date Format: MM slash DD slash YYYY Employer 1 - End date?* Date Format: MM slash DD slash YYYY Employer 1 - Describe your duties at this job.*Employer 1 - Supervisor's name?*Employer 1 - Supervisor's phone number?*Employer 1 - Do we have permission to contact this person as a reference?* Yes NoEmployer 2 - (Second most recent)Employer 2 Name* Employer 2 - Address*Please fill in all information about your most recent employer. Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Employer 2 - Phone Number*Employer 2 - How did you end your employment with this company?* I resigned I was terminated I am currently still employed here I am a seasonal employeeEmployer 2 - Please state reason for your employment ending*Employer 2 - Job title?*Employer 2 - Starting pay?*Employer 2 - Ending pay?*Employer 2 - Start date?* Date Format: MM slash DD slash YYYY Employer 2 - End date?* Date Format: MM slash DD slash YYYY Employer 2 - Describe your duties at this job.*Employer 2 - Supervisor's name?*Employer 2 - Supervisor's phone number?*Employer 2 - Do we have permission to contact this person as a reference?* Yes NoEducationHigh School(s)*Did you graduate from High School?* Yes No I got my GEDDid you attend a college(s) or university(s)?* Yes NoIf Yes, Did you graduate from a college or university?* Yes NoGeneral InformationSignature / Disclosure SectionList special skills, talents or experience you feel will benefit you in the job for which you have applied:*List all convictions for misdemeanors, felonies, or other offenses, except minor traffic violations (if none write none)*List all pending middeameanor, felony or other criminal charges (if none, write none)*No applicant will be denied a position because of a conviction or a pending criminal charge which the employer determines is not substantially related to the circumstances of the job being sought.Military ServicePeriod of Active Duty (From: Month/Year) (To: Month/Year)Branch of ServiceDescribe your duties and any special training:Please read and acknowledge at the bottom.*“ I certify that answers given herein are true and complete to the best of my knowledge.” I understand that I may be required to submit to a pre-employment offer physical examination and/or a drug screen, and that employment is conditioned upon obtaining satisfactory results. I consent to this pre-employment offer physical examination and such further examinations as may be required, which may include drug screenings. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that, if hired, any employment relationship with this Company is of an “at-will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I also understand that acceptance of an offer of employment does not create a contractual obligation to continue to employ me in the future and that no Company official, management or otherwise, is authorized to make any oral assurance or promise of continued employment, and that any such pledge or agreement must be in writing, signed by the President of the Company. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. I understand and acknowledge that what I have submitted it true and complete. I agree and understand the terms of employement.Signature*I understand that by agreeing to the above terms and typing my name here that this is my digital signature.NameThis field is for validation purposes and should be left unchanged.
