School Nameand Add ress
Dates Attended
From______To______
Graduate?
锟0/span>
锟0/span>
Yes 锟伙炕 No
Give Degree
Major Subject
Mo. Yr. Mo. Yr.
High School
College
College
Graduate
School
Business
Trade, Other
APPLICATION FOR EMPLOYMENT
If you require accommodation in order to participate in the application process, please notify
Human Resources at 360-456-1880.
Qualified applicants receive consideration for employment without discrimination because of sex,
marital status, race, color, creed, religion, veteran status, sexual orientation, national origin, age,
the presence of a disability, or any other basis protected by federal, state or local law.
Conditions of employment are stated at the end of this form. Please read carefully before you
sign this application. False statements on this application form shall be considered reason for
termination.
An Equal Opportunity Employer
(PLEASE PRINT LEGIBLY)
WA Revised 9/07
Last
Street
Street
City
City
State
State
Zip
Phone No.
First
Initial
Nam e___________________________________________________________________Date:___________________________
Present Address____________________________________________________________________ (_____)_______________
Previous Address_________________________________________________________________________________________
Position or type of employment desired:_______________________________________________________________________
Available for: Full Time_____________Part Time_____________Temporary_____________Date Available:______________
Rate of Pay Expected:________________________________Social Security Number__________________________________
Why would you like to work in building materials retailing? _____________________________________________________________
____________________________________________________________________________________________________________
Why are you interested in working for Lumbermens?__________________________________________________________________
____________________________________________________________________________________________________________
Please describe what type of work you like best:_____________________________________________________________________
____________________________________________________________________________________________________________
Can you perform the essential functions of the job for which you are applying, with or without reasonable accommodation?
Yes 锟伙炕No 锟0/span>
If necessary, can you work evenings and/or weekends? Yes 锟0o 锟伙炕
Are you 18 years of age or over? Yes 锟0o 锟0/span>
Do you possess a valid driver's license? Yes 锟0o 锟伙炕License Number:______/_____________________________________________
Do you have a Commercial Driver's License? Yes 锟0o 锟伙炕
Have you been convicted or pled guilty, no contest, nolo contendere or entered an "Alford Plea" to a criminal offense? Yes 锟0o 锟0/span>
If yes, indicate the nature of offense, date, court & disposition.
(A conviction will not necessarily disqualify an applicant from employment. )
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Are you prevented from being employed in the United States because of visa or immigration status? Yes 锟0o 锟0/span>
Have you ever worked for a Lanoga/Pro-Build company? Yes 锟0o 锟伙炕锟0/span>
This information will assist in calculating years of service for Pension and 401K.
EDUCATION
PLEASE COMPLETE REVERSE SIDE
State
Do you plan further education? Yes 锟0o 锟0/span>
SKILLS (Please check all that apply)
If yes, please explain______________________________________
______________________________________________________
EMPLOYMENT HISTORY - List previous employers (10 years) starting with most recent (Attach separate sheet if necessary)
锟0ASH REGISTER 锟0YPING - WPM________
锟0ATA ENTRY
锟0ORD PROCESSING
锟0EN KEY BY TOUCH 锟0THER______________
COMPANY NAME & ADDRESS: ____________________________________________________________________________
Employed: From ________ To ________ Salary: Start ___________ Last ___________ Name and title of
Position: Start __________________________ Last ____________________________ Immediate Supervisor: _____________
Main Duties: ____________________________________________________________________________________________
Reason for leaving: ______________________________________________________ Phone (____)_____________________
Mo. Year
Mo. Year
COMPANY NAME & ADDRESS: ____________________________________________________________________________
Employed: From ________ To ________ Salary: Start ___________ Last ___________ Name and title of
Position: Start __________________________ Last ____________________________ Immediate Supervisor: _____________
Main Duties: ____________________________________________________________________________________________
Reason for leaving: ______________________________________________________ Phone (____)_____________________
Mo. Year
Mo. Year
COMPANY NAME & ADDRESS: ____________________________________________________________________________
Employed: From ________ To ________ Salary: Start ___________ Last ___________ Name and title of
Position: Start __________________________ Last ____________________________ Immediate Supervisor: _____________
Main Duties: ____________________________________________________________________________________________
Reason for leaving: ______________________________________________________ Phone (____)_____________________
Mo. Year
Mo. Year
COMPANY NAME & ADDRESS: ____________________________________________________________________________
Employed: From ________ To ________ Salary: Start ___________ Last ___________ Name and title of
Position: Start __________________________ Last ____________________________ Immediate Supervisor: _____________
Main Duties: ____________________________________________________________________________________________
Reason for leaving: ______________________________________________________ Phone (____)_____________________
Mo. Year
Mo. Year
COMPANY NAME & ADDRESS: ____________________________________________________________________________
Employed: From ________ To ________ Salary: Start ___________ Last ___________ Name and title of
Position: Start __________________________ Last ____________________________ Immediate Supervisor: _____________
Main Duties: ____________________________________________________________________________________________
Reason for leaving: ______________________________________________________ Phone (____)_____________________
List periods of unemployment for more that 30 days
Dates: From_________To________ Please explain ____________________________________________________________
Dates: From_________To________ Please explain ____________________________________________________________
Mo. Year
Mo. Year
Signature of Applicant__________________________________________________________Date:_______________________________________________
PLEASE NOTE: Applicant agrees to the following conditions of employment.
I certify that the information given by me to Lumbermens is true and complete to the best of my knowledge. I understand that if I am employed, discovery that I gave false, misleading or incomplete
information during the application process may result in immediate dismissal.
I further certify that I am not engaged in any outside activity or business that could be considered in conflict with Lumbermens' interest or those of its customers, nor will I become engaged in such activity
or business if employed.
I hereby give Lumbermens and its agents the right to verify all data given in this application and during the interview/application process; to investigate my past employment, activities and other personal
background information as they deem appropriate. I understand that this may include, but is not limited to, obtaining driving records, consumer reports, credit checks and other references; interviewing past
employers, managers and co-workers; obtaining educational transcripts and conducting criminal background checks. I authorize all individuals, schools, firms, agencies and employers to release all
requested information and documents. I release Lumbermens and its agents, and the persons and entities who provide information to them, from all claims, liability and damages, including attorneys' fees
and costs, arising out of the provision of information or documents as authorized by this paragraph. If employed, I release Lumbermens from any liability for future references it may provide regarding my
work history at Lumbermens.
If hired, in consideration of my employment, I agree that my employment and compensation can be terminated with or without cause, and with or without notice at any time, at the option of either
Lumbermens or myself. If hired, I will receive a copy of the Lumbermens Employee Handbook and agree to read it fully. I understand that neither the Employee Handbook nor any other communication by
any representative of Lumbermens, has any authority to enter into any agreement for employment for any specified period of time, to create any contract of employment, or to make any agreement contrary
to the foregoing.
If employed, I further agree that if Lumbermens advances any paid leave to me before it has been earned or accrued, overpays me, advances or loans me money, or if through my dishonest or willful act, I
lose, damage or fail to return any Lumbermens property, my signature on this application is my authorization to Lumbermens to deduct from my wages, or any other amounts Lumbermens may owe me,
sufficient funds to repay such loans or advances or to replace its property.
If a conditional job offer is extended to me, I understand that I will be required to submit to a drug test within 24 hours of being notified. Lumbermens actively and proudly promotes a safe, drug and alcohol
free workplace. As a condition of employment, all employees are subject to random, post-accident and reasonable suspicion drug and alcohol testing, if allowed by state law.
Revised date: 09/2007
Disclosure and Authorization of Consumer Report
for Employment Purposes
Washington State Only
The undersigned applicant/employee is hereby notified that Lumbermens may obtain a "consumer report" and/or
"investigative consumer report" through a "consumer reporting agency" ("CRA") for purposes of considering the
applicant for employment, and/or, if hired, for promotion, reassignment, retention or other employment-related
purposes. The Fair Credit Reporting Act defines these terms and applies to you, a "consumer" with rights under both
the federal Fair Credit Reporting Act and the state Fair Credit Reporting Act (collectively "FCRA").
Such reports may include information as to character, general reputation, history of criminal convictions, employment,
education, professional license and/or credit record history. Credit record history checks are only obtained where the
credit information is substantially related to the candidate's or employee's job duties. If requested, the information
contained in such a credit report is required by Lumbermens because you have applied for, or occupy, a position that
deals with money or occupies a position of trust in handling funds and accounts.
Under the FCRA, if information in a consumer and/or investigative consumer report is relied on to make an adverse
employment decision, before the decision is final you will be provided with a copy of the report, the name, address and
telephone number of the CRA, and a description of your rights under the FCRA.
If an investigative consumer report is requested, applicant/employee acknowledges that he/she may request in writing,
within a reasonable period of time after receiving this notice, a complete and accurate disclosure of the nature and
scope of such report. Such disclosure will be mailed or otherwise delivered to applicant within five days from the date
of the applicant/employee's request for disclosure.
AUTHORIZATION
As confirmed by my signature below, I hereby voluntarily authorize Lumbermens to obtain a "consumer
report" and/or "investigative consumer report" about me for the purpose of evaluating me for employment,
promotion, reassignment, retention or other employment-related purpose. I understand that I have rights
under the FCRA.
Signature: Date: _____/____/_____
Position Applying for: ____________________________________ Branch #: _____________________
Print Full Name:
Former Name/Maiden Name (list all):
Address:
City: State: Zip:
Previous Address:
City: State: Zip:
In order for factual information to be obtained & reported, your date of birth and social security number are requested.
This information is used solely for verification purposes in compliance with the Fair Credit Reporting Act.
Social Security Number: -- -- Date of Birth: _____/____/_____
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