Employment Application

This is your form description. Click here to edit.

Bush Supply is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.
PERSONAL
Last Name
First Name
Middle Initial
Date / MM / DD YYYY
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Position Sought
Full Time/ Part Time Full Time Part Time
Date Available / MM / DD YYYY
Salary Desired
Phone Number - (###) - ### ####
Social Security Number
Are you over 18 years old?
Are you legally eligible for employment in the United States? (If offered employment, you will be required to provide documentation to verify eligibility.)
EDUCATION Please indicate education or training which you believe qualifies you for the position you are seeking.
High School
Number of years completed
Diploma
G.E.D.
School(s)
City/ State
College and/or Vocational School
Number of Years Completed
School(s)
City/ State
Major
Degree Earned
Other Training or Degrees
School(s)
City/ State
Course
Degree or Certificate Earned
PROFESSIONAL LICENSE OR MEMBERSHIP
Type of License(s) Held
State and License Number
License Expiration Date / MM / DD YYYY
Other Professional Memberships
(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other projected status.)
SKILLS
Office
Data Entry
Excel
Typing
Words per Minute
Lotus
CRT
Other
Word Processing
Word
MS Word
Other
Other Software Skills
Have you ever been employed in any facility of Bush Supply?
If so, name and location, and dates of employment
RECORD OF CONVICTION
During the last ten years, have you ever been convicted of a crime other than minor traffic offense?
If yes, explain
(A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)
EMPLOYMENT List last employer first, including U.S. Military Service.
May we contact your present employer?
If any employment was under a different name, indicate name
Employer
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Telephone - (###) - ### ####
Position
Dates of Employment
From / MM / DD YYYY
To / MM / DD YYYY
Salary
Supervisor
Department
Duties
Full Time/ Part Time
Number of Hours
Reason for Leaving
Employer
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Telephone - (###) - ### ####
Position
Dates of Employment
From / MM / DD YYYY
To / MM / DD YYYY
Salary
Supervisor
Department
Duties
Full Time/ Part Time
Number of Hours
Reason for Leaving
Employer
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Telephone - (###) - ### ####
Position
Dates of Employment
From / MM / DD YYYY
To / MM / DD YYYY
Salary
Supervisor
Department
Duties
Full Time/ Part Time
Number of Hours
Reason for Leaving
Have you ever been discharged or asked to resign from a job?
If yes, explain
REFERENCES
Professional
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Personal
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Name First Last
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
APPLICANT'S CERTIFICATION AND AGREEMENT I hereby certify that the facts set forth in the above employment application are true and complete to the best of my knowledge and authorize Bush Supply to verify their accuracy and to obtain reference information on my work performance. I hereby release Bush Supply from any/all liability of whatever kind and nature which, at any time, could result from obtaining and having an employment decision based on such information. I understand that, if employed, falsified statements of any kind or omissions of facts called for on this application shall be considered sufficient basis for dismissal. I understand that should an employment offer be extended to me and accepted that I will fully adhere to the policies, rules and regulations of employment of the Employer. However, I further understand that neither the policies, rules, regulations of employment nor anything said during the interview process shall be deemed to constitute the terms of an implied employment contract. I understand that any employment offered is for an indefinite duration and at will and that either I or the Employer may terminate my employment at any time with or without notice or cause. I understand that the Company requires the successful completion of a urinalysis for drug testing purposes and/or a blood alcohol test as a condition of employment. By submitting this Application for Employment, I hereby consent to either or both of said tests, at the Company’s discretion.

Want to learn more about Bush Supply Inc? Click here!

Employment Application

Employment Application

Bush Supply is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, or veteran status.

PERSONAL

EDUCATION Please indicate education or training which you believe qualifies you for the position you are seeking.

High School

College and/or Vocational School

Other Training or Degrees

PROFESSIONAL LICENSE OR MEMBERSHIP

(You need not disclose membership in professional organizations that may reveal information regarding race, color, creed, sex, religion, national origin, ancestry, age, disability, marital status, veteran status or any other projected status.)

SKILLS

Office

Word Processing

RECORD OF CONVICTION

(A conviction will not necessarily automatically disqualify you for employment. Rather, such factors as age and date of conviction, seriousness and nature of the crime, and rehabilitation will be considered.)

EMPLOYMENT List last employer first, including U.S. Military Service.

Dates of Employment

Dates of Employment

Dates of Employment

REFERENCES

Professional

Personal