APPLICATION FOR EMPLOYMENT

Name

Last

First

Middle

Maiden

Present Address

Address

City

State  Alabama Alaska Arkansas Arizona California Colorado Conneticut Delaware D.C. Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip

How long have you lived there?

Telephone

Social Security No.

If under 18, please list age

Work Preferences

Position applied for               Potential Paint Subcontractors Salary desired (be specific)   How many hours can you work weekly?   Can you work nights?     yes     no Employment desired      full time     part time     either When available for work?

Days/hours available to work No Preference Thursday Monday Friday Tuesday Saturday Wednesday Sunday

Education

	NAME OF SCHOOL	LOCATION (complete mailing address)	NUMBER OF YEARS COMPLETED	MAJOR & DEGREE
High school
College
Business or trade school
Professional school

Have you ever been convicted of a crime?     no     yes

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.
Do you have a medical condition that would prevent you from performing your duties as a painter?     no     yes

Driver's License

Do you have a driver's license?     yes     no

What is your means of transportation to work?

Driver's license #

State of Issue Alabama Alaska Arkansas Arizona California Colorado Conneticut Delaware D.C. Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Operator     Commercial (CDL)     Chauffeur

Expiration Date

Have you had any accidents during the past three years?     yes     no

How many?

Have you had any moving violations during the past three years?     yes     no

How many?

References	Please list two references other than relatives or previous employers.
	Name		Name
	Position		Position
	Company		Company
	Address		Address
	Phone		Phone

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for the specific position for which you are applying.

Military	Have you ever been in the armed forces?     yes     no
	Are you now a member of the National Guard?     yes     no
	Specialty	Date entered	Discharge date

Work Experience

Please list your work experience for the past five years, beginning with your most recent job held. If you were self-employed, give firm name.

	Name of employer	Address

Phone

Name of last supervisor

Your last job title

Employment dates     From     To

Pay or salary     Start  $   Final  $

	Reason for leaving (be specific)
	List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

	Name of employer	Address

Phone

Name of last supervisor

Your last job title

Employment dates     From     To

Pay or salary     Start  $   Final  $

	Reason for leaving (be specific)
	List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

	Name of employer	Address

Phone

Name of last supervisor

Your last job title

Employment dates     From     To

Pay or salary     Start  $   Final  $

	Reason for leaving (be specific)
	List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
	May we contact your present employer?     yes     no

Did you complete this application yourself?     yes     no              If not, who did?  

APPLICATION FORM WAIVER
PLEASE READ CAREFULLY

In exchange for the consideration of my job application by Dunkman Paint & Wallcovering, LLC (hereinafter called "the Company"), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of Dunkman Paint & Wallcovering, LLC or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company.

Both the undersigned and Dunkman Paint & Wallcovering, LLC may end the employment relationship at any time, without specified notice or reason.

If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job-related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of Ninety (90) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.


I agree to the above statment


This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.