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Hardware Specialty

* denotes a required field

Date of Application:

August 7, 2008

Position Applied For:

Location:

Referral Source:

Name of Source
(if applicable):

*First Name:

*Last Name:

Middle Initial:

Street Address:

Address (cont):

City:

State/Province:

Zip/Postal Code:

Country:

*E-Mail Address:

Work Phone:

Home Phone:

May we contact you at work?

Yes No

If you are under 18, can you furnish a work permit?

Yes No Not Applicable

Have you filed an application here before?

Yes No

If yes, when?

-- mm/dd/yy

*Are you legally eligible for employment in this country?

Yes No

Date available for work:

-- mm/dd/yy

*Will you relocate if required?

Yes No

*Will you travel if job required?

Yes No

Are you on lay-off and subject to recall?

Yes No

*Have you been convicted of a felony in the past 7 years?

Yes No

If yes, please explain:

Employment Experience:

Employer 1:
Address:
Telephone:
Job Title:
Work Performed:
Length of Service:	Starting Date: Ending Date:
Reason for Leaving:
Ending Salary $:
May we contact them? :	Yes No

Employer 2:
Address:
Telephone:
Job Title:
Work Performed:
Length of Service:
Reason for Leaving:
Ending Salary $:
May we contact them? :	Yes No

Employer 3:
Address:
Telephone:
Job Title:
Work Performed:
Length of Service:
Reason for Leaving:
Ending Salary $:
May we contact them? :	Yes No

Please list any special skills and/or qualifications:

Is there any reason known to you why you might be unable to perform consistently and promptly any of the job duties?

Yes No

If hired, could you give written evidence of a right to work in this country?

Yes No

Send Resume :

I will include my resume as a PDF or Word Document

Additional Comments:

I certify that answers given herein are true and complete to the best of my knowledge. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision.

I hereby authorize Hardware Specialty Co., Inc. to contact prior employers (if checked above) to obtain any and all information related to my past work performance. I understand and agree that any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination from employment.

We consider applicants for all positions without regard to race, color, religion, sex, national origin, age, marital or veteran status, the presence of a non-job related medical condition or handicap, or any other legally protected status.