Employment Application

General Information

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Phone

(###)

###

####

Employment Availability

Which branch are you applying to? *

Which position are you applying for? *

When are you available to start? *

When are you available to start?

YYYY

Background

Are you a citizen of the United States? *

Yes

If you are not a citizen, are you authorized to work in the US?

Yes

Have you ever worked for this company before? *

Yes

What are the dates of your prior employment with Modular Interiors?

Have you ever been convicted of a crime in the past 10 years, excluding misdemeanors and summary offenses? *

Yes

If you have a conviction, please explain in full.

Education

High School *

Start Date *

Start Date

YYYY

Completion Date *

Completion Date

YYYY

Did you graduate? *

Yes

College

Start Date

YYYY

Completion Date

YYYY

Did you graduate?

Yes

References

Reference 1 Name *

Reference 1 Name

First Name

Last Name

Reference 1 Email

Reference 1 Phone *

Reference 1 Phone

(###)

###

####

Reference 2 Name *

Reference 2 Name

First Name

Last Name

Reference 2 Email

Reference 2 Phone *

Reference 2 Phone

(###)

###

####

Reference 3 Name *

Reference 3 Name

First Name

Last Name

Reference 3 Email

Reference 3 Phone *

Reference 3 Phone

(###)

###

####

Previous Employment

Company *

Job Title *

Supervisor

First Name

Last Name

Phone

(###)

###

####

Starting Salary

Ending Salary

Reason for Leaving *

Dates of Employment *

May we contact your previous supervisor for reference? *

Yes

Company *

Job Title *

Supervisor

First Name

Last Name

Phone

(###)

###

####

Starting Salary

Ending Salary

Reason for Leaving *

Dates of Employment *

May we contact your previous employer? *

Yes

Applicant Questionnaire

Do you have a valid driver's license? *

Yes

Modular Interiors is a drug-free workplace. Are you able to pass a drug test? *

Yes

Do you own your tools, i.e. cordless drill and miscellaneous hand tools? *

Yes

Our typical works schedule is Monday - Friday 6:30 am - 3:30 pm. Are you able to work overtime, evenings and / or weekends, and available to go out of town? *

Yes

Do you have reliable transportation? *

Yes

Disclaimer and Signature

Signature *

Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I understand that Modular Interiors, Inc. is a drug-free workplace and I agree to comply. By typing your full name, you agree to the above disclaimer.

First Name

Last Name

Date *

Date

YYYY

WORK WITH THE BOYS IN BLUE

Employment Application