Employment Application

General

First Name Middle Name Last Name Email

Phone # Allow texting? Alternate Phone #

Address Line 1 Address Line 2

City

State

Zipcode

Are you 18 or older? Yes No
Have you gone by another name? Yes No If yes, what name(s)
If hired, can you furnish proof that you are eligible to work in the United States? Yes No If no, please explain
Have you ever been discharged from a job? Yes No If yes, please explain all terminations

Employment History

Starting with your most recent employer, give an accurate, full-time and part-time employment record.

1. Employer (most recent)

Company Name Telephone Supervisor's Name & Title Supervisor's Email/Phone (opt.)

Address Line 1 Address Line 2

City

State

Zipcode

Dates Worked (enter today's date as end date if presently employed) to

Describe the work that you did
Reason for leaving
May we contact this employer Yes No If no, why not?

2. Employer

Company Name Telephone Supervisor's Name & Title Supervisor's Email/Phone (opt.)

Address Line 1 Address Line 2

City

State

Zipcode

Dates Worked (enter today's date as end date if presently employed) to

Describe the work that you did
Reason for leaving
May we contact this employer Yes No If no, why not?

3. Employer

Company Name Telephone Supervisor's Name & Title Supervisor's Email/Phone (opt.)

Address Line 1 Address Line 2

City

State

Zipcode

Dates Worked (enter today's date as end date if presently employed) to

Describe the work that you did
Reason for leaving
May we contact this employer Yes No If no, why not?

Your employment application will be considered active for 30 days. To be considered for a job after 30 days, you must reapply.

Applicant Statement

Please read. By clicking submit you agree to the following:

1. I certify that the facts set forth in this application for employment are true and complete.
2. I understand that any false or misleading information or significant omission on this application shall disqualify me from further consideration for employment and shall lead to my dismissal from employment if discovered at a later date.
3. I understand that if I am hired, I must provide appropriate documentation establishing my identity and proof of my legal authorization to work in the United States, as required by U.S. law.
4. I understand that any offer of employment is contingent upon on the passing of a background check and drug test, and that the refusal of cooperation or a failed test may result in the revoking of an employment offer.
5. I understand that this application does not create a contract of employment between Dey Distributing and myself. If hired, I understand that my employment is governed by the responsibilities of the position and that I am obliged to comply with the company’s current and subsequently adopted or modified personnel policies, procedures, and regulations.
6. I understand and agree that if I am hired my employment is at will and is of no definite period of time. It may be terminated at any time for any reason, with or without notice. I understand that no supervisor, manager, or executive of the company, other than the president and when in writing, has the authority to alter these terms.

Employment Application

General

Availability

Employment History

Starting with your most recent employer, give an accurate, full-time and part-time employment record.

Your employment application will be considered active for 30 days. To be considered for a job after 30 days, you must reapply.

Applicant Statement

Please read. By clicking submit you agree to the following: