APPLICATION FOR EMPLOYMENT	
		
	DATE 		
Name 		
	Last 			First 			Middle 			Maiden	
Present address 		
			Number			Street		City	State	Zip	
How long at this address		Social Security No. _______ –  _____  –  _________	
Telephone (      )		
If under 18, please list age 		

Position applied for  (1)	
	Days/hours available to work
No Pref 	  Thur 	
Mon 	  Fri 	
Tue 	  Sat 	
Wed 	  Sun 		
How many hours can you work weekly? 	  Can you work nights? 		
Employment desired	FULL-TIME ONLY	  PART-TIME ONLY	    FULL- OR PART-TIME	
When available for work?	 	
	
TYPE OF SCHOOL	NAME OF SCHOOL	LOCATION
(Complete mailing address)	NUMBER OF YEARS COMPLETED	MAJOR & DEGREE	
High School					
					
College					
					
Bus. 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. 		

Please note that conviction of a crime does not automatically disqualify a candidate from consideration for employment with Weiss Bros. of Hagerstown, Inc.. 	

APPLICATION FOR EMPLOYMENT

DO YOU HAVE A DRIVER’S LICENSE?	 Yes	 No	
What is your means of transportation to work? 		
Driver’s license 
number 	 State of issue  _______         Operator      Commercial (CDL)     Chauffeur	
Expiration date 		
Have you had any accidents during the past three years?	How many? 		
Have you had any moving violations during the past three years?	How Many? 		
	
Please list two references other than relatives or previous employers.	
Name 		Name 		
Position 		Position 		
Company 		Company 		
Address 		Address 		
						
Telephone  (      )		Telephone  (      )		

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.  Attach additional sheets if necessary.	

Name of employer 
Address	
Name of last supervisor	
Employment dates	
Pay or salary	

City, State, Zip Code
Phone number	
	
From:
To:	
Start:
Final:	

Your last job title:	

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.	

	

	

	APPLICATION FOR EMPLOYMENT		
		
Name of employer 
Address	Name of last supervisor	Employment dates	Pay or salary	
City, State, Zip Code
Phone number		From:
To:	Start:
Final:	
	Your Last Job Title:	
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	Name of last supervisor	Employment dates	Pay or salary	
City, State, Zip Code
Phone number		From:
To:	Start:
Final:	
	Your last job title:	
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	Name of last supervisor	Employment dates	Pay or salary	
City, State, Zip Code
Phone number		From:
To:	Start:
Final:	
	Your last job title:	
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? 		

PLEASE READ CAREFULLY	

APPLICATION FORM WAIVER
	
In exchange for the consideration of my job application by Weiss Bros. of Hagerstown, Inc. (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 Weiss Bros. of Hagerstown, Inc., 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 Owner of the Company.  Both the undersigned and Weiss Bros. of Hagerstown, Inc. 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.	

Signature of applicant__________________________________________ Date: ___________________ 

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.
	
	Thank you for completing this application form and for your interest in our business.