National Vendor is an equal opportunity employer. All qualified applicants will be considered without regard to race, color, creed, religion, gender (including pregnancy, childbirth or related medical conditions), national origin, ancestry, age, physical or mental disability, medical condition including genetic characteristics, family-care status, veteran status, marital status or sexual orientation, or any other consideration made unlawful by federal, state, or local laws. This also includes a perception that anyone has any of those characteristics, or is associated with a person who has or is perceived as having any of those characteristics. National Vendor also makes reasonable accommodations for disabled employees. California is an "at-will" employment state, meaning that any future employment will be on an at-will basis and you or National Vendor can terminate the employment relationship at any time.


APPLICATION FOR EMPLOYMENT

Last Name First Name Middle Name E-Mail

Present Street Address
City State Zip

Phone Number Work Number

Job Code Applied for Salary Desired

How many hours can you work weekly? Can work nights What date can you start work?

Employment Desired:



Education (Do not need to fill out if this information is on your resume)

High School Location
Major/Degree Years Completed

College Location
Major/Degree Years Completed

Business or Trade School Location
Major/Degree Years Completed

Professional School Location
Major/Degree Years Completed

Have you ever worked or attended school under a different name?
If yes, please provide that name

Are you under 18 years old?
If yes you will be asked for a copy of your work permit

If you were offered a position, do you have the legal right to work in the United States?

Have you ever been convicted of a felony?
If yes, please explain number of conviction(s), nature of offense(s) leading to conviction(s),
how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation.


Work Experience (Do not need to fill out if this information is on your resume)

Please list your work experience for the past five years beginning with your most recent job held. If you were self-employed, give firm name.


Name of Employer Phone Number
Present Street Address
City, State, Zip
Start Date End Date
Beginning Salary Ending Salary
Your Last Job Title Name & Phone of Last Supervisor
May we contact this employer?
Specific Reason for Leaving
List job duties, skills used or learned, advancements or promotions while you worked at this company.



Name of Employer Phone Number
Present Street Address
City, State, Zip
Start Date End Date
Beginning Salary Ending Salary
Your Last Job Title Name & Phone of Last Supervisor
May we contact this employer?
Specific Reason for Leaving
List job duties, skills used or learned, advancements or promotions while you worked at this company.



Name of Employer Phone Number
Present Street Address
City, State, Zip
Start Date End Date
Beginning Salary Ending Salary
Your Last Job Title Name & Phone of Last Supervisor
May we contact this employer?
Specific Reason for Leaving
List job duties, skills used or learned, advancements or promotions while you worked at this company.



Did you complete this application yourself?
If not then who did?


References (Do not need to fill out if this information is on your resume)

Please list at least three individuals qualified to give an opinion of youor professional work ability and work experence. Two out of three should be previous supervisors.

Name Relationship
Employer Phone



Name Relationship
Employer Phone



Name Relationship
Employer Phone


Please Read the Following Carefully Before Signing
Note: It is the practice of National Vendor to maintain a safe, and efficient working environment. As part of this practive, we conduct background investigations. In addition, if hired, you must furnish proof of your authorization to work in the United States as specified under applicable U.S. Immigration Laws. One of these documents must be photo identification. If you are employed by National Vendor, you understand and agree that your employment is on an "at will" basis and may be terminated with or without cause, with or without notice at any time, at the option of either National Vendor or yourself. You understand that as a condition of employment all applicants will be asked to sign a confidentiality disclosure agreement. Failure to sign or abide by such agreement(s) may result in dismissal.


Please insert your initials in the appropriate space below if you understand and agree to the following:

  I certify that the answers I have given to the foreging questions and statements (including any information on my resume) are true and correct, without mental reservation of any kind, and I authorize National Vendor to verify them.

  If I obtain employment resulting from this application, I agree to comply with all orders, rules, and regulations of National Vendor.

  I authorize National Vendor to conduct reference checks from my former employers and authorize all educational institutions to give transcripts of my records and grades. I release them and their organizations from all liability for any damage whatsoever for issuing same.

  If hired, a copy of my most recent payroll check stub and evidence of my highest education degree may be required prior to start date.

  If I obtain employment resulting from this application, I understand that any employment-related dispute I may have against National Vendor will be subject to binding arbitration, and I will be asked to sign an arbitration agreement as a condition of employment.

  If upon investigation, anything in this application is found to be untrue, I understand that I will be subject to dismissal at any time during the period of my employment.

  I understand that, in connection with my application for employment or during my employment if I am employed, National Vendor may obtain information bearing upon my general reputation, personal characteristics or mode of living, including public reocrd information, without using a consumer reporting agency to obtain it. "Public record" includes records documenting a conviction, civil judicial action, tax lien, or outstanding judgment against me.

I the right to receive a copy of any public record that National Vendor may obtain about me.

By inserting your name and date below and submitting this document, you are stating that you have read, acknowledge, understand, and agree to the above.

SIGN HERE:     DATE HERE:



AFFIRMATIVE ACTION RECORD KEEPING


Any information you provide on this page is purely voluntary; such information will be kept confidential, refusal to provide this information will not subject you to any adverse treatment, and any such information you provide will be used only in accordance with federal and state law and application regulations. This page will be detached and remain separate from your employment application.


Name:     Date:

Position Applied For:

Gender:

Ethnic Category (check one)


(Not of Hispanic origin): All persons having origins in any of the original peoples of Europe, North Africa, or the Middle East.


(Not of Hispanic origin): All persons having origins in any of the black racial groups of Africa.


All persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race.


All persons having origins in any of the original peoples of the Far East, Southeast Asia, or the Pacific Islands. This area includes, for example, China, Japan, Korea, the Philippine Islands, and Somoa. Also, persons from the Indian subcontinent, including peoples with national origins from Bangladesh, Bhutan, India, Nepal, Pakistan, Sukkim, and Sri Lanka.


All persons having origins in any of the original peoples of North America.


Disabled/Diabled Veteran/Vietnam Veteran

Identify yourself, if appropriate, as an individual with a disablity, a disabled veteran or a Vietnam era veteran to enable us to have accurate data under our Affirmative Action Plan.


1) Has a physical or mental impairrment which substantially limits one of more of that person's major life activities, or 2) Has a record of such impairment, and 3) Is capable (qualified) of performing a particular job with or without a reasonable accommodation to his/her disability.


1) A person entitled to disability compensation under laws administered by the Veterans Administration for disability rated at 30% or more, or 2) A person whose discharge or release from active duty was for a disability incurred or aggravated in the line of duty, and 3) Is capable (qualified) of performing a particular job with or without a reasonable accommodation to his/her disability.


1) A person who a) actively served for more than 180 days, any part of which occurred between August 5, 1964 and May 7, 1975 and was released with other than dishonorable discharge, or b) was released from such active duty for a service-connected disability, and/or 2) A person who was discharged/released within 48 months prior to an alleged violation of the Act and/or of the regulation issued there under on July 26, 1976.

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