86 Walnut Street, Cullman, Alabama 35055
Phone: 1-800-950-0780 or (256) 739-0710, Fax (256) 737-1813

Application for Employment
Equal Opportunity Employer

All statements made by applicants for employment on this application form will be checked for accuracy. We offer equal employment opportunities to all persons without regard to race, color, religion, age, marital or veteran's status, sex, national origin, disability, or any other legally protected status.

PERSONAL

Name, Last: _________________ First: ___________________ Middle: ______________________

Day Phone: ______________________ Evening Phone: ________________ SSN: _______________

CURRENT ADDRESS

Street: __________________________________________________________ Apt. # _____

City: ______________________________________________________ State: ____ Zip Code: ________

How long have you lived at this address? ___ yrs. ___ mo.

If at present address for less than one year, please give previous address.

PREVIOUS ADDRESS

Street: __________________________________________________________ Apt. # _______

City: ______________________________________________________ State: ____ Zip Code: ________

Are you over the age of 18? Yes ___ No ___ If No, employment is subject to verification that you are of minimum legal age.

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? Yes ___ No ___

Can you produce documented proof of your eligibility for employment in the United States? Yes ___ No ___

(Either Driver's License and Social Security Card / Birth Certificate or Immigration and Naturalization Services Documents)

Position(s) Applied For: _________________________________________ How soon could you report to work?: _____________

Type of Employment: Full-Time ___ Part-Time ___ Temporary ___ Rate of pay expected: $_______________________

What days, if part-time? Days: From _________________ To _________________

What hours, if part-time? Hours: From _________ am ___ pm ___ To _________ am ___ pm ___

TRAINING AND EXPERIENCE

EDUCATION

ELEMENTARY

Elementary School: Name and Address _______________________________________________________________________________________________

Did you graduate? Yes ____ Year _________ No ___ Grade Level completed? (Circle One) 5 6 7 8

Type of Degree received? _______________________________________

HIGH SCHOOL

High School: Name and Address _____________________________________________________________________________________________________

Did you graduate? Yes ___ Year _________ No ____ Grade Level completed? (Circle One) 9 10 11 12

Type of Degree received? _______________________________________ Do you have a GED? Yes ___ No ___

COLLEGE

College: Name and Location _________________________________________________________________________________________________________

Did you graduate? Yes ____ Year _________ No ____ Years completed? (Circle One) 1 2 3 4 Higher

Type of Degree or Award received?: _____________________________________________________________________________

EMPLOYMENT HISTORY

Have you applied for a job with us before? Yes ___ No ___ Have you ever worked for us before? Yes ___ No ___

If yes, provide Company Name. ________________________________________________________ Year of Employment ___________

How did you come to apply? (Circle One) Employee Referral Former Employee High School Recruitment College Recruitment

Classified Ad Walk-In Other

If referred by individual, please provide name. __________________________________________________________________________________________

Have you ever been bonded? Yes ___ No ____ Have you ever been refused a bond? Yes ___ No ___

If so, state reason and date of refusal: ___________________________________________________________________________

Have you ever served in the U.S. Armed Forces? Yes ___ No ___ If yes, which branch? _______________________________________

Date entered (mm / yyyy): _____________________________ Date Discharged (mm / yyyy) ________________________

Have you ever been convicted of a violation of the law except a minor traffic violation? Yes ___ No ___

If so, state date, court, and place where offence occurred: ______________________________________________________________

Have you ever been discharged or requested to resign from a position? Yes ___ No ___

Are you currently employed? Yes ___ No ___ If yes, may we contact your present employer? Yes ___ No ___

Why do you desire to make a change? ___________________________________________________________________________

Have you ever held a position of trust (handling money or confidential material)? Yes ___ No ___

If yes, explain: __________________________________________________________________________________________

Do you have any reason to believe that you would have difficulty meeting this company's work schedules? Yes ____ No ____

If your position requires; are you willing to travel? Yes ____ No ____

Are you interested in career work? Yes ____ No ____

CURRENT / PREVIOUS EMPLOYER

Job Title: _______________________________ Company Name: ____________________________________________________________

Address: _____________________________________ City: _____________________________ State: ____ ZIP: _________ Phone: _____________

Date of Employment: (From) ____________________ (To) ___________________ Starting Pay: $______________ Ending Pay: $____________

Supervisor: _________________________________________________ Reason for Leaving: ____________________________________________________

Job Description: ___________________________________________________________________________________________________________________

PREVIOUS EMPLOYER

Job Title: _______________________________ Company Name: ____________________________________________________________

Address: _____________________________________ City: _____________________________ State: ____ ZIP: _________ Phone: _____________

Date of Employment: (From) ____________________ (To) ___________________ Starting Pay: $______________ Ending Pay: $____________

Supervisor: _________________________________________________ Reason for Leaving: ____________________________________________________

Job Description: ___________________________________________________________________________________________________________________

PREVIOUS EMPLOYER

Job Title: _______________________________ Company Name: ____________________________________________________________

Address: _____________________________________ City: _____________________________ State: ____ ZIP: _________ Phone: _____________

Date of Employment: (From) ____________________ (To) ___________________ Starting Pay: $______________ Ending Pay: $____________

Supervisor: _________________________________________________ Reason for Leaving: ____________________________________________________

Job Description: ___________________________________________________________________________________________________________________

PREVIOUS EMPLOYER

Job Title: _______________________________ Company Name: ____________________________________________________________

Address: _____________________________________ City: _____________________________ State: ____ ZIP: _________ Phone: _____________

Date of Employment: (From) ____________________ (To) ___________________ Starting Pay: $______________ Ending Pay: $____________

Supervisor: _________________________________________________ Reason for Leaving: ____________________________________________________

Job Description: ___________________________________________________________________________________________________________________

Please provide any additional information such as special skills, training, management experience, equipment operation, or qualifications you feel will

be helpful to us in considering your application. ____________________________________________________________________________________________

____________________________________________________________________________________________

REFERENCES (Do Not List Relatives Or Former Employers)

Name: ________________________________ Address: ____________________________________________________ Contact Number: _________________

Job Applicant's Agreement and Certification

"I certify that the information given by me in this application is true in all respects, and I agree that if the information given is found to be false in any way, it shall be considered sufficient cause for denial of employment or discharge. I authorize the use of any information in this application to verify my statements, and I authorize past employers, all references, and any other persons to answer all questions asked concerning my ability, character, reputation, and previous employment record. I release all such persons from any liability or damages on account of having furnished such information."

"I understand that nothing contained in this employment application or in the granting of an interview is intended to create an employment contract between the company and myself for either employment or for the providing of any benefit. No promises regarding employment have been made to me, and I understand that no such promise or guarantee is binding upon the company unless made in writing. If an employment relationship is established, I understand that I may have the right to terminate my employment at any time and that the company retains the same right."

"I agree to submit to a physical examination whenever requested, and I understand my becoming employed and / or my continued employment are subject to the results of any physical examination related to my job duties in accordance with company policies and procedures."

"I understand that if employed, policies and rules which are issued are not conditions of employment and that the employer may revise policies or procedures in whole or in part at any time."

"I understand that this application will be kept on active file for 60 days from the date completed, after which time I would have to reapply in accordance with established company procedures."

"By submitting this application I agree to the above statements and verify that all requested information is correct. "

Applicant Signature: _____________________________________ Date: _______________________

Please feel free to fax a resume to
Human Resources at (256) 734-3336

or e-mail info@McGriffindustries.com