Application For
Employment
We Conduct Drug Testing
Pre-Employment & Post Offer,
Random Testing and Post Accident
An Equal
Opportunity
Employer
Date:__________________________ Social Security Number:____________________________
Full Name:______________________________________________________________________
Check if you are 18 [ ] U.S. Citizen:___________ Phone Number:_________________________
Present Address:__________________________________________________________________
Permanent Address ( if different from present ):______________________________________________
Type position desired:__________________________ Weekly Salary Expected:_______________
(Negotiable [ ]Yes [ ]No)
Date available for work:____________________________________________________________
Educational History : Number of years attended Major Subjects ( optional )
( Name and location of school )
High School:_____________________________________________________________________
Trade or Business School:___________________________________________________________
College:_________________________________________________________________________
Other:__________________________________________________________________________
Specific job requirements : ( Complete only if applicable to position desired )
Truck Driver Experience [ ]Yes [ ]No How long?_______ C.D.L. [ ]Yes [ ]No
Fork Lift Experience [ ]Yes [ ]No Handling what type of materials?_____________________
Sales Experience [ ]Yes [ ]No How long?_________ Were "cold calls" required?__________
Computer Experience [ ]Yes [ ]No How long?_________
Software Experience (list types):______________________________________________________
Have you ever been convicted of a felony; or, within the past five years, of a misdemeanor other
than a minor traffic violation? [ ]Yes [ ]No
If yes, give details, including type of crime, date, court and sentence.__________________________
_______________________________________________________________________________
Any current Military Reserve commitment? ____________________________________________
20 WESTOVER HILLS BLVD.
RICHMOND, VIRGINIA 23225
PHONE (804) 233-4351
8305 JEFFERSON DAVIS HWY.
FREDERICKSBURG, VIRGINIA 22407
PHONE (866) 233-4351
www.southsidebuilders.com
PDF APPLICATION
Employment History : Give accurate and complete employment record, beginning with present and continuing
consecutively through three most recent employers. (Include military service, if any, as a former employer.)
1. Firm name:________________________________ Address:_______________________________________
Type of business:_____________________________________________________________________________
Employed from (month and year):_______ to _______ Weekly salary beginning: ________ ending: __________
Job title:__________________________ Full time:___________________ or Part time:_____________________
Describe your duties:__________________________________________________________________________
Immediate supervisor, name and title:______________________________________________________________
Why did you leave?____________________________________________________________________________
2. Firm name:________________________________ Address:_______________________________________
Type of business:_____________________________________________________________________________
Employed from (month and year):_______ to _______ Weekly salary beginning: ________ ending: __________
Job title:__________________________ Full time:___________________ or Part time:_____________________
Describe your duties:__________________________________________________________________________
Immediate supervisor, name and title:______________________________________________________________
Why did you leave?____________________________________________________________________________
3. Firm name:________________________________ Address:_______________________________________
Type of business:_____________________________________________________________________________
Employed from (month and year):_______ to _______ Weekly salary beginning: ________ ending: __________
Job title:__________________________ Full time:___________________ or Part time:_____________________
Describe your duties:__________________________________________________________________________
Immediate supervisor, name and title:______________________________________________________________
Why did you leave?____________________________________________________________________________
Which job did you like best and why?_____________________________________________________________
Give at least three references other than relatives or former employers:
Name Address Occupation Phone Number Number of years known
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Remarks :
Please add any information that may serve to clarify any of your foregoing statements, or that you feel may
assist us in evaluating your application. Such information might include college degrees, related trade background, awards, etc.
________________________________________________________________________________________
________________________________________________________________________________________
IMPORTANT COMPANY POLICIES AND PROCEDURES: It is the policy of this company not to discriminate in its employment and personnel practices
because of a person's race, color, creed, religion, sex, national origin, age, or disability.
EMPLOYMENT UNDERSTANDING: This application is made with the understanding that any resulting employment is based on the truthfulness of my
answers to all the questions; any untruth is grounds for immediate dismissal. Furthermore, I agree to give 15 days notice before leaving the company's employ.
Signature of Applicant:
Southside Builders Supply Corporation is an equal opportunity employer.
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