Employment Application

BR Supply, Inc. Welcomes You!

We are an Equal Opportunity Employer.

We consider applicants for all positions without regard to race, color, creed, religion, sex, national origin, age, marital or veteran status, the presence of a non-job-related medical condition or handicap, and any other legally protected status. It is our policy to abide by all federal, state and local laws concerning discrimination in employment. No question in this application is intended to elicit information in violation of any such law nor will any information obtained in response to any question be used in violation of any such law.

Personal Information

Last Name:

First Name:

Middle Name/Initial:

Street Address:

City:

State:

Zip Code:

Phone:

Email Address:

Social Security Number (this field is protected upon submission):

Are you 21 years old or older? Yes No

Emergency Contact:

Emergency Contact Phone Number:

Wages Expected:

Date Available To Start Work:

Employed Now? Yes No

Work Options:

Full Time

Part Time

Position Applying For:

Are you applying for a position in a specific location? Yes No

If yes, which location?

Education and Training

High School

Name and Location of School:

Course Of Study:

Number of Years:

Did You Graduate? Yes No

List the diploma or degree received:

GED Yes No

College Or University

Name and Location of School:

Course Of Study:

Number of Years:

Did You Graduate? Yes No

List the diploma or degree received:

Trade School

Name and Location of School:

Course Of Study:

Number of Years:

Did You Graduate? Yes No

List the diploma or degree received:

List any other education, training, special skills or certificates/licenses that you possess:

List any machines or equipment that you are qualified and experienced at:

Drivers License Information

Type of License Held (commercial, passenger, etc.):

Driver's License Number (this field is protected on submission):

License Expiration Date:

Issuing State

Please list any traffic offenses and dates: (500 chars left)

I authorize BR Supply Inc. to check my driving history: Yes No

Have you had any other experiences or qualifications in addition to those indicated above which relate to this job for which you are applying? If so, describe:

References

List business persons known, but not related to you, other than listed above.

Name:

Title:

Business:

Phone:

Years Known:

Name:

Title:

Business:

Phone:

Years Known:

Name:

Title:

Business:

Phone:

Years Known:

Name:

Title:

Business:

Phone:

Years Known:

Additional Employment Related Information

List any relatives or friends working for this organization:

Name:

Relationship:

Name:

Relationship:

Can you verify your legal right to work in the U.S. by providing a birth certificate, proof of U.S. Citizenship, or by some other means (Proof of U.S. Citizenship or immigration status is required upon employment): Yes No

Have you been convicted of a crime in the past 7 years which has not been annulled, expunged or sealed by a court? Yes No

If yes, please describe:

Are you able to perform the job(s) for which you are applying? Yes No

If no, please explain

NOTE: 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.

Additional Remarks:

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 BR Supply, Inc. to verify their accuracy and to obtain reference information on my work performance. I hereby release BR Supply, Inc. 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 my driver's license history and credit history may be reviewed. By signing, I authorize BR Supply, Inc. to verify my driver's license history and credit rating and history.

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 BR Supply, Inc. 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 that either I or BR Supply, Inc. may terminate my employment at any time with or without notice or cause.

By checking this box and typing my name below, I certify the above:

Applicant Name:

Thank you for your submission!

We acknowledge receipt of your application for a position at BR Supply Inc., and sincerely appreciate your interest in our company.

We will screen all applicants and select candidates whose qualifications meet our needs. We will carefully consider your application during the initial screening and will contact you if you are selected to continue in the recruitment process.

Employment Application

Personal Information

Education and Training

Experience

List present and former employers.

References

List business persons known, but not related to you, other than listed above.

Additional Employment Related Information

List any relatives or friends working for this organization:

Thank you for your submission!

We acknowledge receipt of your application for a position at BR Supply Inc., and sincerely appreciate your interest in our company.

We will screen all applicants and select candidates whose qualifications meet our needs. We will carefully consider your application during the initial screening and will contact you if you are selected to continue in the recruitment process.

BR SUPPLY

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