APPLICATION FOR

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Each inquiry on this application must be fully answered or completed.
Otherwise, you will not be considered for employment.

PERSONAL DATA

Last Name  *
Frist Name  *
Middle Name
Cell Phone  *
Home Phone

Are you 18 years of age or older?

PRESENT ADDRESS

Street  *
Apt/Unit  *
City  *
State  *
Zip Code  *

How long have you live here?

Years  *
Months  *

PREVIOUS ADDRESS

Street
Apt/Unit
City
State
Zip Code

How long have you live here?

Years
Months

CURRENT AND PREVIOUS EMPLOYMENT

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Please list the names of your present and previous employers in chronological order with present or last employer listed first.
Include part-time, seasonal, and all other employment. If self-employed, give the company name and supply business references.

EMPLOYER 1

Company Name

Employed

From
To
Supervisor Name
Job Title
Work Preferred

Salary

Starting
Final

Are you currently working?

Were you ever disciplined?
Reason for Leaving

EMPLOYER ADDRESS

Street
Unit/Bldg
City
State
Zipcode

BACKGROUND INFORMATION

Position Desired(only list one choice)
$ Minimal Acceptable Pay Rate
  • Full-Time
  • Part-Time
  • Temporary
Placement Desired

Are you currently working?

Name Of Employer

How many days of scheduled work did you miss in the last 24 months, not including vacations, holidays, and other approved leave?

No Of Days  *

Please explain fully any gaps in your employment history. Be sure to account for all periods of time including military service and any period of unemployment.

Employment Gap Reasons

List any other names which you may have used and which will be necessary to verify prior to your employment.

List Of Names

If hired, when can you start?

Start Date  *

If hired, can you provide proof that you are legally entitled to work in the U.S.?

What steps must be taken for you to begin employment lawfully?

Have you ever been terminated or asked to resign from any job?

Please Explain circumstances

May we contact your current employer?

Please explain reasons

Can you perform the essential functions of the job for which you are applying, either with or without reasonable accommodation?

Have you ever worked for Millennium Mat Company, LLC or for a related entity?

Please give dates,position,location and reason for leaving

Do you have any friends or relatives working for Millennium Mat Company, LLC or for a related entity?

Please give name(s),relationship and location

How were you referred to us?

Please describe

If another employee prompted your application, please give the employee's name and office location

Employee's name and office loaction

Do you have any commitments to any other employer which could affect your employment with Millennium Mat Company, LLC if hired (for example, an employment agreement, a non-competition, or non-solicitation agreement, etc.)?

Please explain

CRIMINAL HISTORY

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Applicants: Do not disclose any conviction which has been sealed, expunged, or statutorily eradicated.
Do not disclose a conviction for which a court has granted you First Time Offender status.

Have you ever plead no contest, nolo contendere, guilty, or been convicted of a crime?

Please provide the nature of the crime(s),when and where the crime(s) occurred and dispoisition of the case(s)

Do you have any current charges pending against you that could result in the conviction of a criminal offense?

Please provide the nature of the charge(s),when and where the charge(s) are pending and current status od charge(s)

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Answering "Yes" to either of the above questions does not constitute an automatic bar to employment.

The Company will consider the nature of the crime, its seriousness, the substantial relation to the positions functions and qualifications, the number of occurrences, the applicant's age at the time of the crime, the time elapsed since the crime, the applicant's entire work and educational history, employment references and recommendations, and the business necessity of any exclusion when required by law.

EDUCATION

Years Completed School Name & Location Course of Study or Major Specialized Experience, Training, Skills and Extra Curricular Activites
High School
College/University
Graduate/Professional
Trade or Correspondence

OTHER INFORMATION

Briefly describe your qualifications for this position and any special skills or experience you possess which will be of special benefit in the position for which you are applying

Please Describe

List any professional or occupational registration, licensure, or certification you currently hold which may be applicable

Please Describe

Please provide any other information or comments, or describe any other experience that you have which would be relevant to the job for which you are applying

Please Describe

Please describe both your immediate and long term career goals

Please Describe

Are you fluent in more than one language, If so, which one(s)?

Please Describe

DRIVING INFORMATION

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Complete only if driving is an essential function of the job for which you are applying.

Do you have a current valid driver's license?

License Number
State
Exp Date
If you do not have a driver's license for the state in which you currently reside,why note?

Has your license ever been suspended or revoked?

License Number

Do you have personal automobile insurance?

Please Explian

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Please make sure that you correctly filled all required fields.

2018 MILLENNIUM MATS COMPANY, LLC