Employment

Applicant Information

Applicant Name:

Address:

City, State and Zip Code:

Telephone Number:

Email Address:

Employment Position

How did you hear about this position?

What days are you available for work?

On what date can you start working if you are hired?

Do you have reliable transportation to and from work?

Salary desired:

Personal Information

Do you have any friends, relatives, or acquaintances working for Furniture Medic If yes, state name & relationship:
YesNo

Are you 18 years of age or older?
YesNo
Are you a U.S. citizen or approved to work in the United States? What document can you provide as proof of citizenship or legal status?
YesNo

Will you consent to a mandatory controlled substance test?
YesNo
Do you have any condition which would require job accommodations? If yes, please describe accommodations required below
YesNo

Have you ever been convicted of a criminal offense (felony or misdemeanor)? If yes, please state the nature of the crime(s), when and where convicted and disposition of the case:
YesNo

Job Skills/Qualifications

Please list below the skills and qualifications you possess for the position for which you are applying:

Education and Training

High School

College/University

Vocational School/Specialized Training

Military:
Are you a member of the Armed Services?

Previous Employment

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

Employer Name:

Job Title:

Supervisor Name:

Employer Address:

City, State and Zip Code:

Employer Telephone:

Dates Employed:

Reason for leaving:

AT-WILL EMPLOYMENT

The relationship between you and the Furniture Medic is referred to as "employment at will." This means that your employment can be terminated at any time for any reason, with or without cause, with or without notice, by you or the Furniture Medic. No representative of Furniture Medic has authority to enter into any agreement contrary to the foregoing "employment at will" relationship. You understand that your employment is "at will," and that you acknowledge that no oral or written statements or representations regarding your employment can alter your at-will employment status, except for a written statement signed by you and either our Executive Vice-President/Chief Operations Officer or the Company's President

Δ